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Telemedicine Taking Off, Reducing Health Costs

One of the fastest growing parts of the health care system, and which touches significantly on group health plans, is telemedicine.

From 2016 to 2017, insurance claims for services rendered via telehealth as a percentage of all medical claim lines ― grew 53% nationally, faster than any other avenue of care, according to “FH Health Indicators,” a white paper published by the nonprofit FAIR Health.

Telehealth uses technology to provide remote care via video conferencing and other means and is proving to be more and more effective, especially for time-pressed individuals or people who live in rural areas where patients often have to travel great distances for care.

Elderly patients especially find it useful, since it eliminates the need for transportation.

But as telehealth gains traction, the focus is shifting away from the novelty of connected devices and new technology and more toward providing patients with top-notch care ― and giving providers, physicians and nurses alike the power to deliver it effectively. As it evolves, it is also a promising new trend in terms of reducing health care delivery costs.

Telehealth can reduce the cost of care by eliminating the physical barriers that prevent patients from managing their health. As more patients take advantage of digital services like remote patient monitoring, automatic appointment reminders, and remote physician consulting using live video and audio, patients can use these services to reduce the cost of care and improve their chances of early detection.

And that can reduce your overall group health plan costs, as well as out-of-pocket costs for your employees.

Tech firms are coming up with more efficient ways for patients to communicate with their doctors that save time and money, and reduce liability for doctors as well. For example, more and more health care practitioners are adopting an online patient portal as a direct link between the patient and the doctor.

Doctors, patients embrace online portals

The portal can easily be password-protected for each patient and streamline routine interactions from appointment-setting to refilling prescriptions ― and everything in between. 

For example, when it’s time to get a prescription refilled, the patient simply makes a request to his or her doctor, via the patient portal or even via a cell phone or tablet app that can be proprietary to the practice. The doctor checks the dosage and approves the request in a few clicks, and in seconds the information is sent directly to a pharmacy so the patient can pick up the prescription.

The patient doesn’t have to get the doctor on the phone or bug the staff for a moment with the doctor, and the doctor doesn’t have to do additional paperwork or get on the phone with the pharmacy to call in the prescription after already having spoken with the patient on a separate call. The result is tremendous time savings ― and ultimately, cost savings for both the doctor and patient.

Online portals also facilitate communication between doctors and patients between appointments. If a patient has a question or clarification that does not warrant an additional office visit, the doctor or staff can quickly respond in an instant, without playing phone tag, and without having to route calls to busy doctors who can’t always be on the phone.

Physicians can also leverage these portal technologies to send lab results and images directly to the patient using a secured and encrypted link, and to make clinical summaries easily available online. When the doctor adds new information to the file, such as a lab report, the portal system can be programmed to automatically send an e-mail alert to prompt the patient to log onto the portal.

For all the technology though, we still have a way to go in implementing it. According to a recent study in the Journal of General Internal Medicine57% of respondents said they want to use their doctor’s website to review their medical records, but only 7% of those polled reported having made use of that technology to access their own information online.

A study from the Annals of Internal Medicine found that 77% to 87% of individuals who used their physician’s portal to open at least one note, and who completed a post-intervention survey, said that the process helped them be more in control of their health care.


Commercial Crime Policies Cover Some Cyber Crimes

In some instances, a commercial crime insurance policy may offer coverage for money a company loses due to a cyber attack, a court has ruled.

The 11th U.S. Circuit Court of Appeals in Atlanta has ruled that an insurer must indemnify a policyholder that was scammed out of more than $1.7 million in a phishing incident under its commercial crime policy.

The decision is good news for companies who have not purchased cyber insurance but have commercial crime policies.

This is at least the third precedent-setting case in which a court has ruled that a commercial crime policy can cover losses “directly” resulting from computer fraud.

Crime insurance companies, when denying hacking claims that resulted in monetary losses, will often argue that hacks and phishing scams are “indirect” losses, which are not covered by their commercial crime policy because someone on the outside duped an employee into transferring funds to a third party.

The most recent case

In the most recent case, the controller of IT services provider Principle Solutions Group LLC received an e-mail purported to be from the company’s managing director, directing her to write $1.7 million to an account at a Chinese bank. The communication said she would receive instructions in an e-mail from an attorney, which she did and so she initiated the transfer.

