Welcome to Prescribe Me Insurance’s Blog.   My intention is to educate, or make aware every person I can, so that you can maximize all of the benefits available. I feel education is the key to saving money, and maximizing your coverage. Today I am focusing on:

Contracted Rates

This is a critical component of our industry. I feel it is the single most important aspect of why all of us must have coverage. The “usual and customary” charge by the physician, hospitals, pharmacy, lab facilities are a fraction of what the charge would be if you have coverage versus not having coverage. The “contract” between these providers, and the insurance company is what will save you many thousands of dollars, if God forbid …  hospitalized, or in need of any services. The balance of the potentially huge claim IS “written off”.

I have many claims on hand, and please allow me to share two with you:

The hospital charge was over $95,000 for one of my clients, Steve H. , and the final amount owed by Steve was $1500 as the rest of the balance due was written off because of the CONTRACTED RATE!

Another claim that recently came in was for knee surgery. The claim was for $8800, BUT my client only had to pay $1100 as the balance was again “written off” due to the CONTRACTED RATE.

Make sure that you ONLY pay the USUAL AND CUSTOMARY or the CONTRACTED RATE on all of your procedures or claims, please make sure you have an expert handling your claims as well.

Always stay “in network” … which will be the topic of my next educational piece.

Regards,

Evelyn Jackson
President & Insurance Specialist
Prescribe Me Insurance, LLC
Kennesaw, GA
800.961.8546
www.PrescribeMeInsurance.com

Your lifestyle will affect the cost of your insurance coverage – if you smoke, are overweight, or have an otherwise unhealthy lifestyle, your insurance costs will be higher. Pre-existing medical conditions will also increase the cost of your insurance coverage.

Most plans cover normal medical expenses – but before signing anything, think about what other services you and your family are likely to need, and if the plans you’re considering cover those needs. This is where it pays to know about the medical history of your relatives, so that you can make decisions based upon what types of medical conditions might run in the family.

If you require specialist care, make sure your plan covers it.

Emergency care – usually a referral from your doctor is a prerequisite of emergency medical care. Some health insurance policies won’t pay for weekend hospital visits unless you are referred by your doctor, and some will require that you wait until a weekday if it’s not a matter of life and death. Check out these types of details before making a commitment.

Prescriptions – think about what prescriptions you currently need and what you may require in the future. Insurance plans vary as to the percentage you are required to pay on prescriptions, and some charge a flat fee rather than a percentage.

Supplemental insurance – dental insurance and chronic or acute illnesses such as cancer are not usually covered by normal health insurance. Dental insurance is usually covered by an entirely separate policy. Diseases such as cancer, or critical conditions such as heart attack or stroke, can quickly become expensive, and supplemental insurance is designed to kick in when regular health coverage is exhausted.

I hope you used the tips and the posts from this month to re-invent your relationship with money. It’s a sure way to realize the future you created for yourself faster.

Since my LIFE LAYOUT is mostly about retiring in a couple of years, I really needed to get serious about money.

Here’s what I did:

1. I began by calculating how much money I would need monthly to be able to live in retirement and cover financial risks.  I realized I needed additional information so I contacted my benefits department to learn:

• The exact amount and start date of my future monthly pension
• An estimate of my 401(k) plan total at my planned retirement date
• Transferability of my medical, dental, and vision, and life insurance

2.  The news?  My monthly pension and 401(k) were both higher than I realized.  Fantastic!

While my health and life insurance weren’t transferable, I would have Cobra to fall back on (if I can’t get less expensive health insurance) until Medicare kicks in.  And I will leave my employment insurable for both health and life.  My benefits representative helped me estimate these costs.  So I factored all of this into my budget.

3.  I budgeted for $100,000 of life insurance to cover burial costs and a small legacy for each of the kids.  Just enough for a first house down payment, extra schooling, or to start a new business.

4.  I added in the cost of a good long term care insurance policy to cover retrofitting a home, assisted living, at home care, or a nursing home.  If I become infirmed, I don’t want my kids to suffer financially or have to make difficult decisions based on money.

5.  I reviewed my annual Social Security statement to calculate my monthly income at various ages.

6.  When it was all said and done, I could enter retirement debt-free, pay for the move, and maintain a modest nest egg.  But, because I’m insistent that I want to cover all financial and health risks and maintain my current discretionary spending habits, I’m $800 short of what I need monthly for a couple of years.  Airplane tickets to visit the children and grandchildren and books I’m not really willing to cut back on!

I can easily cover this shortfall, without touching the nest egg, with my writing, book sales, and my marketing and job search business.

7.  To test out my calculations, I began living on my retirement budget as of my mid-November paycheck.  The rest I’m plowing into the 401 (k) plan.  My employer has a very generous match and I’m fully vested now.  I can always cut back on my contribution if I absolutely have to.  But because my contribution is not taxable, I increased my income tax withholding allowances.  This softened the blow to the net paycheck somewhat.

It’s amazing how focused I’ve become, especially about the “nickel and dime” spending!  Here’s the test I use:  Am I willing to pay to move this?  Am I willing to compromise my retirement strategy for this?

• I’m cleaning out all of my books – you know how heavy those are to move- and selling unwanted books at the book store.  Pin money for sure, but I cover a sack or two of groceries with each trip.

• I sold my treadmill which is, of course, like brand new, too heavy to move, and the walk from my apartment to the fitness room is, after all, more exercise.

• I’m not renewing any magazines.

• I sold the extra TV, which brought in a little cash, but saved $50 on the monthly cable bill.

• I experiment with a generic or store brand item every shopping trip.  I previously have been “brand loyal” no matter the cost.  it’s been a real eye-opener for me how less costly items can be very satisfactory.

• But here’s the most fun and powerful budget move I made, totally inspired by Nadia’s rule to “buy everything you would typically buy anyway at the lowest price”:

I made a spreadsheet of everything I routinely buy:  groceries, cosmetics, pet, and household, by brand name.  Yes, it took a while!  But I already had an Excel spreadsheet grocery list with little boxes to check that I use to create my shopping list.  So that helped.

The list of items went down the left hand column of the spreadsheet.

Then, across the top, I titled each column for a store at which I typically shop:  Target, CVS Pharmacy, Walgreens, Petsmart, HEB Plus. I could have added Walmart, but it’s a little further than the others and I rarely shop there.  These are my “go-to” stores. I rarely veer.

I printed out the list, clipped it to a clipboard, and stashed it in the car.

Over the last few weeks, as I’ve shopped, I’ve been jotting down the prices of my items at each of the stores.  Not the sale prices, the regular prices.   Someone more ambitious might do a field trip and knock it out in one day.  That is not me.

So I’m about a third of the way in completely listing and comparing the routine cost of each of my routinely purchased items.  But my master grocery list is already expanded and continually updated by store.  When I’m in Walgreen’s, I pick up certain items.  In Target, others.  And, of course, I buy my $50 of sale items I typically purchase.  So I’m always buying low.

