Comparing the Pros and Cons of 100% Coinsurance (2024)

Q: What are the risks and advantages of insuring a commercial property with 100% coinsurance?

Response 1: The advantage is a lower rate. But if the limit is less than the actual value of the property, the disadvantage is that the insured is going to be penalized on just about every claim.

Response 2: As long as the limit of liability equals the actual cash value or replacement cost, there’s no risk. The advantage is a lower premium and a happier client if there is a loss. If you don’t insure the property to the correct value, the risk is that there will be a serious penalty at the time of loss.

Response 3: Add 5% additional agreed value optional coverage. That way, at the time of a loss, 100% coinsurance will generate a 10% credit.

Response 4: Don't ever do this. Yes, you should insure at 100% total insurable value, but never use 100% coinsurance on a property. What if you’re wrong at the time of the loss, which is when the value is calculated? Don't subject the insured to such an onerous condition. Insure at 100% total insurable value and use 90% coinsurance.

Response 5: The risk is that you have no cushion if your replacement cost figures are not accurate. Yes, there is a discount on the rate, but it’s better to insure for 100% of the value and use an 80% coinsurance percentage—then you have a 20% cushion. Better yet, use agreed value and suspend coinsurance.

Response 6: The risk is that it may place a high burden on the insured, leaving no room for any variance and potentially exposing them to a coinsurance penalty. On the other hand, if you use a 100% clause in conjunction with an agreed value endorsem*nt, there is no risk except whether a sufficient amount of coverage was purchased to actually replace the property.

Response 7: The obvious risk is that at the time of loss—not application—the 100% coinsurance requirement must be met, which puts a heavy burden on the insured. The advantage is the premium savings.

Response 8: The advantage is that the rate is lower than at 90% coinsurance, or any other agreed amount. The disadvantage is that there’s no wiggle room in the property values, and it doesn’t provide the protection of an agreed amount. Basically, 100% coinsurance increases the likelihood that your client will suffer a penalty at a time of loss.

I’ve avoided 100% coinsurance for over 40 years. I’ve seen too many nasty losses and prefer to give the client better odds.

Response 9: In the case of 100% coinsurance, if a property insurance limit is lower than the value of the insured property, a proportional penalty will be assessed after a loss. A typical 80% coinsurance clause leaves more leeway for undervaluation, and thus a lower chance of a penalty in a claim situation. Insuring a property on an agreed value basis may well be a better option for some insureds as it eliminates the possibility that a coinsurance penalty will be invoked.

Response 10: I think people often elect for 100% coinsurance without considering the pros and cons. The risk of using 100% coinsurance is that at the time of the covered loss, the value of the covered property—either replacement cost or actual cash value—is greater than the limit of insurance on the property, which can occur during times of inflation in building materials.

For example, assume you set a property’s limits at $1 million with 100% coinsurance on a replacement cost basis. When the building sustains a covered $300,000 loss 11 months later, it is determined that the actual replacement cost of the building at the time of the loss is actually $1.1 million. Under the coinsurance formula—amount insured divided by the amount you should have insured, multiplied by the loss—the calculation is $1 million divided by $1.1 million, multiplied by $300,000. In this scenario, the insurer would pay $272,700 for the loss, leaving your client with a coinsurance bill to the tune of $27,300, which is obviously not good.

During times of inflationary pressure, the risk can be a real issue. We often see this phenomenon after major catastrophes, such as hurricanes and tornadoes.

The major advantage of using 100% coinsurance is lower rates. Under ISO property rules, a credit of 10% is applied to the published 80% property loss costs. It is important to remember that in the coinsurance calculation, the limit of insurance is compared to the value of the property at the time of loss, not the effective date of the policy.

Response 11: In a total loss situation, the advantage is immense.It's interesting to see people argue about deductibles on the front end and then insure buildings for 80% and 90% of their replacement cost. When they have a total loss, they are down 10-20% immediately. Then, assuming the site is not congested or obstructed, debris removal in a total loss averages 12-15% of the cost to build new. This puts the insured down 25-35% of replacement cost. If the site is congested or obstructed, debris removal may be 25-40% of replacement cost, and the policy debris removal supplement is $10,000. At this point, the insured is down 45-60%.

Then they learn about credit risk. The lender is named in the mortgagee clause and named on the check. Lenders are required to post much larger reserves on any loan with damaged collateral, so they take insurance proceeds to pay off the loan. The insured receives the difference between the loan amount and the policy limit, which is often a very modest sum, and usually not enough to remove the debris.

