by The Associated Press, NJ.com -- New Jersey will get nearly $8.8 million in federal "performance bonus" money for its efforts to enroll more children in government health insurance programs.
U.S. Health and Human Services Secretary Kathleen Sebelius announced the award on Tuesday.
New Jersey is among 15 states being rewarded for increasing the number of uninsured children enrolled in Medicaid and making it easier for families with eligible children to get coverage.
Type rest of the post here
Friday, December 31, 2010
N.J. to get $8.8M in federal money for child health coverage
Tuesday, December 28, 2010
More small businesses are offering health benefits to workers
By Noam N. Levey, LATimes.com -- Major insurers around the country are reporting that a growing number of small businesses are signing up to give their workers health benefits, a sign of potential progress for the nation's battered healthcare system.
The increase, although not universal, has brought new security to thousands of workers, many of whom did not have insurance or were at risk of losing it.An important selling point has been a tax credit that the nation's new healthcare law provides to companies with fewer than 25 employees and moderate-to-low pay scales to help offset the cost of providing benefits. The tax credit is one of the first few provisions to kick in; much of the law rolls out over the next few years.
"We certainly did not expect to see this in this economy," said Gary Claxton, who oversees an annual survey of employer health plans for the nonprofit Kaiser Family Foundation. "It's surprising."
For insurers, the market presents a big opportunity. Nationally, three-quarters of businesses with 10 to 24 workers offer benefits. About half of those with three to nine employees provide health plans. By comparison, 99% of firms with more than 200 employees offer benefits.
Now some insurers are reporting significant jumps in coverage.
In the six months after the law was signed in March, UnitedHealth Group Inc., the country's largest insurer, added 75,000 new customers who work for companies with fewer than 50 employees. The Minnesota company called the increase notable but declined to reveal further details.
Coventry Health Care Inc., an insurer in Maryland that focuses on small businesses, signed contracts to cover 115,000 new workers in the first nine months of this year, an 8% jump.
In California, Warner Pacific Insurance Services in Westlake Village, a major servicer of insurance brokers, has seen business grow more than 10% this year, a company executive said.
And Blue Cross Blue Shield of Kansas City, the largest insurer in the Kansas City, Mo., area, is reporting a 58% jump in the number of small businesses buying insurance since April, the first full month after the legislation was signed into law.
The independent nonprofit insurer has been particularly aggressive in marketing the new tax credit, which can mean a discount of as much as 35% for very small companies with low payrolls.
"One of the biggest problems in the small-group market is affordability," said Ron Rowe, who oversees small-group sales for the insurer. "We looked at the tax credit and said, 'This is perfect.'"
Rowe said that 38% of the businesses it is signing up had not offered health benefits before.
When the law was signed, the company partnered with H&R Block to create a website for small businesses to calculate how much they can save with the tax credit.
For Bistro Kids, a small business in the Kansas City suburb of Gladstone that serves school meals made with locally grown, organic produce, the deal was too good to pass up.
"We said, 'How could we not do this?'" said Kiersten Firquain, 42, a trained chef who started the company after being appalled by the quality of the food her son was being served at school.
"The whole message of Bistro Kids is doing the right thing," she said as she watched students at Oakhill Day School dig into chili and cornbread made with local beef, cheese and corn. "We wanted to do what was right for our employees, not just for our kids."
Like other small-business owners nationwide, Firquain had been keeping a file of health insurance quotes. But every year, the prices seemed to get more out of reach. "It just wasn't realistic," she said.
Now, Firquain is offering her 10 chefs a standard individual preferred provider organization plan with a $1,000 deductible and $30 co-pays. The employees pay $67 to $212 a month, depending on age and gender.
The company's share, including the tax credit, comes to $434 a month per employee, although that may rise next year as more of Bistro Kids' chefs opt for the health plan. So far, four have signed up for benefits.
It's unclear how many businesses around the country are taking advantage of the new tax credit. National statistics will not be available until next year after 2010 tax returns are analyzed.
Many small businesses don't qualify for the tax credit, which is available to employers that have fewer than 25 full-time positions and pay an average salary of less than $50,000 a year.
And only those with fewer than 10 employees and an average salary of less than $25,000 a year can claim the full 35% credit. Employers with more employees and higher salaries can get a smaller credit.
"I'm not sure the credit is big enough to convince anyone to buy insurance that hasn't already," said Russ Childers, an insurance broker in southern Georgia. Childers said he expected about 10% of the firms he works with to qualify for some tax credit.
For many businesses, even the tax credit may not make insurance affordable at a time when the average premium for an individual health plan is more than $5,000 a year and many insurers are hitting businesses with double-digit rate increases.
That has prompted some critics of the health insurance overhaul, including the National Federation of Independent Business, to dismiss the tax credit.
Some insurers have seen a decrease in small-business sales. But in Kansas City, officials at Blue Cross Blue Shield say the credit is a major selling point.
"I hear some people saying that this tax credit is not a big deal, that most small businesses won't qualify," Rowe said. "Well, I wanted to sell to those that do."
