Americans with Disabilities Act (ADA)_Employers with more than 15 EE's

Effective January 1, 2009, The ADA Amendments Act of 2008 (ADAAA) redefines who is considered “disabled” under the ADA and thus leads to a potentially larger number of “disabled” employees seeking accommodations and of those who may claim they were “regarded as” disabled in unfair treatment claims. (Note: The Americans with Disabilities Act (ADA) applies to businesses with 15 or more employees.)

Highlights include:

Covered Individuals. The number of individuals covered by the ADA will increase including those with:
Conditions corrected by medication (i.e. diabetes, epilepsy),
Conditions currently in remission, and
Conditions that are episodic.

Reasonable Accommodation and the Interactive Process.

Make sure job descriptions are current and relevant,
Maintain an on-going dialogue with employees who may have a disability that needs to be accommodated, and
Document any evidence and / or discussion about potentially providing reasonable accommodation.

KEEP UPDATED ON HR with AMS and HR Answerlink; ask us how, for our Clients

Resolve to Have a New You in the New Year

At Least a Healthier, More Relaxed You

(Washington, December 15, 2008)—Seventy-five percent of respondents polled in a survey conducted by VacationBetter.org this month, did not take all of their vacation this year, often foregoing it due to economic or work issues. As the New Year approaches, many of us make resolutions to lose weight, exercise more or do something that makes us look or feel better. The best resolution this year is to commit to taking an annual break to reconnect and recharge. Giving up vacation may actually cost you more in healthcare costs in the long run.

Perhaps it is time to follow New Year advice from a group of people that do tend to keep their resolution past January: timeshare owners. Studies show that there are undisputed, long-term benefits associated with taking regular vacations that contribute to better health, relationships and job performance. 2008 was the year of the “Staycation,” a new idea designed to make staying home sound like a good use of vacation time. Unfortunately, staying confined to the normal routines of daily life will not produce the long-lasting benefits of a traditional vacation.
“Put away the cell phone and laptop and disengage from the daily hassles of your life,” says John de Graaf, executive director of Take Back Your Time, an initiative encouraging time outside of work. “Our goal is to make 2009 the year we all actually take our vacations.”

Although Americans are experiencing tighter budgets, vacations should be viewed as a necessity rather than a luxury. Traveling with timeshare eases the necessity of vacation by taking the stress out of planning for one while accommodating every traveler’s desires. And, vacation ownership accommodations provide for better family time because people can participate in activities at their own leisure. Timeshare ensures this process will happen at least once a year, every year, which means a healthier, more relaxed life.

Everyone deserves a vacation in 2009, and not just a good one, but a better one. Go to http://www.vacationbetter.org/ to take a survey on your New Year’s goals.

Then go to:

AMS Travel Related Services and start planning today, book that special trip.

What to do should you need Unemployment Benefits

Unemployment is on the rise with more job cuts likely for 2009. Most economists believe this recession will continue until 2010. We hope they’re wrong and that this and that you or someone you know will need this information. If you or someone you know does then we hope this will help you or them.

A common question receive has to do with unemployment benefits and how to file for them.

There are a few things you should know that will help you get your benefits sooner.
First, make sure you’re eligible. To get unemployment benefits you must have been an employee, not a private contractor or any other type paid by 1099. If you received a W-2, you’re likely considered an employee.

Regulations and enforcement vary by state. California, for example, is very pro-employee while more conservative states like Ohio could side with the employer for some disputes.
Second, if you know that you’re eligible, submit the paperwork as soon as you can. There is a period of time between the request and the first check arriving so the sooner you apply, the better for your cash flow.

Third, be prepared to show you’re looking for work and to take a mandatory class. Unemployment classes are typical. They provide assistance in finding a job and also show that you’re being proactive with your search. If you don’t go to the class, you will not qualify for benefits. Check with the unemployment office in your state to see if there is a required class.
Fourth, know that your unemployment check is much less than your standard paycheck.

Unemployment is meant to keep you on your feet while you look for a new job.
Last, obviously unemployment does not last forever. You’ll eventually need to find a job because benefits will stop. The sooner the better.

*During this financial crisis some states’ unemployment funds are running dry. This would be a disaster for many. Although unemployment benefits have been a sound program for many years, we recommend not counting on it to pay the bills. Funds could run out depending on your state.

To find the local unemployment office in your state, search Google for unemployment office and state name. This search for the state of California returned this link to file a claim.

Health Care Costs Slowing and how each $ is spent!

Rates increased by 6.1 percent from 2006 to 2007, compared with 8.8 percent from 2004 to 2005 and 13.7 percent from 2000 to 2001. The growth rate for premiums can be attributed to general inflation (64 percent), health care price increases in excess of inflation (30 percent), and increased utilization of services (25 percent), according to the report.