Insure property for 100% of replacement cost using an agreed amount endorsem*nt. When coverage is specific, always add increased debris removal coverage in anticipation of a total loss, as well.

This question was originally submitted by an agent through theVU’s Ask an Expert Service. Answers to other coverage questions are available on theVU website. If you need help accessing the website,request login information.

Comparing the Pros and Cons of 100% Coinsurance (2024)

FAQs

Is 100% coinsurance good or bad? ›

100% coinsurance: You're responsible for the entire bill. 0% coinsurance: You aren't responsible for any part of the bill — your insurance company will pay the entire claim.

Which is better, 80% coinsurance or 100% coinsurance? ›

Response 9: In the case of 100% coinsurance, if a property insurance limit is lower than the value of the insured property, a proportional penalty will be assessed after a loss. A typical 80% coinsurance clause leaves more leeway for undervaluation, and thus a lower chance of a penalty in a claim situation.

What are the disadvantages of coinsurance? ›

However, coinsurance has drawbacks like: Must meet deductible first: To gain the benefits of coinsurance, you must pay your deductible first. Your deductible varies based on the plan you choose. If you cannot pay out-of-pocket deductible fees, you have to cover the entire service cost.

What is the best coinsurance percentage? ›

Coinsurance Examples for Affordable Care Act Health Plans
Metal tierPortion you pay for servicesPortion the insurance company pays for services
Bronze40%60%
Silver30%70%
Gold20%80%
Platinum10%90%
Feb 20, 2024

Does 100% coinsurance mean agreed value? ›

The Agreed Value option in the Commercial Property Coverage Part is often misunderstood. It is, in a manner of speaking, effectively a 100% coinsurance requirement, though not really a coinsurance requirement since it waives the coinsurance requirement.

What are the advantages of coinsurance? ›

Benefits of Coinsurance:
  • Cost Sharing: Coinsurance allows individuals to share the cost of medical expenses with their insurance provider. ...
  • Lower Premiums: Insurance plans with coinsurance often have lower monthly premiums compared to plans with fixed copayments.
Sep 21, 2023

Is it better to have a high deductible or high coinsurance? ›

However, if you expect to have many health care costs, a plan with a lower deductible would be more cost-effective. A lower deductible means there will be a smaller amount that you will need to pay before the insurance carrier begins to pay its share of your claims: the coinsurance.

What does 100% coinsurance mean on Reddit? ›

So in our case 100% coinsurance means insurance is responsible for 100% after deductible.

What does 0 deductible and 100 coinsurance mean? ›

In your question, “100% coinsurance with no deductible” basically means you have to pay the full cost out of your pocket (until reaching out-of-pocket maximum). For this kind of plan, the monthly premium is generally low, but you have to pay a lot out of your pocket if you were hit by a huge bill.

Does coinsurance kick in after deductible? ›

A deductible is the amount you pay for coverage services before your health plan kicks in. After you meet your deductible, you pay a percentage of health care expenses known as coinsurance.

What is the issue of coinsurance? ›

The coinsurance clause in a property insurance policy requires that a home (or other physical property) be insured for a percentage of its total cash or replacement value. Usually, this percentage is 80%, but different providers may require varying percentages of coverage (90%, 70%, etc.).

Is 100 percent coinsurance good? ›

Unfortunately, if you have a 100% coinsurance, this means that you are responsible for the entire service fee. This will be paid out-of-pocket and likely does not have any eligibility for reimbursem*nt.

Why would a person choose a PPO over an HMO? ›

PPOs Usually Win on Choice and Flexibility

If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.

Does coinsurance count towards out-of-pocket? ›

Typically, copays, deductible, and coinsurance all count toward your out-of-pocket maximum. Keep in mind that things like your monthly premium, balance-billed charges or anything your plan doesn't cover (like out-of-network costs) do not.

Is it better to have coinsurance or copay? ›

Is it better to have a $700 Co-Pay for your hospital visit or a 30% Co-Insurance? Again, the Co-Pay is going to be less expensive. Co-Pays are going to be a fixed dollar amount that is almost always less expensive than the percentage amount you would pay. A plan with Co-Pays is better than a plan with Co-Insurances.

What does 100 after deductible mean? ›

There are plans that offer “100% after deductible,” which is essentially 0% coinsurance. This means that once your deductible is reached, your provider will pay for 100% of your medical costs without requiring any coinsurance payment.

Is 50% coinsurance good or bad? ›

If you have 40% coinsurance after the deductible, you will pay the deductible first and then 40% of the costs. 50% coinsurance means the same thing; only you will pay 50% of costs. While these are higher upfront costs, you will reach your out-of-pocket limit faster.

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