Before the bank issued the wire, its fraud unit intervened and held the money transfer. The controller contacted the “attorney,” who confirmed that the managing director had approved the transaction. Upon receiving that information, the bank released the wire.  Unfortunately, it was all a fraud and the managing director knew nothing about it.

After Principal Solutions discovered that request was fraudulent, it filed a claim under its commercial crime policy with Ironshore Indemnity Inc., which denied coverage. The company subsequently sued the insurer and the local court ruled in its favor. Ironshore appealed, but the appeals court upheld the lower court’s ruling.

In rejecting the insurer’s argument that the loss did not result directly from the fraudulent instruction, the court found that the ordinary meaning of the phrase “resulting directly from” requires proximate causation between a covered event and a loss, not an immediate link. The court held that as a matter of law there was proximate cause and the intervening communications, including the bank’s hold, were not sufficient to sever the causal chain.

This decision follows two 2018 decisions by federal appellate courts — the Second Circuit in Medidata Solutions, Inc. vs. Federal Insurance Company, and the Sixth Circuit in American Tooling Center, Inc. vs. Travelers Casualty & Surety Co. — which ruled that the insurers’ policies in both cases covered losses “directly” resulting from computer fraud.

In the American Tooling case, the court wrote that the policy language did not distinguish between frauds based on how they induce a transfer.

What to do

  • Try to avoid getting hit by phishing scams in the first place by training employees to recognize suspicious e-mails.
  • Invest in the latest security measures.
  • Set up stricter protocols for paying large sums to new accounts.
  • Review your crime coverage and any policy relating to computer, business e-mail compromise or social-engineering fraud to see if you are covered. If you have concerns, feel free to call us for a review.
  • If you do suffer a breach and loss, promptly notify all potentially implicated lines of insurance coverage.

New Rules Allow Employers to Reimburse for Health Premiums

Starting Jan. 1, 2020, employers can establish accounts for their employees to help them pay for individual health insurance policies they purchase, as well as for other health care expenses.

A new regulation expands on how health reimbursement accounts can be used. Currently, employers and their workers can contribute to these accounts, which can be used to reimburse workers for out-of-pocket medical expenses.

With these new Individual Coverage HRAs, employers can fund the account workers would use to pay for health insurance premiums for coverage that they secure on their own.

Up until this new regulation, such arrangements were prohibited by the Affordable Care Act under the threat of sizeable fines in excess of $36,000 per employee per year.

This rule is the result of legislation signed into law by President Obama in December 2016, which created the “qualified small employer health reimbursement arrangement (QSEHRA),” which would allow small employers to reimburse for individual insurance under strict guidelines.

The Trump administration was tasked with writing the regulations, which created the Individual Coverage HRA (ICHRA).

How it works

Under the new rule, if an employer is funding an ICHRA, the plan an employee chooses must be ACA-compliant, meaning it must include coverage for the 10 essential benefits with no lifetime or annual benefit maximums — and must adhere to the consumer protections built into the law.

Once the ICHRA is created, the employer will a set amount every month into the account on a pre-tax basis, which the employee can then use to buy or supplement their purchase of health insurance benefits in the individual market.

The law allows employers to set up as many as 11 different classes of employees for the purposes of distributing funds to ICHRAs. The employer can vary how much they give to each different group. For example, one class may get $600 a month per single employee with no dependents, while members of another class may receive $400 a month.

The allowable classes are:

Full-time employees — For the purposes of satisfying the employer mandate, that means a worker who averages 30 or more hours per week.

Part-time employees — Like the above, the employer can choose how to define what part-time is.

Seasonal employees — Workers hired for short-term positions, usually during particularly busy periods.

Temps who work for a staffing firm — These employees provide temporary services for the business, but are formally employed through a staffing firm.

Salaried employees — Staff who have a have a fixed annual salary and are not typically paid overtime.

Hourly employees — Staff who are paid on an hourly basis and can earn overtime.

Employees covered under a collective bargaining agreement — Employees who are members of a labor union that has a contract with the employer.

Employees in a waiting period — This class would include workers who were recently hired and are in their waiting period before they can receive health benefits (in many companies, this is 90 days).

Foreign employees who work abroad — These employees work outside of the U.S.