I’m not obsessive about it but frankly, before now, I bought strictly on convenience.  I couldn’t have told you the cost of anything I purchased routinely if my life depended on it.  I’m already seeing a difference in my budget.  And it’s kind of fun.  It’s a challenge I’m freely embracing to meet my goal.

Me, thrifty.  Somewhere my kids are laughing…

The state of Michigan could be well on its way to becoming one of the healthiest states in the country by popping up two spots in ranking when compared against other states but there are some points that we should take note of too. One of them would be that although Michigan health insurance holders can take heart in the fact that there is a drop in the number of incidences relating to injury or fatality while on the job, there is a rise in the number of people who report health problems relating to drinking and crime.

The Michigan health insurance industry is, nevertheless, proud to be the nation’s fifth healthiest state with only 3.7 deaths in every one-hundred-thousand workers in 2008. On top of that, there is a significant drop of 18% in the number of children living in poverty or suffer from malnourishment. While there is a slight rise in the number of people suffering the health consequences of drinking, there is a drop in the percentage of Michigan locals smoking. So, why, you must be asking, should more people consider taking up a Michigan health insurance policy?

And here’s the bad news. One, I’ve mentioned the rise in the number of people who complain of health problems due to excessive or binge drinking related problems. Two, the state of Michigan continues to hold tight to its spot as one of the more violent cities, crime wise. With the above cited two, it’s enough to send many people running for the next Michigan health insurance policy that they can find but hang on, there’s more.

For example, there are more cardiovascular deaths and there are less people who are being covered with proper health insurance in 2008 compared to 2007. And in case you did not notice, Michigan is a state with one of the worst public health funding, hence, if you were to suffer injuries in your line of work and not have a proper Michigan health insurance policy in place, you could end up forking all the money in hospital bills through your credit card. Also please take note that there is a geographical disparity for the state of Michigan too, ranking at thirteenth.

Life is unpredictable and things happen as and when they happen; that is all the more reason why we have to be prepared….at least for the sake of our loved ones.

How Allstate treats people…

“I left Allstate in 2000 when they fired us all.  I was with the company 23 1/2 years and was 53 years old.   I suspended my health coverage at that time.  Last year my wife’s company liquidated so we lost our health coverage.   Because we had preexisting medical problems, we had to go with Allstate under my suspended coverage.

This year they had us with United Healthcare for $870.50 per month.  Next year (1/1/2010) they are putting us with Blue Cross/ Blue Shield.  Out premium will be $957.00 per month.  That is a killer but what other choice do we have?”

Last week I was at our family physician’s office.  It’s a busy place with lots of commotion.  If I didn’t like our doctor so much I wouldn’t go there.  Then there’s my kids, who, for some reason decide that a physician always needs to see how active and completely annoying they can be.  Maybe this proves some sort of health and well-being in a child, but I HATE taking my children to the doctor’s office.  All three of them at the same time is a complete zoo.  Then, the added craziness of the office is total chaos.  My only salvation in this mess lately has been my iphone.  Crazy, but true.  If you have a toddler, the iphone can save you much grief.  It’s all in the applications.  You can download many of them for free and they have animal sounds, shapes, ABC’s, matching, you name it.  It will keep Elijah content for quite a while.  The problem is when all three of them are with me and they decide to fight over the phone.  Then it’s not so fun.  But Elijah usually wins the battle because he cries the loudest and he can’t sit still for more than a millionth of a second without deciding to climb the chairs and warm-up the stirrups. 

So it’s always an adventure when I head to see Dr. S.   But he always seems to enjoy Elijah and the girls and he doesn’t seem the least bothered by them, nor does he seem like he thinks my kids are overly crazy.  Most doctors tell me this is somewhat normal for young children.  Maybe it’s the lighting?

So when we went to leave the other day, I went up to the reception desk and I have to sign the paperwork really quick usually and then I leave.  I’m pretty sure we have met our out-of-family maximum with our deductible, so I’m really not sure what we owe on our co-pay so I always tell them to send us the bill.  And anyone with cancer knows, you decide how much you can pay each month and you just start making payments.  And since I had my major reconstruction in April, I’m quite certain we’re pretty close at this point.  So the office manager happens to be at the registration desk as I check out, and she asks me if I have a co-pay….and I say, “I’m not really sure,”  I’m pretty sure we’ve met our deductible at this point so I’m not sure what we owe.”  And with that she said “lucky you.” 

So my kids were already running out the door so I had to leave, but if I hadn’t had three kids with me that I had to tear after, I would have gone back in and done a reality check with her.  Because this is what I have to say…..and she should know this because she works with medical bills…..but I AM NOT LUCKY to have reached my deductible….lol!  If you have reached your deductable in this day and age, chances are you either have dynamic insurance or someone in your family is seriously ill.  And there’s a really great chance it’s the later possibility.    Oh, or maybe I’m a hypochondriac who visits the doctor WAY too much because I have health insurance, and in that case, well, maybe then I would be considered lucky.

“At first blush, the notion of eating our way out of huge public health challenges like obesity, diabetes and heart disease may seem an overly simplistic and idealistic fix for complex, multifaceted problems. But health experts say that, in fact, an apple a day does keep the doctor away, and that many studies prove it.”

Nice affirming news from The New York Times. Companies like Safeway are realizing that health care costs are getting out of control, and are now focusing on preventative care. So many of today’s “expensive” diseases–obesity, type 2 diabetes, heart disease, and cancer–are tied to diet and lifestyle choices and are quite preventable. And so, the reasoning goes, if an employer can encourage its workers to eat things like vegetables and whole grains instead of Doritos and McDonald’s, costs for health insurance will ultimately go down or at least stabilize. And it’s working.

The article acknowledges that it’s easier said than done to make dietary and lifestyle changes. There’s so much conflicting info about nutrition out there–which should you listen to?

That’s why I do what I do. As a holistic nutrition counselor, I help my clients discover what works for them, and I support them every step of the way–holding them accountable, but also serving as their biggest cheerleader. You can make lasting changes. And you don’t have to do it alone.

Our National Conscience, Nicholas Kristof asked the question in his column a week ago:  Are we going to let John die?

45,000 Americans die each year because of a lack of health insurance.  What do you think:  Should we allow John to die?

Which system saves John’s life, “socialism,” or “free enterprise?”

Here, you can help:

UPDATE: Several readers have asked how they can help or if there is a fund to help John. There isn’t any such fund, but with John and Esther’s permission I’m posting their mailing address: John and Esther Brodniak, 770 W Main St., Sheridan, OR 97378.

Check Kristof’s blog for more details, and nearly 400 comments.

The proposed legislation before both the U.S. House and Senate would artificially raise health insurance rates for those in their 20’s and 30’s to in affect lower costs for the 40+’s. Now that’s not fair, but that’s your government hard at work for you. Send ‘em a big thank you note. Read this article from FoxNews’ Jim Angle:

Is ‘Cadillac’ health tax fair? Cushy insurance often held by teachers, other public employees

There’s been so much written on this subject that I hesitate to add to the noise.  But a recent article brought me back.  The article – Healthcare’s a Difficult Case - by Thomas Donlan of Barron’s is really a review of the book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (Penguin Press) by T.R. Reid.  Reid took his injured shoulder to doctors around the world to determine how each of the different systems works.  His shoulder is still not healed but he knows a lot more about the world’s healthcare systems.  Donlan believes Americans should read the book to better understand the tradeoffs that other societies make to get some form of universal healthcare.