The report also found that 87 cents out of every dollar goes toward medical services, including 10 cents that is dedicated to medical liability and defensive medicine. The remaining 13 cents is divided between consumer services such as health information technology (4 cents), administrative costs (6 cents), and profits (3 cents).

How to save on your health care costs with Consumer Directed Plans:

Health Savings Account Plans Explained …click here!

Get Ready for the Newly-Revised FMLA Regulations

The federal Family Medical Leave Act (FMLA) has been a significant and often challenging compliance obligation for many businesses nationwide. Recognized as one of the most crucial workplace issues for 2009, however, specific recent FMLA developments are anticipated to provide employers with new tools to help administer this type of leave more effectively. Within only about 3 months, employers subject to FMLA need to get familiar and get ready based on the revised regulations which become effective on January 16, 2009.

The FMLA Basics:
FMLA is governed by Federal law. Employers with 50 or more employees must grant up to 12 weeks of unpaid FMLA leave to their employees for certain qualifying events; health care benefits must be continued during FMLA leave; and the employee must be reinstated to his or her former position or an equivalent position at the end of the leave. Employees are eligible for FMLA leave if they have worked for the employer for the 12 months, have worked 1,250 hours or more in that period, and are at a work site where there are at least 50 employees within a 75 mile radius.

Employees must follow the company’s call-in policies if they plan to miss work “absent unusual circumstances.” Currently, employees have up to two days after an absence to notify the company about their need for leave.

An employee’s time spent performing light duty does not count toward FMLA entitlement.
Employers may consider additional medical information obtained through ADA, paid leave, or workers’ compensation procedures.

Employers may account for FMLA absences to determine bonus and incentive rewards.
The regulations interpret and implement the Military Family Leave Amendments enacted earlier this year.

The application of FMLA to professional employer organizations also is addressed.

In the midst of current economic uncertainties, incorporating and applying the revised FMLA regulations may be very frustrating for many employers. At the same, businesses simply cannot afford to ignore the issue. Employers must prepare, review, and update their policies, forms, etc. as needed to communicate clearly and effectively – verbally and in writing – with and for all of its employees.

Learn More by clicking on the HR Link:

A Value Added service available to AMS Clients.

Health Care in Retirement:

One of the most complex parts of your retirement paycheck is the cost of your health care. As you plan for your retirement, make your health a priority by getting acquainted with your healthcare options now. Medicare, the federal program that provides health insurance for people over age 65 is a health care lifeline to the millions who rely on it. As you consider what your future costs will be, keep in mind that not all Medicare services are free and not all medical services are covered by Medicare. So, as you plan, be sure you include the cost of health care—public and private insurance as well as out-of-pocket expenses. Estimating how much you will need in addition to Medicare can be difficult, because a lot of what you need to know to create a plan depends on guesswork.

For example, how long will you live? How healthy will you be? Will you have any “pre-existing conditions?” What will be the cost of Medicare Part B or a Medicare Advantage Plan when you reach age 65?

To help you get started, here is some information on how to supplement Medicare costs and where you can go for more information.

The ABCs of Medicare at:

The Official U.S. Government Site for People with Medicare

http://www.mymedicare.gov/


In your quest to create retirement savings through IRA’s, Roth IRA’s 401K’s and other retirement programs consider an HSA aka; Health Savings Account as an alternative. Unlike some company sponsored FSA or Section 125 plans the money in an HSA plan is yours, roles over year to year and any unused money from spending on Medical, Dental and Vision care will be there in Retirement.



Check out the Benefits here. Health Savings Account Plans Explained …or look into an IRA or 401K at: Pension Plans…

Employee Benefits: Health Plan Changes For 2009 And 2010

A number of new laws and regulations will affect the design and administration of group health plans beginning in 2009.

Change in Definition of Dependent

A "dependent" for purposes of group health plan coverage is typically defined by reference to section 152 of the Internal Revenue Code ("Code"), which describes dependent status based on whether an individual is a "qualifying child" or a "qualifying relative." Effective January 1, 2009, the Fostering Connections to Successful and Increasing Adoptions Act of 2008 changed the definition of "qualifying child" under Code Section 152(c).

Two new requirements are added to the definition of "qualifying child:"

1. The child must be younger than the taxpayer claiming the individual as a dependent; and

2. The child must not have filed a joint return (other than only for a refund claim) with the child's spouse for the taxable year in question.

The new law also allows a non-parent to claim the child as a dependent, as long as the parents do not, and the non-parent's adjusted gross income is higher than the highest adjusted gross income of any of the parents.

Massachusetts Creditable Coverage Requirements

Residents of Massachusetts must have health insurance that is "creditable coverage" or else pay a significant penalty to the Commonwealth. Regulations describing what constitutes minimum creditable coverage were recently issued by the Commonwealth Health Insurance Connector Authority. Although the regulations do not directly apply to group health plans sponsored by employers, an employer with a group health plan that is not "creditable coverage" will be under significant pressure from its employees to improve coverage.