Employees in different locations, based on rating areas — These employees live outside the individual health insurance rating area of the business’s physical address.

A combination of two or more of the above — Businesses can also create additional classes by combining two or more of the above classes.

The rules for ICHRAs are as follows:

  • Any employee covered by the ICHRA must be enrolled in health insurance coverage purchased in the individual market, and must verify that they have such coverage (as mentioned above, that coverage must be ACA-compliant);
  • The employer may not offer the same class of workers both an ICHRA and a traditional group health plan;
  • The employer must offer the ICHRA on the same terms to all employees in a class;
  • Employees must be allowed to opt out of receiving an ICHRA;
  • Employers must provide detailed information to employees on how the ICHRA works;
  • Employers may not create a class of employees younger than 25, whom they might want to keep in their group plan because they’re healthier;
  • A class cannot have less than 10 employees in companies with fewer than 100 workers. For employers with 100 to 200 employees, the minimum class size is 10% of the workforce, while for employers with 200 or more staff, the minimum size is 20 employees;
  • While benefits must be distributed fairly to employees that fall within each class, each class can be broken down further by age and family size. That means employees with families can be offered a higher amount per month and rates can be scaled by age.

Happy New Year!

As we are all waiting for a New Year with hope, we would like to thank you for the opportunities you have given us and wish a better New Year for you and your family. Cheers to a prosperous 2020!


New Booklet Helps Employers Set Up Safe Driving Programs

OSHA has published a set of guidelines to help employers reduce accidents among their driving employees.

The document is not a set of new regulations or a new standard. It is only advisory ― the federal agency describes it as “informational in content” ― and is intended to assist employers in providing a safe and healthful workplace.”

Nonetheless, the guidelines are an excellent way to establish a system that can reduce the likelihood of crashes involving your driving workers.

OSHA recommends implementing a safe driving program that includes the following:

Management commitment and employee involvement

Senior management can provide leadership, set policies and allocate resources (staff and budget) to create a safety culture. Actively encourage employee participation and involvement at all levels of the organization to help the effort to succeed. Involve workers in the planning phase of the policy.

Written policies

Create a clear, comprehensive and enforceable set of traffic safety policies and communicate them to all employees. They can cover such things as:

  • A zero-tolerance policy for using smartphones while driving and only using hands-free technology when talking on the phone.
  • A zero-tolerance policy of driving under the influence of alcohol or illegal drugs.
  • Requiring all driving staff to wear seat belts at all times.

These policies should be posted throughout the workplace, distributed to staff and discussed at company meetings. Offer incentives for sticking to the rules, and set consequences for disregarding them.

Driver agreements

Establish a contract with all employees who drive for work purposes, whether they drive assigned company vehicles or use their personal vehicles. By signing an agreement, the employee acknowledges awareness and understanding of the organization’s traffic safety policies, procedures and expectations regarding driver performance, vehicle maintenance and reporting of moving violations.

Check driving records

Check the driving records of all employees who drive for work purposes. Screen out drivers who have poor records. Review their moving violation records periodically to ensure that the driver maintains a good driving record. Clearly define the number of violations an employee/driver can have before losing the privilege of driving for work.

Crash reporting

Establish and enforce a crash reporting and investigation process. Require employees to report all accidents to their supervisor as soon as feasible after the incident. Set policies for what driving employees should do after an accident. Also, investigate all crashes and try to identify their root causes, so you can possibly help workers avoid making the same mistakes in the future.

Vehicle maintenance and inspection

Selecting, properly maintaining and routinely inspecting company vehicles is an important part of preventing crashes and related losses.

Review the safety features of all vehicles to be considered for use. Conduct routine preventative maintenance on vehicles as per manufacturer’s recommendations. Also check safety-related equipment and brakes regularly.

Disciplinary action system

Set rules for dealing with employees who are cited for a moving violation or are involved in a preventable crash while driving on the job. Options include:

  • Assigning points for moving violations.
  • Progressive discipline if a driver begins to develop a pattern of repeated traffic violations and/or preventable crashes.
  • The system should describe what specific actions will be taken if a driver accumulates a certain number of violations or preventable crashes in any predefined period.

Reward/incentive program

Develop and implement a driver reward/incentive program that includes recognition, monetary rewards, special privileges or the use of incentives to motivate the achievement of a predetermined goal or to increase participation in a program or event.