I haven’t read the book but, in some ways, I’ve lived it.  I’m a Canadian living as a permanent resident in the U.S. who was raised in Aruba and lived in various corners of the globe.   I have a wide range of experiences with healthcare around the world and, fortunately, none of them have been bad.  For example, in 1982 I shattered my wrist (yes, shattered) in Saudi Arabia where it was expertly put back together by an Australian orthopaedic surgeon.  Back in Canada my rehabilitation was also expertly managed – and fully covered – by the “socialized” healthcare system.  That was almost 30 years ago and I haven’t had any problems with my wrist despite a 10+ year period as an active squash player.  Now my shoulder on the other hand…

My perspective on healthcare options and outcomes has also been influenced by other factors including my parents experience living in Spain for the past 25 years.  They’ve used both the public and private healthcare options in Spain and have been happy with both.  Last, but not least, six months ago I was laid off and I’m experiencing – for the second time this decade – what it’s like not to have employer-subsidized insurance premiums.  It’s costly and unsettling.  I would prefer some form of publicly funded safety net.
 
Despite all that experience I can’t honestly say I know what the right solution is for the U.S.  Unlike almost every other developed country that has some form of public health care, the U.S. is not a very homogeneous society.  And Americans, in general, have a lower health IQ than people in other developed countries. As a result we have an unhealthy (literally!) over reliance on doctors and the medical system to manage our health.  This no doubt adds to our costs.  
 
Regardless of the unique challenges we face there’s a consensus in this country that everyone should have some form of coverage.  My thought, and I don’t have any data to back it up, is that we should be thinking of some form of free, or relatively low-cost, public health clinics that the government helps subsidize.  These public health clinics should also be supported by the healthcare community including doctors and pharmaceutical companies in the form of charging less for products and services. (It‘s somewhat analogous to our approach to legal aid.)  This approach has the benefit of being true to the American spirit of giving back while at the same time keeping costs in check.  Would do you think?

[In my previous blog on the subject I suggested that healthcare savings accounts would be a good option.  I still believe it would be a good way to bring down the costs of the private part of our healthcare system.  But you still need a public part to cover those that never have the resources to build a health savings account in the first place.]

I’m concerned that we only add cost to an already costly system if we try to create a publicly funded system that mimics the current private system.  But I’m not sure our politicians share that concern.  Congress typically only knows one way to solve a problem - create complicated legislation that serves the needs of as many vested interests as possible, at a tremendous cost to the taxpayer.  Hopefully, our politicians will wake up and realize that building another wing on a burning house will not prevent it from burning to the ground.  It only delays the inevitable.

Quote Freely From The Article – Leave The Pseudonym Alone

Charles Krauthammer writing in the Washington Post is not the only voice of reason when it comes to asking the United States Congress to slow down and legislate changes in health care that make sense and will not mire us completely under the muck of a severe depression like the Reid and Pelosi bill is liable to do.  But, he may be the most succinct of all critics of Obamacare.  Mr. Krauthammer, is nothing, if not discerning and astute when it comes to matters of  the economy and just plain common sense. In his article, Kill the bills. Do health reform right, he fills a column or so enumerating the follies of the House bill and the Senate bill.

Mr. Krauthammer begins his article by stating in part:

The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.

He continues that there is nothing to bring the components of the bills together and that both depend on political expediency for the string to bind them up. Mentioned in his article are the 118 commissions, boards and other “political” string that must also be bound up to make the pork roast. Mr. Krauthammer slams mandates with financial penalties, which he maintains are,  ”picked out of a hat. He complains of  insurance companies being told what weights to give risk factors (something at which they are quite expert).  And, he speaks to sliding scales, also “picked out of a hat,” that will raise income taxes for the middle class along with other unintended consequences.

Mr. Krauthammer suggest three components for a health care overhaul that aren’t at all mentioned in either the House or Senate bills. Of course there are reasons why they are not mentioned and he does not leave them hanging.  After he trashes both bills by naming them irredeemable, he goes forth to explain why, suggesting the sacrifice of a couple of sacred cows and pigs in the process:

First, tort reform. This is money — the low-end estimate is about half a trillion per decade — wasted in two ways. Part is simply hemorrhaged into the legal system to benefit a few jackpot lawsuit winners and an army of extravagantly rich malpractice lawyers such as John Edwards. [he has much more to say on tort reform and the reader would do well to read his words]

Second, even more simple and simplifying, abolish the prohibition against buying health insurance across state lines. Some states have very few health insurers. Rates are high. So why not allow interstate competition? After all, you can buy oranges across state lines. If you couldn’t, oranges would be extremely expensive in Wisconsin, especially in winter.

But neither bill lifts the prohibition on interstate competition for health insurance. Because this would obviate the need — the excuse — for the public option, which the left wing of the Democratic Party sees (correctly) as the royal road to fully socialized medicine.

His third  component may be the least popular, but it is sure less dangerous and more practical than the silliness that our senators and representatives tell us about actual cost measures in their bills:

Third, tax employer-provided health insurance. This is an accrued inefficiency of 65 years, an accident of World War II wage controls. It creates a $250 billion annual loss of federal revenue — the largest tax break for individuals in the entire federal budget.

This reform is the most difficult to enact, for two reasons. The unions oppose it. And Barack Obama savaged the idea when John McCain proposed it during last year’s campaign.

Mr. Krauthammer ends his piece with a plea to take the issues one by one which amounts to the same thing as saying, “slow down you’re going to fast.” Something said,  over and over. Take the complete article and it makes sense and puts the Senate and House bills where they belong … in the trash bin. Grab the article. And, you don’t have to read th bill … these folks hearthebill.org will read it for you.

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• The Party Of Maybe (andrewsullivan.theatlantic.com)

I find this a pretty convincing argument that the Senate healthcare bill is about rationing, if you define rationing as Ewe Reinhardt did in a recent NY Times piece, meaning decisions by insurers about what will be covered, versus what has to be paid for out-of-pocket. As this article indcates, in the future these decisions by insurers are more likely to be made collectively in response to various pressures including taxes on high-cost plans, government guidelines on effective and cost-effective treatment such as the recent breast and cervical cancer screening recommendations, the bi-partisan Medicare cost-control Commission, and finally reimbursement reform including moving away from fee-for-service and toward payments for doctors and hospitals bundled together for particular medical care episodes akin to managed care.

As this and another recent NY Times piece explain, the Obama administration favors the Senate bill, as it incorporates its four cornerstones of healthcare reform: (1) a Medicare cost-containment Commission, (2) taxing high-cost private insurance, (3) reform of medical payment incentives, and (4) deficit reduction.