Blue Cross Blue Shield of North Carolina, another independent nonprofit that has aggressively marketed the tax credit, also is expecting a substantial uptick in policies when it tallies its numbers next month, said Drew Narayan, the company's sales director.
Nationwide, the Kaiser survey found that 59% of firms with three to nine employees offered health benefits, up from 46% last year.
"Prices keep going up, but we are seeing insurers trying to be competitive," said Neil Crosby, Warner Pacific's director of sales. "And businesses are buying, so they must see some value."
Breasia Studios, a recording studio in Maryland, is one of those businesses.
After learning about the tax credit from a local activist, studio owner Jamal Lee got a health plan for his four employees for the first time. He said it's already making a difference.
"You get more done when people are happy," said Lee, who opened the studio five years ago. "And it feels good to look at my employees and know that I'm helping to provide something that they really need."
Copyright © 2010, Los Angeles Times
Wednesday, December 22, 2010
Feds fire warning shot to health insurers
by CNN.com/health -- Health insurance companies trying to bump up rates by more than 10 percent will have to answer to federal regulators, according to a new plan announced by Health and Human Services Secretary Kathleen Sebelius Tuesday. The proposed rule explains how the government will oversee insurers as required by the massive health care bill – the Affordable Care Act – that was signed into law this spring.
After 2011, regulators will decide on a state-by-state basis which rates will be reviewed.The process will determine which rate hikes are “unreasonable,” a tricky definition since “a 10 percent increase by a company that’s not had a rate increase in five years and is looking at a narrow profit margin, is not necessarily the same as a company that’s raised rates three years in a row and is looking at fat profits,” Sebelius said. “We decided we would start somewhere and we went with 10 percent, not as a definition of unreasonable, but as a figure that would bring scrutiny.”
As part of the scrutiny, proposals for large rate hikes will be posted online, along with each company’s justification for the increase. A significant number of plans are likely to be affected; according to HHS, hikes greater than 10 percent make up the majority of rate increases in the individual market over the past three years.
The new federal requirement does not replace but adds a layer to various state laws regulating insurers. According to HHS, 43 of 50 states currently review health insurance rates. In states without “an effective process,” HHS will conduct the review, said spokeswoman Jessica Santillo.
While federal regulators won’t have the power to block rate increases, insurers whose rate hikes are deemed “unreasonable” could be barred from insurance “exchanges” – the planned marketplaces where many companies and consumers will purchase coverage plans, starting in 2014.
The online postings will also discourage sharp hikes by making consumers better informed, Sebelius said.
Insurance companies and the public have 60 days to comment on the rules, before the new regulations take effect.
Tuesday, December 21, 2010
N.J. lawmakers approve bill pushing Gov. Christie to submit federal application for family planning services
By Susan K. Livio, NJ.com -- Thousands of working women who lack health insurance would gain access to subsidized family planning services under a bill that won final legislative passage today with some unexpected bipartisan support.
In August, Gov. Chris Christie, a Republican, vetoed an earlier version of this Democrat-sponsored bill, saying he refused to spend money that had not been part of the June budget agreement with the Legislature. But it may have a chance of becoming law this time because the state would not have to spend any money before July 2012, said Sen. Jennifer Beck (R-Monmouth) one of the two Republican senators who voted yes today."The people we are talking about are working women who are looking to plan their pregnancies, and we do have some concern that a lack of access to contraception may lead to unwanted pregnancies," Beck said, who voted yes along with Sen. Diane Allen (R-Burlington). According to the bill, the state would need to put up $1.1 million in order to qualify for $15.1 million from the U.S. Centers for Medicare and Medicaid Services. The money would be used to provide birth control, cervical exams and other family planning services to women earning as much as twice the poverty rate — $29,140 for a family of two — who ordinarily would make too much money to qualify for Medicaid.
Beck said if the federal government accepts the application, the aid would not be available until July 2012. "That’s a long time to wait. I think we need to work with the governor’s office on this issue in the coming budget cycle," she added.
The bill, sponsored by Sen. Loretta Weinberg (D-Bergen) passed, 26-12. Christie spokesman Kevin Roberts said he would not comment on the bill before the governor’s staff reviews it.
Marie Tasy, executive director for New Jersey Right to Life, urged Christie to veto it because so many clinics are operated by Planned Parenthood. She said it would "result in the lucrative expansion and promotion of Planned Parenthood’s abortion business in New Jersey, all to the detriment of women and children’s lives and health, and all paid for by New Jersey taxpayers."
Christie also vetoed a bill to restore $7.4 million in grant shared by 58 clinics, many operated by Planned Parenthood.
© 2010 NJ.com. All rights reserved.
Sunday, December 19, 2010
Double bind on health reform
by Sarah Kliff, Politico.com -- Republican lawmakers on the state level are largely against the new health reform law—but they aren’t against all of the behemoth legislation.
Virginia dominated headlines this week when a federal judge ruled the individual mandate to buy insurance unconstitutional on Monday. Much less noticed: the very next day, a task force appointed by Republican Gov. Bob McDonnell recommended that the state implement a health insurance exchange earlier than federal guidelines require.