Driver training and communication

Provide continuous driver safety training and communication. Even experienced drivers benefit from periodic training and reminders of safe driving practices and skills. It is easy to become complacent and not think about the consequences of our driving habits.


Happy Holidays!

Happy Holidays! Wishing you every happiness this holiday season and throughout the coming year.


Many Employees Choosing the Wrong Health Plans

A new study has found that many people in employer-sponsored health plans are enrolling in plans that are costing them more than they ought to be paying.

Many employees choose pricey plans with low deductibles, which force them to spend more up front on premiums to save just a few hundred dollars on their deductible. As result, many employees are spending hundreds, if not thousands of dollars more on their health care/health coverage than they need to.

A study by Benjamin Handel, a U.C. Berkeley economics professor, found that the majority of employees at one company he studied were in the highest-premium, lowest-deductible plan ($250 a year) their employer offered. This resulted in them spending about $4,500 a year on health care, compared to only $2,032 had they gone with the cheaper plan (which had a $500 annual deductible) and received exactly the same care.

Additionally, the research paper “Choose to Lose: Health Plan Choices from a Menu with Dominated Options,” published in the Quarterly Journal of Economics, found that more choices also didn’t yield more savings for individuals in employer-sponsored plans.

The study examined the health plan choices that 23,894 employees at one large U.S. employer made. They were able to choose from 48 different combinations of deductibles, pharmaceutical copayments, co-insurance and maximum out-of-pocket expenses. All of the plans offered the same network of doctors and hospitals.

As a result, workers paid an extra $528 in premiums for the year to keep their deductible at $750 instead of $1,000. In other words, they paid $528 to save $250.

For nearly every plan with a deductible of $1,000 (the highest deductible available for those seeking single coverage), the additional premiums required to reduce the deductible, with all other plan attributes fixed, exceeded the maximum possible out-of-pocket savings provided by the lower deductible.

The study also found that the lowest-paid workers were significantly more likely to choose dominated plans (the most expensive).

Both of the studies above looked at plan options with relatively low deductibles when compared with high-deductible health plans, which have become more popular with time.

In 2018, the minimum deductible for an HDHP is $1,350 for an individual and $2,700 for a family. But, under current regulations, total out-of-pocket expenses are limited to $6,650 for an individual and $13,300 for a family with a HDHP.

While these plans have gotten a bad rap lately, a study published by the National Bureau of Economic Research found they are often cheaper for employees, as well.

The authors, both from the University of Wisconsin-Madison, found in a study of 331 companies, that at firms offering both a HDHP and a low-deductible plan, selecting the HDHP typically saves more than $500 a year.

Strategies

To help offset the cost of a HDHP, you can offer your staff health savings accounts (HSAs), which offer a tax-advantaged way to save for health care costs. While there are annual contribution limits, HSAs allow your employees to roll over their balance from year to year. The funds they contribute to their HSA are pre-tax, so the savings are significant.

The Wisconsin-Madison authors surmised that many people choose the costlier health plan for two reasons:

  • Inertia – It’s easier for consumers to stick with their old plan rather than crunch the numbers to see if a new plan may be more appropriate.
  • Deductible aversion – When employees see a low-deductible plan they may associate it with better quality care, even though the network and coverage may be the same.

The best strategy to guide your staff to the plan that best suits them is to educate them. You should have workshops for your staff prior to open enrollment, to help them understand why the higher-deductible plan may often be the best choice for them if they want to save money on their overall premium and out-of-pocket expenses.

Ideally, you could encourage them to set aside the same amount of money in their HSA that would be enough to cover their deductible. This way, your employees would not feel burdened by health expenses they may have to pay for during the year.


More Companies Bar Manager-Employee Relationships

The recent news of McDonald’s Corp. dismissing its chief executive for having a consensual sexual relationship with an employee reflects the hardening stance in corporate America towards inter-office romances.

Many large companies have instituted zero-tolerance policies for managers who are romantically involved with company employees. The companies are mainly cracking down to reduce their chances of being sued for the actions of one of their management team ― and for those of “skirt-chasers.”

That liability issue is just as potent for mid-sized and small businesses who have managers or supervisors on staff. With lawsuits for sexual harassment and discrimination rising, and employers paying out millions in settlements or judgments, businesses need to carefully consider how they want to handle these new risks.