If the whole package costs roughly $900 billion over ten years, that roughly $90 billion per year. For comparison, sending 35,000 troops to Afghanistan, at $1 million/individual troop/year will cost roughly $35 billion.

The Atlantic, Nov 21 2009, 11:29 am by Ronald Brownstein

A Milestone in the Health Care Journey

When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won’t succeed unless it “bends the curve” in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

“I’m sort of a known skeptic on this stuff,” Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. “The bottom line,” Nichols says, “is the legislation is sending a signal that business as usual [in the medical system] is going to end.”

Both the Senate bill’s priority on controlling long-term health care costs, and its strategy for doing so, represents a validation for Senate Finance Committee chairman Max Baucus (D-MT). When Baucus released his health reform proposal last September, after finally terminating months of fruitless negotiations with committee Republicans, Democratic liberals excoriated his plan as a dead end. And on several important fronts–such as subsidies for the uninsured, the role of a public competitor to private insurance companies, and the contribution required from employers who don’t insure their workers–Reid moved his product away from Baucus toward approaches preferred by liberals.

But the Reid bill’s fiscal strategy, and its vision of how to “bend the curve,” almost completely follows Baucus’ path from September. Baucus’ bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that’s the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas’ for shifting the medical payment system away from today’s fee-for-service model toward an approach that more closely links compensation for providers to results for patients. In the Reid bill, there is some backtracking from Baucus’ most aggressive reform proposals, but not much.

Almost everything Baucus proposed to control long-term costs have survived into the final bill. And, with only a few exceptions, that’s just about all the systemic reforms analysts from the center to the left have identified as the most promising strategies for changing the economic incentives in the medical system. (The public competitor to private insurance companies championed by the Left would affect who writes the checks in the medical system, but not what the checks are written to pay for.) Most of the other big ideas for controlling costs (such as medical malpractice reform) tend to draw support primarily among Republicans. And since virtually, if not literally, none of them plan to support the final health care bill under any circumstances, the package isn’t likely to reflect much of their thinking.

In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform. They maintained that the bill needed to include a tax on high-end “Cadillac” insurance plans; to pursue “aggressive” tests of payment reforms that will “provide incentives for physicians and hospitals to focus on quality” and provide “care that is better coordinated”; and establish an independent Medicare commission that can continuously develop and implement “new efforts to improve quality and contain costs.” Finally, they said the Congressional Budget Office “must project the bill to be at least deficit neutral over the 10-year budget window and deficit reducing thereafter.”

As OMB Director Peter Orszag noted in an interview, the Reid bill met all those tests. The CBO projected that the bill would reduce the federal deficit by $130 billion over its first decade and by as much as $650 billion in its second. (Conservatives, of course, consider those projections unrealistic, but CBO is the only umpire in the game, and Republicans have been happy to trumpet its analyses critical of the Democratic plans.)  “Let’s use the metric of that letter,” said Orszag, who helped shape the health reform debate for years from his earlier posts at CBO and the Brookings Institution. “Deficit neutral; got that. Deficit-reducing second decade, got that. Excise tax: That was retained. Third is the Medicare commission: has that. Fourth is delivery system reforms, bundling payments, hospital acquired infections, readmission rates. It has that. If you go down the checklist of what they said was necessary for a fiscally responsible bill that will move us towards the health care system of the future, this passes the bar.”

McClellan, the former Bush official and current director of the Engleberg Center for Health Care Reform at the Brookings Institution, was one of the economists who signed the November letter. McClellan has some very practical ideas for improving the Reid bill (more on those below), but generally he echoes Orszag’s assessment of it. “It has got all four of those elements in it,” McClellan said in an interview. “They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go.”

Reid gave ground on one Baucus proposal that the economists identified as a priority-taxing high-end insurance plans. Like many health reformers, the economists who wrote Obama argue that such a tax “will help curtail the growth of private health insurance premiums by creating incentives to limit the costs of plans to a tax-free amount.” Amid intense opposition from unions, Reid raised the thresholds at which family plans would face that excise tax from $21,000 to $23,000. But given all the pressure from labor, the more striking thing may have been that Reid didn’t increase the thresholds even more; the CBO calculated the proposal, which the House excluded from its bill, would still raise $35 billion annually by 2019. “They held pretty strong,” said one administration health care expert. “It’s not like unions haven’t been making the case that it shouldn’t have been a much higher number.”

On delivery reform, Reid stayed even closer to the Baucus blueprint. The Finance bill laid out a series of measures to change the way providers are paid for delivering care to Medicare recipients; the hope was that once Medicare instituted these reforms, private insurers would also adopt many of them. “The goal here is that the things we do in Medicare will translate over into the private sector, and there is quite a bit of historical precedence for that,” said one Democratic aide involved in drafting the package.

The Baucus delivery reform ideas revolved around two central aims. One was to reward Medicare providers who deliver care more efficiently and penalize those that don’t. The Reid bill upholds the major proposals Baucus offered to advance that goal. For instance, hospitals under current law must report on their performance in treating patients for common conditions like heart problems and pneumonia; under the bill, their Medicare payments, for the first time, would be affected by their ranking on those reports. Hospitals would also be penalized if they readmit too many patients after surgery or allow too many to acquire infections while in the hospital itself. Another provision would begin the process of applying such “value-based purchasing” toward other providers like hospice providers and inpatient rehabilitation facilities.

With physicians, the Reid plan takes a step back from the Finance Committee bill but still a long step beyond current law. The Finance Bill proposed automatic reimbursement reductions for doctors who order up the most care for Medicare recipients with similar medical and demographic characteristics. That was meant to respond to the research showing big disparities in spending on medical services for similarly-situated patients in different communities. But, Democratic sources say, that proposal ran into charges that it would promote rationing-and even function as “a death panel by proxy”-by compelling doctors to arbitrarily reduce care. So the final bill takes a less direct route toward a similar end. It requires Medicare to begin studying the utilization patterns of doctors participating in the program. And then it establishes a “values based payment modifier” that would, in a budget-neutral manner, increase reimbursements for physicians found to deliver high-quality care at lower cost, and reduce them for physicians at the other end of that spectrum. “It will, we believe, have the same net effect [as the original proposal],” said the Democratic aide. “It should change behavior around that threshold.”

The other set of Baucus proposals were intended to promote more coordination among providers. These have survived almost verbatim into the final bill. The bill encourages groups of providers to establish doctor-led “accountable care organizations” to more comprehensively manage patients’ care by allowing them to share in any savings for Medicare they produce. It also establishes a voluntary national pilot of “bundled” payments that would encourage hospitals, doctors and other providers to work more closely together. Another pilot program would test coordinated home-based care for chronically ill seniors.