Effective January 1, 2009, a health plan must provide "core services" (i.e., physician services, inpatient acute care, day surgery and diagnostic treatment and tests) and, at a minimum,


Preventive and primary care;

Emergency services;

Hospitalization;

Ambulatory patient services;

Prescription drugs; and

Mental health and substance abuse services.
Effective January 1, 2010, the list of required services increases.

The plan can impose reasonable exclusions and limitations, including different benefit levels for in-network and out-of-network benefits, as well as co-payments, deductible and co-insurance; however, limits apply. In addition, a health plan may not impose an overall aggregate annual maximum benefit limitation or an annual cap on core services. Further, preventive care services may not be subject to a deductible (co-payments or co-insurance consistent with primary or routine physician office visits are permissible).

The regulations do not address the date as of which "creditable coverage" is determined, so it is unclear whether mid-year amendments to a health plan to bring it up to the regulatory standards will avert the employee penalty. Finally, the regulations impose no requirement that employers inform employees whether the health plan is "creditable coverage," but employers should be ready to answer questions on the subject.

Mental Health Parity

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was enacted as part of the Emergency Economic Stabilization Act of 2008. Although the new law does not require group health plans to provide benefits for mental health and substance abuse, it requires those plans that offer both medical/surgical and mental health/substance abuse benefits to do so on an equal basis.


The financial requirements of the plan, such as deductibles and copayments, can be no more restrictive for mental health or substance use disorder benefits than those that apply to substantially all medical and surgical benefits covered by the plan;

Mental health and substance abuse benefits cannot be subject to separate cost sharing requirements;

Any treatment limitations applicable to such mental health or substance use disorder benefits can be no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan; and

There can be no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.

A plan must provide out-of network coverage for mental health or substance use disorder benefits if the plan provides coverage for medical or surgical benefits provided by out-of network providers.
The financial parity requirements of the law do not apply if, after complying with the Act for a minimum of six months, an actuary determines and certifies that compliance with the new law results in an increase in the total costs of coverage (medical and surgical benefits and mental health and substance use disorder benefits) of more than 2% for the first plan year and 1% for each subsequent plan year. If the exemption is claimed, a notification must be sent to plan participants and beneficiaries, the Secretary of Health and Human Services, and appropriate state agencies.

In addition to financial parity provisions, the new law requires the plan administrator to disclose the criteria for medical necessity determinations and the reason for any denial of reimbursement or payment for services made under the plan with respect to mental health or substance use disorder benefits.

The new law is effective for plan years beginning on or after October 3, 2009 (January 1, 2010 for calendar year plans). For collectively bargained plans, the law applies to plan years beginning on or after the later of January 1, 2009 or the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after October 3, 2008).

Michelle's Law

Group health plans that extend coverage for dependents based on full-time student status must continue that coverage for one year (or until coverage would otherwise end for all dependents, regardless of student status, or earlier) if the dependent is on a medically necessary leave of absence from the educational institution. A medically necessary leave of absence is a leave of absence or other change in enrollment that (a) begins while the dependent is suffering from a severe illness or injury; (b) is certified by a physician as medically necessary; and (c) causes the dependent to lose student status under the terms of the group health plan.

When requesting certification of student status, a group health plan must describe the extension of coverage during a medical leave of absence. In addition, a summary of material modifications must be provided to plan participants describing the plan amendment that implements Michelle's Law.

Michelle's Law is effective for plan years beginning on or after October 9, 2009 (January 1, 2010 for calendar year plans).

How Does Your Benefits Plan Rank

Rankings reflect results of consumer surveys and success in preventing and treating illness compared with average health plan. The highest possible score is 100 points.
Listed are California only PLANS. This information was pulled from a national list of companies being ranked, and this list changes annually.

Rank Company Name Score Consumer Prevention Treatment
Assessment

#48 Kaiser N. Cal 85.3% 2 4 5

#100 Kaiser S. Cal 82.9% 3 3 4

#159 Western Health 81.3% 2 3 2

#172 Pacific Care Cal 80.5% 1 3 2

#184 Health Net Cal 80.1% 1 3 2

#189 Blue Shield Cal 79.7% 2 2 2

#198 Cigna Cal 78.8% 1 2 2

#212 Aetna Cal 76.3 1 1 2


Other helpful tools for picking a health plan:

Poring over health insurance alternatives, as millions of Americans will do this month and next, is nobody's notion of a fun time. But mulling over the various options is the only way to meet your needs without devastating your paycheck. These 10 tips will help you focus.