And they are risks, especially now in the #MeToo era and the ramifications of a disgruntled party in the relationship taking the ship down with them if things turn sour with their paramour.

What was once an overlooked part of a company’s risk management policies, damages payouts for a manager who has gone too far can be devastating and easily run into the millions of dollars. The action by McDonald’s is not the only instance of a company’s board taking action:

  • In 2018, the chief executive of technology for Intel Corp. resigned after an internal investigation had found he had a consensual relationship with an employee, which was against company rules.
  • Best Buy Co. Inc.’s CEO resigned in 2012 after it was found that he had been in a relationship with an employee.
  • A CEO for HP Inc. quit his job in 2010 amid sexual harassment allegations, though an internal probe later cleared him of the charges.

While many companies do allow relationships among staff who are in different departments or equals, the risks of allowing the same for managers who are seeing subordinates are too great.

One main reason is that some workers may be too afraid to refuse a sexual advance by a supervisor or boss because they are scared of losing their job, or of suffering some other career-related fallout.

Unfortunately, power can go to people’s heads. The number of CEOs who are forced to leave their jobs due to ethical issues continues climbing.

In 2018, 39% of chief executives who left their jobs did so for ethical reasons, far exceeding other factors such as poor company financial performance, according to a study by PricewaterhouseCoopers. In 2017, 26% of CEOs left for ethical lapses, and in 2007 only 8% did so.

What you can do

Put a fraternization policy in place. You can consider including the following elements:

  • Prohibit romantic relationships between managers and their direct reports.
  • Bar dating between employees who are at least two levels apart in your company hierarchy. This will restrict fraternization between managers and subordinates across your company.
  • State what behavior is unacceptable in the workplace, such as public displays of affection and discussing relationship issues at work.
  • Spell out consequences for violating your company rules.
  • Establish an anonymous reporting process to make it easier for employees to report having witnessed distracting misconduct in the workplace, or to lodge complaints about perceived sexual harassment.

Also, if you have not already done so, consider purchasing an employment practices liability policy, which will step in to provide coverage if an employee is sued for sexual harassment, discrimination or other action. An EPLI policy covers:

  • Discrimination (based on sex, race, age or disability, for example)
  • Wrongful termination
  • Harassment
  • Other employment-related issues, such as failure to promote.

Depending on the size of your company, EPLI can be offered as an endorsement to a business owner’s policy or a general liability policy. Also, a specific stand-alone policy can be written in conjunction with a BOP.


New Rules Aim for Hospital, Insurer Transparency

The Trump administration on Nov. 15 announced two rules that would require more transparency in hospital pricing and health insurance out-of-pocket costs for enrollees.

The final rule on hospital pricing will require hospitals to publish their standard fees both on-demand and online starting Jan. 1, 2021, as well as the rates they negotiate with insurers. The administration also proposed rules that would require health insurers to provide their enrollees instant, online access to an estimate of their out-of-pocket costs for various services. 

The latter are just proposed rules and will have to go through a comment period before final rules can be issued. 

The two sets of rules are part of the Trump administration’s efforts to bring more transparency into the health care and insurance industry. They are in response to more and more consumers’ stories of serious financial strife after receiving surprise bills from hospitals and other providers, particularly if they had to go to a non-network physician or hospital.

Both rules could benefit health plan enrollees by giving them more information on hospital services, particularly if they are in high-deductible plans and can shop around for a future procedure, such as a mammogram or knee replacement surgery.

Hospital pricing transparency

In the original proposed regulations, the administration had proposed the effective date of the hospital price transparency rule as Jan. 1, 2020, but health providers said they would need more time to ramp up.

The new rules, effective Jan. 1, 2021, will require hospitals to publish in a consumer-friendly manner their standard charges price list of at least 300 “shoppable services,” meaning services that can be scheduled in advance, such as a CAT scan or hip replacement surgery.

The list must include 70 services or procedures that are preselected by the Centers for Medicare and Medicaid Services. Hospitals will have to disclose what they’d be willing to accept if the patient pays cash. The information will be updated every year.

Hospitals will be required to publish their charges in a format that can be read online. This rule could pave the way for apps that patients can use to compare services between hospital systems.

Under the rule, hospitals will have to disclose the rates they negotiate with third party payers.