Finally, the Reid bill maintains the two powerful institutions the Finance legislation proposed to promote these reforms and develop new ones. The one that’s attracted the most attention is an independent “Medicare Advisory Board.” Under the Senate bill, that board would be required to offer cost-saving proposals when Medicare spending rises too fast; Congress could not reject its proposals without substituting equivalent savings. Since the board would be prohibited from offering changes that raise taxes or “ration care,” and since the legislation initially exempts hospitals from its recommendations, it could choose to promote the sort of payment reforms the bill establishes. (More prosaically it might also clear away some of the expensive coverage mandates that Congress imposes on Medicare under pressure from different elements of the medical industry). Given the limitations imposed on the commission, an equally important means to expand these reforms might be a second institution the legislation creates: a Center for Medicare and Medicaid Innovation in the Health and Human Services Department. Though this center has received much less attention than the Medicare Commission, it could have a comparable effect. It would receive $1 billion annually to test payment reforms; in a little known provision, the bill authorizes the HHS Secretary to implement nationwide, without any congressional action, any reform that department actuaries certify will reduce long-term spending. While the House bill omitted the Medicare Commission (a top priority for Obama) it included the innovation center.

No one can say for certain that these initiatives will improve efficiency enough to slow the growth in health care spending. Some are only pilots; others would affect only a small portion of providers’ revenue from Medicare. CBO typically evaluates them skeptically: it generally scores little or no savings from most of them. Former CBO director Robert Reischauer, who signed the November 17 letter, says that’s not surprising. “CBO is there to score savings for which we have a high degree of confidence that they will materialize,” says Reischauer, now president of the Urban Institute. “There are many promising approaches [in these reform ideas] but you…can’t deposit them in the bank.” In the long run, Reischauer says, it’s likely “that maybe half of them, or a third of them, will prove to be successful. But that would be very important.”

While generally supportive of Reid’s approach, McClellan, the former Medicare administrator under Bush, offered several specific ideas for strengthening it. He says the Senate should improve the capacity of HHS to more quickly evaluate whether the payment reforms are working, and also to provide data and technical assistance to new physician groups like the accountable care organizations that will be attempting to better coordinate care. “Ideally you’d both be able to tell the organizations involved and Congress what is working or not, and give the organizations the feedback and data they need to know whether they are doing a good job,” he says. McClellan also believes that the plan needs sharper sticks-tougher penalties on providers who don’t provide efficient and effective care. “There are a lot of carrots and not so many sticks,” he maintains. Of course, tougher penalties might provoke more opposition from provider groups like hospitals and physicians now tenuously supporting the legislation.

[[McClellan stands at the forefront of centrist Republican thinking on health. Even the more ideologically conservative health care thinkers to his right generally don't oppose long-term reform ideas like bundling payments (John McCain promoted that during his presidential campaign). But they tend to view them as insufficient or tangential to the real problem. Their view highlights a fundamental difference between the parties' on health care. To save costs, Democrats mostly want to change the incentives for providers. Republicans mostly want to change the incentives for patients by shifting toward a model where insurance covers only catastrophic expenses and people pay for more routine care from tax-favored health savings accounts. In essence, the Republican view is that the best way to hold down long-term costs is to directly expose patients to more of them. Few Democrats accept that logic though and it has little influence on either chamber's legislation.

Another Republican cost-containment priority missing from the bill is meaningful medical malpractice reform. (The bill only encourages states to think about it.) Nichols, of the centrist New America Foundation, would like to see that included as well. Its omission is one reason he says he gives the plan a “b” rather than an “a”; the other is he’d like to see mechanisms to more quickly diffuse into the private insurance system reforms that show promise in Medicare. Democratic sources say a group of centrist Democrats led by Virginia Senator Mark Warner is trying to devise a package designed to do just that, perhaps by expanding the role of the independent Medicare advisory commission.

The attempt in all these ideas to nudge the medical system away from fee-for-service medicine toward an approach that ties compensation more closely to results captures how much the health care debate has shifted toward cost-control. So far, the rise in health care spending has proven almost invulnerable to every previous attempt to tame it, like the managed care revolution in the 1990s. Even if Obama signs into law a final bill embodying all these reform proposals, many skeptics wonder if they can bend, much less break, the seemingly inexorable increase in health care spending. Reischauer understands that skepticism, but isn’t able to entirely suppress a kernel of optimism that this latest reform agenda may prove more effective than its predecessors. “One never knows whether we’re turning the corner or if this is just playing the same old game for another inning,” he says. “But I sense there’s something different out there. I think the medical profession and its leaders have read the handwriting on the wall and are trying to evolve.” If so, the ideas the Senate will begin voting on tonight could mark a milestone in that journey.

The Japanese government will tell you it’s the law to buy into the Japanese Health Insurance system but this is a lie. Health Insurance, like most laws in Japan involve a big grey zone. A more accurate statement by the Japanese government would be, “Pretty please join our super expensive medical coverage but if you dont, we can’t force you to.” There is no way penalty for not joining the system and as long as you’re a fine outstanding citizen it won’t effect your VISA or Permanent Residence application in any way.

In the summer of 2009 the Japanese government made a surprise announcement that getting your new VISA would require you enrol into the Japanese Health system. It was later clarified by the government that the new “no health insurance, no visa” law in fact wasn’t a law at all but just a guideline with no legal standing. In other words you can’t be denied a VISA for the sole reason of not having Insurance. This doesn’t mean that Japanese government officials won’t tell you that you, “have” to enrol into the government Health system but the best way to brush them off is to just say you have private insurance whether you do or you don’t.

Now that doesn’t mean you shouldn’t have health coverage in Japan. There are many private companies (Interglobal and IMG are some of the bigger ones) that offer good private health coverage for relatively cheap rates. Interglobal offers a silver plan that covers you 100% in Japan and all over the world except the US for around $1000 a year.

Joining the system

Now if you want to join the system for whatever reason the first question is why?? There is no legal reason. If you do join the government plan the Japanese system will only cover 70% of your medical bills while taking 10% of your pay check every month while the private plans listed above will cover you for 100% of hospital bill for a fraction of the cost. Also if you’ve been in Japan for longer than a year you will have to pay a Health penalty for the time you’ve stayed in Japan without paying into the system. Depending on your city government this could mean anywhere from 5 years to 2 years back payment in one lump sum. If you’ve been working at the same job earning 250,000 YEN a month that means to join the Japanese health system you will be required to pay a MINIMUM of 2 years of coverage or about 600,000 YEN (Around $6000).

Now if you still want to join first you need to decide which of the Japanese plans will fit your needs:

Break down of Japanese Health system

In Japan there are two major health plans in Japan (There are six other very specific minor plans )

1. Employee health insurance (kenkou hoken, 健康保険)
2. National health insurance (kokumin kenkou hoken, 国民健康保険)

Like the name implies the Employee plan is supposed to be taken care of by your company and the National plan is for independent workers or employees an employer doesn’t want to cover.

Employee health insurance (kenkou hoken, 健康保険)

If you are a foreigner in Japan your company will most likely either not tell you about the Employee plan or do everything in their power to keep you off it as they are by law supposed to pay 50% of the cost of the monthly payment. But it is not just foreigners who are kept off the company’s health coverage plan; Japanese companies are increasingly kicking their employees off or not adding new employees to their company plan as a way to increase profits. Millions of Japanese are left uninsured even though the law requires Japanese companies to cover them.