1. Weigh flexibility. The three main types of health plans differ in members' degree of personal choice in selecting caregivers. Someone with diabetes or another chronic condition may want a point-of-service (POS) plan or preferred provider organization (PPO), which offer unrestricted access to specialists. An HMO, which limits members to physicians in a defined network, might provide enough choice and protection for someone young and healthy.
2. Check the provider network. If physicians you use are not in the plan, switching to others will be a hassle—and if you chose them for their specific expertise, your health might even be affected.
3. Consider coupling catastrophic care with a special fund. You can cover the high deductibles in a catastrophic-care plan from a health reimbursement arrangement (HRA) set up and funded by your employer. Otherwise, you can pay the deductible from a tax-deductible health savings account you set up yourself.
4. Monitor the maximums. Most plans specify the out-of-pocket total, often thousands of dollars, that members must pay before full coverage kicks in. But employees in 20 percent of health plans are never fully covered, according to the Kaiser Family Foundation's 2008 Employer Health Benefits Survey. And copays usually don't count toward the maximum.
5. Check for caps. Many plans impose annual limits—on coverage for medications, for example, or the number of visits for physical therapy following an injury. A 2008 report by the Commonwealth Fund found that one fourth of insured adults face steep bills because of coverage limitations.
6. Review your medications. A brand-name drug for a chronic condition can be costly. The plan's list of medications, or formulary, will show your copay.
7. Get meds by mail. Many plans offer this convenient option, which often includes lower copays.8. Cut expenses with a tax-deductible FSA. Like HRAs, flexible savings accounts are set up by employers, but unlike HRAs, they are employee funded. Contributions are subtracted from pretax income.
9. Check out wellness management incentives. Many plans offer discounts if you take a health risk assessment, stop smoking, or keep your diabetes under control.
10. Use comparison tools. Ninety percent of employers provide online cost estimators for comparing plans, but only 9 percent of employees use them, says benefits consultant Hewitt Associates.

If your company stumbles, what happens to your health coverage?

For years, workers have watched their healthcare outlays rise and benefits shrink, and for some, whether they will have benefits at all suddenly is in doubt. As Wall Street's turmoil sloshes over Main Street, it seems that every day another trusted company files for bankruptcy, succumbs to a takeover, or shuts its doors. Nearly 34,000 businesses filed for bankruptcy in the 12 months ending in June, 42 percent more than the year before—and the word from on high is that this may be just the beginning. If your company stumbles, your healthcare, along with your job and your 401(k), could suffer as well. Many employees may worry they're only a couple of bad balance sheets away from joining the ranks of the nearly 46 million Americans without health insurance.

Costly COBRA. Extending coverage under COBRA, the federal law that gives employees who lose jobs the right to continue coverage under the company's health plan for up to 18 months. The law applies only to companies with 20 or more workers, but some states extend the option to workers from smaller companies such as in California with Cal Cobra.
Taking advantage of COBRA can be costly, however. Workers must pay the full premium—their former share and the former employer's share—plus a 2 percent fee. The monthly tab to cover may be far more than people can afford. There are programs which children can get for lower income households at no cost or minimal costs under Health Families Programs. For those who have little or no health issues, them may be eligible for an individual plan including less costly high deductible plans "Basically, if something catastrophic were to happen, they wouldn’t be bankrupted."

When companies shed workers, COBRA can cushion the blow. But with the average total premium for a family health insurance policy approaching $13,000 a year, many families, cannot afford the expense in their newly strained circumstances. Only about 27 percent of eligible workers elect COBRA coverage, according to a survey by Spencer's Benefits Reports. There is another option for two-earner couples: If one partner still has a job and is covered, the newly jobless spouse can join that plan under special enrollment rules that kick in following a bankruptcy or other "qualifying event."

Employees aren't always left so exposed when a company gets into financial trouble. Another company often takes over the ailing firm, as happened with Washington Mutual, Wachovia, and Merrill Lynch, which were acquired by other banks during the financial meltdown. Employees absorbed into the new firm may see no changes in their benefits, at least not initially. "The new employer may continue the existing program for a period of time." It may be a year or more before employees have to think about changes."

Stable Insurers. A comforting note amid the current economic wreckage is that healthcare insurance providers themselves are unlikely to go under. State regulators keep close tabs on these companies. They must submit quarterly financial statements and annual reports demonstrating sufficient reserves to cover claims. The standard in all states for "sufficient" requires that for every $100 in premiums collected, an insurer must have $250 in reserve. If a company's reserves drop below that level, regulators can effectively take over management of the company until its reserves are back in line.

Troubled insurers can—and occasionally do—become insolvent. If a company loses liquidity because of underperforming investments, for example, it might be unable to pay claims or continue operations, but in those relatively rare instances, claims are covered by a guaranty fund into which all insurers must pay.

In these uncertain times, that's one less thing to worry about.

Report compares candidates' healthcare proposals.