The new rules face some uncertainty, however. The health care trade press has reported that a number of trade groups such as the American Hospital Association and the Federation of American Hospitals, among others, announced in a joint statement that they would sue the government, alleging that the new rules exceed the bounds of the CMS’s authority.

Out-of-pocket transparency

The proposed rule would require insurers to provide their health plan enrollees with instant online access to estimates of their out-of-pocket costs.

The regulations would require health insurers to create online tools their policyholders can use to get a real-time personalized estimate of their out-of-pocket costs for all covered health care services and products, such as:

  • Hospitalization
  • Doctor visits
  • Lab tests
  • Surgeries
  • Pharmaceuticals.

They would also be required to disclose on a public website negotiated rates for their in-network providers, as well as the maximum amounts they would pay to an out-of-network doctor or hospital. 

The proposed regs would also let insurers share cost savings with their enrollees if the individuals shop around for services that cost less than at other providers. This would give enrollees an incentive to shop around.

This proposed rule is also certain to face push-back from the insurance industry.

These out-of-pocket transparency regs are just proposals, so they have to go through the standard rule-making procedure of soliciting public comments before eventually issuing the final rules.


The Holidays Have Their Own Workplace Perils

All year long you have been reminding your employees to “work safely … don’t take short cuts … prevent accidents.”

To do this they have to keep their minds on their work, but this time of the year as the holidays near, their minds might be everywhere else but on work.

They may be thinking “what to buy for everyone for Christmas – I hate shopping!” and “how will I pay for Christmas?” Meanwhile, relatives coming to stay add yet more distracting thoughts.

For some employees, the holiday period is a wonderful time, and for others it is dreadful, but it is stressful for most anyone. Normal routines and schedules are disrupted, and there is a lot of rushing around the town to crowded and chaotic stores and malls.

Be aware that accidents may be more likely to happen at this time of the year at the workplace, on the road or at home. Employees tend to take extra physical risks ― such as when hanging lights and lugging trees around.

And when roads and freeways are jammed, auto accidents increase.

In-office safety

When planning decorations for the office, it is important to keep holiday safety in mind.

Decorating the office helps workers enjoy the spirit of the season together, but remember that proper safety precautions should be observed at all times:

  • Be mindful of potential fire hazards when selecting holiday decorations and where you place them.
  • Be careful of stapling holiday lights, do not add too many strings of lights and make sure illuminated items are turned off.
  • Verify that all fire extinguishers are in place and fully charged and accessible.
  • Do not block exits, hang decorations on fire extinguishers, fire alarms or fire hose boxes, or obstruct the view of exit signs.
  • Do not hang decorations from sprinkler heads or electrical panels.
  • Without proper planning, holiday decorations can create tripping hazards. Extension cords should not be run through traffic areas where they pose trip hazards and, if you have to use an extension cord, use the proper one.
  • Avoid placing trees, freestanding decorations and presents in traffic areas.

Holiday party

The holidays bring office parties and, if alcohol is being served, keep in mind the liability involved.

Provide plenty of alternatives to alcohol, such as soft drinks, coffee, tea, water and cocoa. Consider non-alcoholic beers and virgin drinks at the bar.

Also, so your staff is safe on the way home, stop serving alcohol a few hours before the party ends.

It’s essential to make transportation arrangements for employees who should not drive – whether the party is held at the office, restaurant, your home or any other location.

The takeaway

If you keep in mind that the holidays put extra pressure on everyone, it may help you to keep your workplace free of accidents.

By following a few simple safety tips, it will be easy to enjoy the holiday and the events at work without dealing with injuries or damage to property.

When planning for the holidays, incorporate safety precautions into the planning process.

Need Gift Ideas for Your Christmas Party?

Give a gift of safety that just might save a life. Here are some ideas of safety items we don’t think about until we need them and/or it’s too late:

  • A smoke detector and batteries.
  • A quality fire extinguisher.
  • A flashlight and batteries, or light sticks.
  • A first aid kit.
  • An automobile safety kit including jumper cables, flares, fix-a-flat and reflectors.
  • A carbon monoxide detector.
  • An emergency kit flashlight, energy bars, batteries and first aid kit ― packed in a small travel bag.
  • A radio that runs by cranking rather than batteries.

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