Under the Employee health insurance if you get sick you will apply for the following:

-70% of all medical costs
- 60% of salary from lost days (beginning from the third day absent from work due to injury or sickness)
- High-cost medical expenses cannot exceed 80,100 yen/month
- 0% interest loans are available to cover excessive costs

National health insurance (kokumin kenkou hoken, 国民健康保険)

This is the plan you will most likely join. If you fall sick you can receive the following benefits:

-70% of all medical costs
- High-cost medical expenses cannot exceed around 100,000 yen/month
- 0% interest loans are available to cover excessive costs

Top up coverage

As both of the above only cover 70% of the costs it is worth while to look into a TOP UP plan to cover the remaining 30%. AFLAC and Intergobal both offer good coverage.

Cost Break down

In the table below are three options for 100% medical coverage based on making 250,000 yen a month.

Name of coverage plan	Monthly cost
Employee health insurance 1	12,5002 + 2000 TOP UP3 = 14,500 YEN
National health insurance 1	25,000 + 2000 TOP UP3 = 27,000 YEN
Interglobal private insurance	US$83 = 7200 YEN4

1- In the Japanese system the amount you pay will go up according to how much you make where as health coverage outside the Japanese system will stay the same. So for example if you make 500,000 a month and are under the National health insurance coverage you will be paying 50,000 YEN a month for 70% coverage.
2- Employee pays half of medical premium cost
3- Based on cheapest TOP UP plan provided by Interglobal
4- Yen dollar conversion based on Dec 2009 rates for the Interglobal silver plan which offers $1000 yearly premium for 100% coverage

Why does Health and Human Services Sec. Kathleen Sebelius want the current health care bill to pass? It probably has a lot to do with her personal policy preferences and her loyalty to the Democratic platform and the Obama administration. It probably also has a lot to do with the unprecedented powers the HHS Secretary would assume under the plan.

With Reid’s health care bill, the Department of Health and Human Services would get to decide what medical care should be offered by insurers, the terms and conditions of the coverage, who is able to receive it, what the basic cost should be for coverage, and to decide where abortion is allowed to be covered.

The bill allows an end run around Congress when it comes to Medicare and Medicaid as well, empowering the department to make “cost-saving cuts.” The biggest power grab, though, according to Edmund Haislmaier of the Heritage Foundation, is the shift of authority for regulating insurance from the states to the federal government.

Keep in mind that all of this bureaucracy will be overseen by a member of the executive branch, making it tougher for Congress to get involved in policy changes. Indeed, the person in charge of the nation’s health care will be an unelected political appointee that doesn’t have to answer to voters or lawmakers.

I’m uncomfortable with investing that much authority in someone politically insulated from their missteps and overreaches, regardless of the party to which they belong or the ideology to which they ascribe. It’s just another reason the current bill winding its way through Congress would be an absolute disaster and why we’re nowhere close to a rational solution to health care reform.

:: :: :: :: :: :: :: :: ::

Whether you are a business bringing a new, exciting product to market or a 20 year-old firm selling the latest version of a successful product line, you face certain risks. People may suffer injuries or damage to their property from using your product. These accidents may stem from inappropriate use of the product, such as using a lawn mower to trim hedges or it may be that some products may be dangerous under normal use but either way you can face a lawsuit. Furthermore, vendors or contractors who sell or install a product may modify it or otherwise affect its performance. These changes can increase the chances that the product will cause injury or damage, and that can land the manufacturer or the seller in a courtroom.   Sure, you have Product Liability Insurance to help you in these cases but it saves a lot of headaches to simply transfer the risks of financial loss from these incidents.

The easiest by to transfer risk is to require, as part of your contracts with contractors, that those parties name you as an additional insured on their liability insurance policies. If the contractor is at least one percent liable for the accident, the endorsement gives the manufacturer rights to coverage under the policy for amounts necessary to settle a lawsuit. Perhaps more importantly, it covers the cost of defending the firm against the suit. These costs are often substantially higher than the cost of the settlement. The contracts should require that your contractor provide you with certificates of insurance showing that the liability policies include you as an Additional Insured.

Simple solutions such as this can protect your company, decrease the cost of your insurance and make your life much simpler in the event of a loss.   At SteelBridge Insurance Services we are committed to finding easy and cost effective solutions to our clients needs.   For more information on this article or Business Insurance in general please call us at 800-900-1068.

Working for myself as I have for most of my life, I did without health insurance for a long time.  Now, thanks to the Freelancers Union, self-employed workers can get health insurance at affordable group rates.  Dental, Life and Disability insurance are available as well.

http://www.freelancersunion.org/

Less to worry about when it comes to quilting accidents like slicing your hand with a rotary cutter or sewing a finger with the sewing machine or worse . . .

(But let’s hope you never need it for more than your annual checkup!)

I wish I could click my heels three times and be transported back to a time when healthcare was not a business and patients were more than a commodity. I am NOT a healthcare provider. I’m a physician who was taught to heal.

I wish pregnant moms had time to bond with their babies before being booted out of a hospital. And I didn’t have to threaten billing clerks for not admitting my patients for emergency tests because they didn’t have the “right” insurance.

I wish the ob hospitalists hadn’t sent a patient home inappropriately with low fluid and no further follow-up. The patient thought everything was “okay”, traveled to another state on vacation and had to be tracked down. She was advised to go the nearest hospital where she had an emergency c/section that saved her baby’s life.

I wish I could have avoided the hassle with a local hospital when I attempted to send a patient for a diagnostic test and they said they were “too full and too busy.” I ultimately sent the patient to a specialty hospital that was further away where she immediately had a cesarean section because the baby had stopped growing at 33-weeks. Both mom and baby are fine.

I wish the triage department at a local hospital had performed an ultrasound on a patient who complained of bleeding at 27-weeks. They listened to the baby’s heartbeat, said everything was fine and sent her home. When I sent her for an ultrasound, the radiologist contacted me emergently. The patient’s placenta completely covered the opening to her womb and there was a cord wrapped around the baby’s neck three times. I referred the patient to a specialty hospital where she remained for the next nine weeks until she delivered her baby with the cord still wrapped around its neck. However, both mom and baby are fine.

I wish I could run interference for ALL pregnant moms when somebody drops the proverbial ball . . . but I can’t. So I wrote The Smart Mother’s Guide to a Better Pregnancy instead.

“A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.”

As the Centers for Disease Control (CDC) continues cautioning Americans to expect a resurgence of the H1N1 virus, employers should continue to take prudent steps to defend their organization and their workers against a widespread H1N1 outbreak and the attendant lost time, health and disability costs, OSHA and other liability exposures and other personal and financial consequences likely to result from an outbreak. 

Employers wishing to deter the spread of the disease in their workplace should educate workers about these recommendations and consider taking steps to encourage workers to comply with these recommendations. When planning or taking steps to protect their workplaces from the H1N1 virus pandemic or other outbreaks of communicable diseases, however, employers must use care to avoid violating the Americans With Disabilities Act or other employment laws.