The Orlando Sentinel (10/2, Shelton) reported, "In a 63-page comparison, the nonpartisan Commonwealth Fund found that both" Sens. John McCain (R-Ariz.) and Barack Obama's (D-Ill.) healthcare "proposals lack specifics and each would cost more than $1 trillion during a 10-year period."
HealthDay (10/2) noted, however, that although "both presidential candidates want to make health insurance available to more Americans," The Commonwealth Fund's analysis favored Sen. Obama's plan, saying that it "shows greater potential for making care more affordable, accessible, efficient, and higher quality, though it will likely fall short of covering everyone." The report indicated that Sen. McCain's plan, on the other hand, "is likely to increase insurance administration costs" and that it "would not likely lead to universal coverage" either.
Modern Healthcare (10/3, Blesch) adds that one of the Commonwealth Fund's top "criteria for judging the proposals" was whether they "advocate universal coverage as a goal." The report contended that Sen. Obama's plan would "provide more people with affordable health insurance that covers essential services, achieve greater equity in access to care, realize efficiencies and cost savings in the provision of coverage and delivery of care, and redirect incentives to improve quality." Meanwhile, because Sen. McCain's plan "focuses on making it easier for people to buy insurance on the individual market if they don't get it at work, providing tax credits, and allowing policies to be purchased across state lines," The Commonwealth Fund was "critical of [his] strategy." The report indicated that Sen. McCain's plan may result in less employer-sponsored coverage, "and that insurance deregulation might encourage insurance companies to compete on price but also neutralize consumer protections."
"Robert Moffit, Ph.D., who directs the Center for Health Policy Studies for the conservative think tank Heritage Foundation, called the projections 'nonsense,'" WebMD (10/2, Boyles) noted. Moffit, "criticizing the report's projections of uninsured people," said that "he's not surprised by the report's conclusion, since the Obama plan is very similar to one proposed by The Commonwealth Fund earlier this year." He also faulted "the report for concluding that McCain's proposed tax changes will only have limited effects on boosting the number of insured Americans." Moffit argued that because the country has "never had a tax policy like" Sen. McCain's in the past, "there is no historical experience to draw from." And, he found it "hard to believe that" Sen. McCain's "generous tax relief, including refundable tax credits...will only result in two million more insured."
With regard to the candidates' focus on health IT, the report indicated that "greater adoption of health information technology could save the country" an estimated "$88 billion in a 10-year period," according to Government Health IT (10/2, Robinson). The report, however, "assumes a one percent assessment imposed on insurance premiums and Medicare outlays -- money the federal government would then provide to state and local agencies to accelerate the adoption of health IT." And, although the report "states that about $368 billion in savings could [be] realized by establishing a center for medical effectiveness," Government Health IT noted that neither candidates' "proposals have offered many details about their health IT plans."

Request a copy of "What really ails the U.S. health care system" (FACT or FICTION). email request with title of book, and your name, address, and phone number to:
info@amsinsure.com .

Small Firms More Likely To Offer 100% Employer-Paid Health Care Coverage

From Spencer's Benefits Reports: In 2005, 23.4% of employees in firms offering health insurance had access to at least one plan where no employee contribution for the health insurance premium was required for individual coverage, according to a new report from the Agency for Healthcare Research and Quality (AHRQ). In the statistical brief, the AHRQ presents estimates of offer rates and enrollment in employer-sponsored health insurance plans requiring no employee contribution in the ten most populous states in 2005. “The availability of such plans varies considerably by state and firm size, among other factors,” the AHRQ noted. The brief also reviewed state variations from the national average.The great majority (86.9%) of the 112.2 million private sector employees in the United States in 2005 worked at firms that offered employer-sponsored health insurance, the AHRQ said. Among the ten most populous states, California had the highest percentage (37.1%) of workers whose employer offered at least one health care plan for which an employee premium was not required for individual coverage, and the largest proportion of employees (36.1%) with individual coverage who were covered by such plans. Florida and Ohio had the lowest proportion of such covered workers (18% and 16.7%, respectively).Workers at small firms that offered group health insurance were most likely (49.4%) to have available premium-free individual coverage in 2005. Furthermore, such employees were much more likely than those in large firms to be enrolled in a plan that required no premium contribution for individual coverage. More than half of individuals enrolled in an employee-only plan in small firms had no required employee premium contribution; this also was true for more than one-third of those with family coverage in small firms. Workers for small firms in New York who were enrolled in employer-sponsored family coverage were most likely (55.1%) to have such coverage premium-free.Overall, 11.9% of workers in firms that offered health insurance were offered at least one family coverage plan that required no employee contribution. In California, Michigan, New Jersey, and New York, a higher than average percentage of workers in small firms were offered health insurance and had access to at least one plan with no required employee contribution for family coverage; while in Florida the same percentage of workers was lower than the national average.Among large employers, the national average for coverage in premium-free employee-only plans was 14.4%; the national average for family coverage was 9.1%. California (26.9%) New York (14.6%) and Michigan (15.5%) had higher than average individual rates. California (15.5%), Michigan (13.0%), New York (10.0%), and Pennsylvania (12.4%) had higher than average family rates.State Differences in Offer Rates and Enrollment in Employer-Sponsored Health Insurance Plans that Required No Employee Contribution to the Premium Cost, 2005, Statistical Brief #213, Medical Expenditure Panel Survey (MEPS), issued in July 2008.

What really ails the U.S. heatlh care system

Right now, the United States is undergoing a national debate about how best to deliver health care to her people. The lives of our most vulnerable-aging citizens, those with chronic illness, tiny babes-are at stake. Our future financial strength and ability to make personal decisions about our own lives, likewise, lie at the center of this critical debate.



Be informed and request your copy of (What really ails the U.S. health care system) now, email us at info@amsinsure.com and put the title in the subject line and your address in the body of of the email. We will be happy to send you a copy free of charge. We want everyone to be knowledgeable and be able to add in to this great debate with competent knowledge.

Othere topics in the book: facts, not fiction;

• The Common Myths, Misconceptions, & Deceptions



• Cost of Health Care Administration



• Quality Measurements of U.S. Health Care: Infant Mortality and Life Expectancy



• The Uninsured "Crisis"



• The Cost of Health Care and Health Insurance



• Defining Terms



• What are the Facts about Government-run Mandatory Universal Health Care



• Why the U.S. has Avoided Mandatory Universal Health Coverage



• Where & How Did We go Wrong



• The Key Issue



• Patients as Consumers



• Curing What Ails U.S. Health Care

Its informative, filled with factual information and most important easy to read and uncomplicated.

Once again; info@amsinsure.com






310-534-8071

Controversial Medical Billing Practices by the medical profession

Controversial billing practice may account for $1 billion in medical fees paid by patients.
BusinessWeek (8/29, Terhune) reports, "As healthcare costs continue to soar, millions of confused consumers are paying medical bills they don't actually owe" due to a common, yet often illegal practice known as balance billing. When this happens, "an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid," and the provider "demands the balance from the patient." BusinessWeek notes that "state and federal laws generally bar the medical providers from pressuring patients to pay the difference." Yet, as this practice continues, "economists and patient advocates estimate that consumers pay $1 billion or more a year for which they're not responsible." In fact, in California alone, an estimated "1.76 million policyholders...received such bills in the past two years, totaling $528 million," and 56 percent paid.

Typically, patients fall victim to balance billing when "medical providers participating in a managed-care network believe the plan's insurer is imposing too deep a discount on medical bills or is taking too long to pay." Currently, 47 states "ban in-network providers from billing insured patients beyond co-payments or co-insurance required by the plan," and "federal law prohibits providers from billing Medicare patients for unpaid balances." Yet, "regulators in most states have been slow to take action in billing disputes."

Industry experts say small business owners can make use of summer downtime.

The last few weeks of summer can be a useful time for small business owners whose companies are going through a slow period -- they have a chance to tackle some of those tasks they've been putting off. While some owners use summer downtime for big projects like writing an employee handbook, other owners cross off more mundane items from their to-do lists, such as entering that pile of receipts into their accounting software. Summer is a good time to get all this stuff done, in preparation for the fall. ... A mistake so many business people make is they wait until Sept. 1 to really gear up. They're really short-shrifting themselves. In planning downtime projects, owners may want to consider what changes...to make to their products or services, or how to adjust their marketing programs. Other experts recommend making changes to websites, examining costs and seeing what...can be cut, and thinking about employee issues.

Aging U.S. population visiting hospitals more, study shows.

There are reports that the "aging of the U.S. population is translating into many more visits to doctors' offices and hospitals, a reality that is taxing weak spots in the healthcare system, according to a government report released Wednesday." Investigators found that overall, "[p]eople made an average of four visits a year to doctors' offices, emergency rooms, and hospital outpatient departments in 2006, a total of 1.1 billion visits." The data also showed that the "number of medical visits increased 26 percent between 1996 and 2006, significantly higher than the 11 percent population growth during that period."

The national Centers for Disease Control and Prevention (CDC) in Atlanta released the statistics, and they came "from various components of [the] CDC's National Center for Health Statistics National Health Care Survey".

According to the CDC, "the observed increase in medical visits 'can be linked to both the aging of the population, as older persons have higher visit rates than younger persons in general, and an increase in utilization by older persons.'" In terms of racial disparities, the "overall visit rate was not significantly different for white and black persons." But, "African-Americans had higher visit rates than whites to hospital outpatient departments and emergency departments, and lower visit rates to office-based surgical and medical specialists." Additionally, "[r]egardless of setting -- physician office, outpatient clinic, or emergency department -- seven out of 10 patients left the medical visit with at least one prescription, and analgesics were the most common drug prescribed."