Preventing, Recognizing & Mitigating Risks of H1N1

Although the number of reported cases of H1N1 virus cases has declined in many states in recent weeks, CDC officials are warning American’s that the crisis is not over yet.  CDC officials last week warned Americans to expect H1N1 infection to rise as the holiday approaches and the winter progresses. With flu activity already higher than what is seen during the peak of many regular flu seasons and the H1NA virus accounting for almost all of the flu viruses identified so for this season,  Accordingly,  the CDC continues to encourage Americans to be alert for symptoms of H1N1 or other flu and to take other precautions including to get vaccinated.

Employers should continue to encourage workers and their families to take precautions to avoid catching the virus, to be on the watch for H1N1 virus or other flu infection and to respond appropriately if they, members of their families or others in the workplace exhibit these symptoms.   To help promote health habits within their workforce, many businesses may want to download and circulate to employees and families the free resources published by the CDC here.  Businesses and other concerned parties also can track governmental reports about the swine flu and other pandemic concerns at here.   

For those not already suffering from the virus and particularly for those at higher risk, the CDC continues to recommend vaccination. People recommended by the CDC to receive the vaccine as soon possible include:  health care workers; pregnant women; people ages 25 through 64 with chronic medical conditions, such as asthma, heart disease, or diabetes; anyone from 6 months through 24 years of age; and people living with or caring for infants under 6 months old.  As the vaccine becomes available, many employers are encouraging workers and their families to get vaccinated by offering vaccination clinics at or near their worksites, arranging for health plan coverage for vaccinations with reduced or no co-payments or deductibles, and/or sharing information about government sponsored or other vaccination clinics. 

While the CDC says getting employees and their families to get a flu shot remains the best defense against a flu outbreak, it also says getting employees and family members to consistently practice good health habits like covering a cough and washing hands also is another important key to prevent the spread of germs and prevent the spread of respiratory illnesses like the flu.  Employers should encourage employees and their families to take the following steps: 

• Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too;
• Stay home when you are sick to help prevent others from catching your illness;
•  Cover your mouth and nose;
• Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick;
• Clean your hands to protect yourself from germs;
• Avoid touching your eyes, nose or mouth;
• Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth; and
• Practice other good health habits.  Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Employers also should encourage workers and their families to be alert to possible signs of H1N1 or other flu symptoms and to respond appropriately to possible infection.  According to the CDC, all types of flu including H1NA typically include many common symptoms, including:

• Fever
• Coughing and/or sore throat
• Runny or stuffy nose
• Headaches and/or body aches
• Chills
• Fatigue

Patients suffering from H1N1 flu usually report these same symptoms, but the symptoms often are more severe. In addition to the above symptoms, a number of H1N1 flu cases reported vomiting and diarrhea.

CDC recommends individuals diagnosed with H1N1 flu should:

• Stay home and avoid contact with others for at least 24 hours after a fever (100°F or 37.8°C) is gone without the use of fever reducing medicine except to get medical care or for other things that must be done that no one else can do;
• Avoid close contact with others, especially those who might easily get the flu, such as people age 65 years and older, people of any age with chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant women, young children, and infants;
• Clean hands with soap and water or an alcohol-based hand rub often, especially after using tissues or coughing/sneezing into your hands;
• Cover coughs and sneezes;
• Wear a facemask when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza;
• Drink clear fluids such as water, broth, sports drinks, or electrolyte beverages made for infants to prevent becoming dehydrated;
• Get plenty of rest;
• Follow doctor’s orders; and
• Watch for signs for a need for immediate medical attention. Suffers should get medical attention right away if the sufferer has difficulty breathing or chest pain,  purple or blue discoloration of the lips, is vomiting and unable to keep liquids down, or shows signs of dehydration, such as feeling dizzy when standing or being unable to urinate.

In seeking to contain the spread of the virus within their workplace, employers also should be sensitive to workplace policies or practices that may pressure employees with a contagious disease to report to work despite an illness and consider whether the employer should adjust these policies temporarily or permanently in light of the ongoing pandemic.  For instance, financial pressures and the design and enforcement of policies regarding working from home and/or qualifying for paid or unpaid time off significantly impact the decisions employees make about whether to come to work when first experiencing symptoms of illness.  Employers of workers who travel extensively – may wish to delay or restrict travel for some period. 

Employers Must Employment Discrimination & Other Legal Compliance Risks

Many employers may want to evaluate and appropriately revise existing policies with an eye to better defending their workforce against a major outbreak.  Whether or not the disease afflicts any of its workers, businesses can anticipate the swine flu outbreak will impact their operations – either as a result of occurrences affecting their own or other businesses or from workflow disruptions resulting from safeguards that the business or other businesses implement to minimize swine flu risks for its workforce or its customers.  Many businesses also will want to prepare backup staffing and production strategies to prepare for disruptions likely to result if a significant outbreak occurs. 

Employers planning for or dealing with an H1N1 or other epidemic in their workplace should exercise care to avoid violating the nondiscrimination and medical records confidentiality provisions of the Americans with Disabilities Act (ADA) and/or the Genetic Information Nondiscrimination Act (GINA), the Family & Medical Leave Act of 1990 (FMLA), the Fair Labor Standards Act (FLSA) and applicable state wage and hour laws, and other employment and privacy laws.

Improperly designed or administered medical inquiries, testing, vaccination mandates and other policies or practices intended to prevent the spread of disease may expose an employer to disability discrimination liability under the ADA or GINA.  For instance, the ADA generally prohibits an employer from making disability-related inquiries and requiring medical examinations of employees, except under limited circumstances permitted by the ADA. Likewise, improperly designed or communicated employer inquiries into family medical status which could be construed as inquiring about family medical history also may raise exposures under genetic information nondiscrimination and privacy mandates of GINA that took effect November 21, 2009.

During employment, the ADA prohibits employee disability-related inquiries or medical examinations unless they are job-related and consistent with business necessity. Generally, a disability-related inquiry or medical examination of an employee is job-related and consistent with business necessity when an employer has a reasonable belief, based on objective evidence, that:

• An employee’s ability to perform essential job functions will be impaired by a medical condition; or
• An employee will pose a direct threat due to a medical condition.

This reasonable belief “must be based on objective evidence obtained, or reasonably available to the employer, prior to making a disability-related inquiry or requiring a medical examination.”

Additionally, the ADA prohibits employers from making disability-related inquiries and conducting medical examinations of applicants before a conditional offer of employment is made.  It permits employers to make disability-related inquiries and conduct medical examinations if all entering employees in the same job category are subject to the same inquiries and examinations.   All information about applicants or employees obtained through disability-related inquiries or medical examinations must be kept confidential. Information regarding the medical condition or history of an employee must be collected and maintained on separate forms and in separate medical files and be treated as a confidential medical record.  The EEOC Pandemic Preparedness In The Workplace and The Americans With Disabilities Act Guidance makes clear that employer inquiries and other H1N GINA’s inclusion of information about the “manifestation of a disease or disorder in family members” is likely to present a liability trap door for many unsuspecting employers H1N1 and other epidemic planning and response activities should be carefully crafted to avoid violating these proscriptions.