Medicare Supplements - Click for rates if you are 65+

At Home Employees doing Company work

Here's a question you may not have thought about: If one of your employee's is working at home and is injured, are you responsible? The answer depends on individual circumstances. For example, electrocution from a faulty cord on a computer you provided is different from a slip and fall on the way to the bathroom. As technology allows more and more work to be performed at home, it's a good idea to adopt safety expectations for your employees' home offices.
Here are some ideas to keep in mind if you have staff working from home:

* Temperature, noise, ventilation and lighting levels should be adequate.
* Electrical equipment should be free from hazards (e.g., frayed or exposed wires). Wiring and electrical cords should be secured and out of the way.
* The work area should be large enough to safely accommodate all equipment, wiring and so on without posing a risk of hazard to the employee.
* Hallways and doorways should be free from obstructions.
* The working environment should be free from clutter or materials that could create fire hazards.
* Floor surfaces should be clean and dry. Carpeting should be properly secured.
* There should be ample lighting for the work that the employee will be doing.
* The working area should be equipped with sufficient electrical outlets to accommodate all necessary equipment safely.
* Desks and chairs should be the appropriate size, height, etc., to provide comfort.
* Some organizations ask employees to sign a statement indicating that they will comply with the company's stated safety requirements; others even ask employees to bring in photos of their work areas indicating that they are in compliance with safety regulations.

Employee safety needs to be your concern even when their working from home.
If you or someone you know has staff that telecommutes or works from home contact your Business Insurance agent or we can offer references to you. For more HR updates ask us about our HR platform offered free to AMS clients. 800-334-7875

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Information which will help you to manage your business keeps you updated and ready. Sharpening Your Screening Interviews is a current article from our HR Affiliate.

Many employers adopt some sort of interview process. Unfortunately, many employers also abbreviate the process by hastily moving from the resume review stage right into the hiring interview stage. In between those two stages, however, the prudent employer will conduct screening interviews to separate the truly qualified job candidates from the unqualified candidates.There are four basic tips to help managers make the screening interview stage an integral part of a successful employee selection process:

Know Your Business Needs. Before placing that ad or starting the search, you hopefully already developed a job description that defines what your business needs are. The job description should be specific about the job duties, the necessary skills set, the type of required experience / education, and any other information to help you identity the ideal job candidate.

Review the Resume. Get familiar with the candidate’s resume before the phone or in-person screening interview. Make a checklist of standard questions to ask each candidate and any notes specific to the resume in question. Have all this information with you to briefly look over just before the interview to help confirm your mental map for the discussion.

Figure Out the Fit. During the screening interview, exercise sound judgment in assessing the candidate’s personality traits. Pay attention to the candidate’s overall attitude, behavior, and knowledge toward the company and any employees the candidate may have met already. For example, how well does the candidate respond during the interview?

Watch the Warnings. With the resume at hand, be sure to verify statements made on the resume, and isolate any apparently exaggerated or seemingly falsified information. For example, how the candidate phrased his or her familiarity of certain computer office programs on the resume may be questionable. In turn, ask the candidate to provide a concrete example.

By verifying the integrity of each candidate’s resume through the screening interview process, you will gain a clearer perspective of the how to better define your pool of truly qualified candidates towards selecting your next great employee.

Not Understanding At-Will Employment Puts Your Business at Risk

"At-will" employment refers to a common-law rule that the employment relationship may be terminated by the employer or the employee at any time, for any reason, with or without cause or notice. For employers, the ability to terminate an employee whenever they want and for whatever reason is invaluable. This perception, however, is not quite accurate. Over time, the establishment of various federal and state regulations and the application of certain employment law concepts have created conditions and layers much more in favor of today's employee. To minimize the risks of wrongful termination claims, every employer needs to understand at least the three big exceptions to the employment at-will concept:

Public Policy: A wrongful discharge when the reason for employment termination is contrary to an established state public policy (i.e. terminating a pregnant employee protected under the federal Family Medical Leave Act).

Implied Contract: A contract between the employer and the employee although no written documentation exists regarding the employment relationship (i.e. “Probationary Period” language in the Employee Handbook).

Covenant of Good Faith: An implied agreement the employer is to treat employees honestly and fairly (i.e. A “just cause” standard placing a burden of proof on the employer to justify the basis for discipline or discharge of an employee.)

Tool of the Month: HR Checklists

Whether faced with a hiring, performance management, or employment termination issue, the manager needs to make sure certain steps are covered. To help keep track, you may review and download various HR Checklists developed by HR professionals.To learn more about the HR Checklists, become a client of AMS and receive free HR support.

Are Regular Old 401(K)s Better Than Roth 401(K)s?

Conventional wisdom touts Roth 401(k) plans as the better choice for most taxpayers over regular 401(k) plans. But a paper in the July 2008 issue of the Journal of Financial Planning, published monthly by the Financial Planning Assn. (FPA), argues that not only are regular 401(k) accounts superior to Roth 401(k)s for all but the wealthiest of taxpayers, but they’ll also remain superior even if future tax rates rise.

The conventional wisdom is that, if a retiree’s tax rate is the same as the tax rate when they were contributing to a 401(k), it shouldn’t make any difference whether that person puts money into a regular 401(k), whose contributions are tax-deferred or a Roth 401(k), whose contributions are made with after-tax dollars. The retiree will end up with the same amount of after-tax money way.However, side fund analyses argue that it isn’t an apples-to-apples comparison. For example, an affluent taxpayer putting the maximum $41,000 into a 401(k) would actually need $56,944 in order to fund the Roth. That’s because the taxpayer would need to pay $15,944 in taxes on the $56,944 (at a 28% tax rate) in order to have $41,000 left to fund the Roth. A taxpayer using a traditional 401(k) would need only $41,000, as it’s not taxed upfront.

To make the comparison fair, side fund analyses create a taxable side account for the regular 401(k) contributor and fund it with an amount equal to the extra amount needed to fund the Roth 401(k)—in McQuarrie’s example, $15,944. They then compare the after-tax results, and the Roth version wins. McQuarrie illustrates that the supposed superiority of these analyses is flawed because so much depends on analysis assumptions such as the taxpayer’s age and asset allocation.But the more important argument McQuarrie makes for the superiority of the regular 401(k) is the difference between marginal and effective tax rates. Let’s say a taxpayer is in the 28% marginal tax bracket. That is, all or most of that taxpayer’s deferred contributions to a regular 401(k) account would probably have been taxed at that 28% rate if not contributed to the 401(k). That saves the taxpayer money upfront, but of course they have to pay taxes on the contributions and their earnings, when withdrawing funds during retirement. But that person doesn’t pay the 28% tax rate on every withdrawal dollar.

Under our progressive tax system, the first dollars of taxable income are assessed at the lowest tax rate (10%), then the next chunk of income is taxed at the next higher rate, and so on until the last chunk of dollars is taxed at the taxpayer’s highest rate. The result is an effective or average rate for the taxable income that’s lower than the top marginal rate. In McQuarrie’s example, the effective rate is 19.4%, not 28%. Workers using regular 401(k)s are deferring taxes at their marginal rate, but paying taxes at their lower effective rate when they withdraw the money during their retirement years, making them a superior choice for most taxpayers. McQuarrie also demonstrates that, the effective tax rates are likely to remain lower than the marginal rates for most taxpayers even if Congress increases future tax rates, leaving the regular 401(k) still the better choice.

For more information, visit: http://www.quotit.net/ams/pension.htm


Check the difference of: Taxable vs. tax-advantaged saving comparison

401(k)s Are More Important Than Ever

Employees who contribute to their 401(k) plan and who are willing to make small improvements to their saving and investing habits can increase their future income potential, according to a study by Hewitt Associates. When factoring in inflation and increases in medical costs, Hewitt predicts that employees will need to replace, on average, 126% of their final pay at retirement. That is significantly more than the traditional targets of 70% to 90% pay replacement.The Hewitt’s study examined the projected retirement levels of nearly 2 million employees at 72 large U.S. companies using actual employee balances and behaviors. Only 19% will be able to meet 100% of their estimated needs in retirement. On average, employees are projected to replace just 85% of their income in retirement, compared to the 126% they need. In other words, assuming inflation of 3% and a retirement age of 65, an average 40 year old with 10 years of service and earning $83,000 at retirement in today’s dollars would have saved enough to provide just $70,500 per year in retirement in today’s dollars -- a $34,000 annual shortfall. In fact, 67% of employees are expected to have less than 80% of their projected needs at retirement.The scenario is even more serious for employees who do not contribute to their 401(k) plans. Employees who contribute an average of 8% of pay to their 401(k) plan can replace 96% of their preretirement income at age 65, providing about 80% of what is needed to provide the same standard of living during retirement. That number drops to just 54% for employees who do not contribute, which equates to less than 40% of projected needs. Even employees who have a pension plan can expect to replace just 62% of their income at retirement if they do not contribute to their 401(k) plan, compared to 106% for those who do contribute. Recent Hewitt research shows that 26% of employees do not participate in their 401(k) plan, and of those that do, 61% contribute less than 7% a year. Hewitt’s study found that employer-subsidized retiree medical coverage has a dramatic affect on an employee’s ability to achieve adequate retirement savings. The good news is that people can take small actions in several areas and make a big difference. Gradual increases in savings rates, smarter investing, lower fees and delaying retirement can have a significant affect and enable most people to achieve a much more comfortable standard of living once they retire.

For more information, visit http://www.quotit.net/ams/pension.htm