GINA’s inclusion of information about the “manifestation of a disease or disorder in family members” also could present a liability trap door for some employers designing pandemic or other workplace wellness, disease management or other programs.  GINA defines “genetic information” broadly as including not only information about genetic tests about an individual or his family member as well as information about the “manifestation of a disease or disorder in family members of such individual, GINA also specifies that any reference to genetic information concerning an individual or family member includes genetic information of a fetus carried by a pregnant woman and an embryo legally held by an individual or family member utilizing an assisted reproductive technology.  For more information about the new GINA genetic information employment discrimination rules, see here.

As part of their pandemic planning, employers also generally should review their existing wage and hour and leave of absence practices.  Employers should ensure that their existing or planned practices for providing paid or unpaid leave are designed to comply with the FLSA and other wage and hour and federal and state leave of absence laws. Employers also should review and update family and medical leave act and other sick leave policies, group health plan medical coverage continuation rules and notices and other associated policies and plans for compliance with existing regulatory requirements, which have been subject to a range of statutory and regulatory amendments in recent years.  If considering allowing or requiring employees to work from home, employers also need to implement appropriate safeguards to monitor and manage employee performance, to protect the employer’s ability to comply with applicable wage and hour, worker’s compensation, OSHA and other safety, privacy and other legal and operational requirements. 

Businesses, health care providers, schools, government agencies and others concerned about preparing to cope with pandemic or other infectious disease challenges also may want to review the publication “Planning for the Pandemic” authored by Curran Tomko Tarski LLP partner Cynthia Marcotte Stamer available at here.  FLU.gov is a one-stop resource with the latest updates on the H1N1 flu. An additional resource is CDC INFO, 1-800-CDC-INFO (1-800-232-4636), which offers services in English and Spanish, 24 hours a day, 7 days a week.  Schools, health care organizations, restaurants and other businesses whose operations involve significant interaction with the public also may need to take special precautions.  These and other businesses may want to consult the special resources posted  here. 

Cynthia Marcotte Stamer and other members of Curran Tomko and Tarski LLP are experienced with advising and assisting employers with these and other labor and employment, employee benefit, compensation, and internal controls matters. If your organization needs assistance with assessing, managing or defending these or other labor and employment, compensation or benefit practices, please contact the author of this article, Curran Tomko Tarski LLP Labor & Employment Practice Group Chair Cynthia Marcotte Stamer.  Board Certified in Labor & Employment Law by the Texas Board of Legal Specialization and Chair of the American Bar Association RPTE Employee Benefits & Other Compensation Group and a nationally recognized author and speaker, Ms. Stamer is experienced with assisting employers and others about compliance with federal and state equal employment opportunity, compensation, health and other employee benefit, workplace safety, and other labor and employment laws, as well as advising and defending employers and others against tax, employment discrimination and other labor and employment, and other related audits, investigations and litigation, charges, audits, claims and investigations by the IRS, Department of Labor and other federal and state regulators. Ms. Stamer has advised and represented employers on these and other labor and employment, compensation, health and other employee benefit and other personnel and staffing matters for more than 22 years. Ms. Stamer also speaks and writes extensively on these and other related matters. For additional information about Ms. Stamer and her experience or to access other publications by Ms. Stamer see here or contact Ms. Stamer directly.   For additional information about the experience and services of Ms. Stamer and other members of the Curran Tomko Tarksi LLP team, see here.

Other Information & Resources

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• New GINA Genetic Information Based Employment Discrimination & Confidentiality Mandates Take Effect
• SHRM Urges American’s To Oppose HR 3962, The Affordable Health Care For America Act
• Businesses Cautioned To Strengthen Investigation & Employment Practices To Minimize Potential Exposure To Retaliation Claims In Light Of Recent Supreme Court Retaliation Decision
• OFCCP To Apply Special Procedures, Heightened Scrutiny To Equal Employment Practices of Government Contractors, Subcontractors On ARRA Funded Projects
• US and UK Agree to Share Information & Cooperate On Pension Security As US Defined Benefit Plan Sponsors Face Tough New Defined Benefit Plan Funding Requirements
• Congress Considering Extending & Expanding Group Health Plan COBRA Subsidy Mandates On Heels of Enactment of Expanded Military Leave-Related Family Leave Mandates
• EEOC Prepares To Broaden “Disability” Definition Under ADA Regulations
• Tighten Employment, Ethics & Internal Controls Policies & Practices To Minimize DOJ & Other Antitrust Exposures
• IRS Proposes To Update Regulations On Exclusion of Damages Received on Account of Personal Physical Injuries or Physical Sickness To Eliminate Tort Test
• OSHA Final Rule Updates OSHA Personal Protective Equipment Standards
• DOL Proposes Changes To H-2A Temporary & Seasonal Agricultural Nonimmigrant Worker Certification Procedures & Related Rules
• “Disability” Definition Not Retroactive, Employer Action Needed To Manage Post 1/1/2009 Risks
• Employer & Other Health Plans & Other HIPAA-Covered Entities & Their Business Associates Must Comply With New HHS Health Information Data Breach Rules By September 23
• Speak Up America: Where & How To Read & Share Your Feedback About The Health Care Reform Legislation

For important information concerning this communication click here.   If you do not wish to receive these updates in the future, send an e-mail with the word “Remove” in the Subject here.

©2009 Cynthia Marcotte Stamer. All rights reserved. 

Recently, the biggest insurance company of private sector, TATA AIG launches life InvestAssure Superstar ULIP plan. ULIP is known as Unit-Linked Life Insurance Plan. The plan is dedicated to the children’s education. The plan is known as InvestAssure Superstar.

InvestAssure Superstar will pay the sum assured to the nominee in case of the parent’s or proposer’s demise unfortunately. In this case, the further premium will be paid by the company through the inbuilt Waiver of Premium. WOP pays the premium among other benefits also.

The claim fund will grow under the policy and would continue till maturity. This statement is proposed by the company, TATA AIG in an official statement.

The plan offers another benefit of investors Systematic Money Allocation and Regular Transfer. SMART of the plan will give a solution for managing investment.

SMART will give a path of choice for an investor of simple switching of a part of the customer’s investment from the accumulation to the target fund.

You can enjoy with Tata AIG Life InvestAssure Superstar’s flexible policy term which will be between 10-25 years.

Anyone can buy the policy whose age is between 18-55 years. The maximum maturity age for Tata AIG Life InvestAssure Superstar is 65 years.

Tata AIG launches Life InvestAssure Superstar which gives the maximum security in the plan about the maturity and premium. The child ULIP plan is better for any person because of WOP. The plan gives an investment opportunity also by SMART features.

Tata AIG launches Life InvestAssure Superstar that will create the biggest competition with HDFC children’s Plan. In the insurance market, it is the best plan by TATA AIG for Indian people.

In Indian insurance market, Apollo DKV health plan was the best. Apollo DKV had been launched recently as the health insurance plan. So, the both plans- Tata AIG Life InvestAssure Superstar and Apollo DKV health plan are the best plan for Indian customers.