“I was pleased with the ruling. I don’t think the government can mandate you have to buy a product,” says Virginia Republican State Sen. Chris Jones. But Jones also sees the value in moving forward on implementation—he sits on the state’s health task force and is adamant Virginia run its own exchange.
“We have to be prudent and plan for implementation as it is before us today,” he tells POLITICO. “It’s the prudent thing we have to do as public servants.”
In Minnesota, outgoing Gov. Tim Pawlenty has repeatedly and vigorously opposed any participation in health reform programs, but one of his own state departments—the Management and Budget Office—is quietly receiving benefits through health reform’s Early Retiree Re-Insurance Program.
And in Alabama, Gov.-elect Robert Bentley, a Republican, said he supports Alabama creating its own health insurance exchange—a key part of the new law. He said this even as his state is party to the 20-state challenge to health reform hearing oral arguments in Florida tomorrow.
The exchanges, which will be web sites similar to Orbitz or Expedia where people can buy insurance, emphasize the GOP-friendly concepts of consumer choice and competition. Republicans are embracing them quietly even as they loudly fight other aspects of the law in federal court.
“Obviously the governors and attorney generals involved with these lawsuits are responding to the politics of this and pursuing a legislative course of action,” says Timothy Jost, a law professor at Washington and Lee University. “My experience with the state officials who are in fact implementing this is that they are civil servants in the best sense of the word. They’re government officials who understand this is the law of the land, and they do the best they can with their state.”
Republicans trumpeted the federal court ruling that struck down health reform on Monday. The judge declared the individual mandate—which requires the purchase of government-approved insurance—unconstitutional. In the closely watched suit brought by Virginia Attorney General Ken Cuccinelli, District Judge Henry Hudson found that the mandate “exceeds the constitutional boundaries of congressional power.”
"The individual mandate at the heart of Obamacare puts the federal government in the business of forcing you to buy health insurance and taxing you if you don't. This is unwise, unaffordable, and as we have argued all along, unconstitutional," said Speaker-elect John Boehner.
But at the state level, the picture looks markedly different. In Boehner’s home state of Ohio, for instance, a health reform stakeholders forum has been meeting for months now and implementation is well underway. And all states, regardless of their politics, have accepted some form of Affordable Care Act grants, according to HealthCare.gov. Thirty-three states have taken either legislative or executive action to implement health reform, according to the National Association of State Legislatures.
“For many conservative states, there’s an anxiety that if they don’t do something it will be implemented for them by the federal government, and they’re not comfortable with that,” says Melissa Boudreault, director of Dell’s State Health Services division. Boudreault has spent months now consulting with states on reform implementation. “When we have conversations with them, they want to make this politically palatable. At the end of the day, it comes down to them saying ‘I think we’d rather control our own destiny.’”
The Obama administration expects the majority of states to participate in one of the most crucial health reform programs: the state-based health exchanges, where individuals and small groups can purchase coverage beginning in 2014. Forty-eight states applied for, and received, $1 million exchange planning grants in August. Of the two states did not apply, one will change course: Minnesota governor-elect Mark Dayton has indicated he would pursue the grant opportunity that predecessor Tim Pawlenty declined.
“We’re currently working with 48 of the 50 states who are all engaging in the process of figuring out where they want to go on exchanges,” Joel Ario, who oversees health exchanges for HHS’ Office of Consumer Information and Insurance Oversight, said on a Tuesday conference call for National Conference of State Legislators.
For their part, Republican governors walk a tightrope between preparing for the implementation of health reform while also rallying against it.
Perhaps the most striking contrast between court challenges and state implementation is in Virginia, where McDonnell has walked a tightrope, opposing health reform one day then implementing it the next.
McDonnell has been an outspoken critic of the health reform law. The day after the federal health reform law passed, he signed the Virginia Healthcare Freedom Act, the first of many state laws prohibiting the mandated purchase of health insurance. The law laid the groundwork for Cuccinelli’s legal challenge.
McDonnell came out strongly in support of the Monday Court ruling. “This decision sets the correct limits on federal power in favor of individual liberty, and supports the critical tenants of federalism enshrined in the U.S. Constitution,” the governor said in a Monday statement.
But at the same time, McDonnell has more quietly gone about the business of implementing health reform. In August he appointed a task force to the Virginia Health Reform Initaitive, which would oversee the work of implementing the federal law.
"Every Virginian needs access to affordable health care. The challenge is how to provide that access in an economically responsible manner,” McDonnell said in an August statement appointing the task force. “The make-up of these taskforces includes a wide array of expertise and opinions from across the Commonwealth. The taskforces are comprised of individuals who recognize the need for Virginia to lead the nation by establishing a responsible model for health reform and will work to the success of this initiative, both professionally and personally."
That taskforce came out Tuesday with an 85-page report advocating that the state move quickly to implement the Affordable Care Act.
“Since so many recommendations hold promise to improve quality, lower cost, or make insurance and care more affordable and accessible, opportunities for ‘early adoption’ should be prudently explored and acted upon,” the task force wrote.
© 2010 Capitol News Company, LLC
Tuesday, December 14, 2010
Judge Voids Key Element of Obama Health Care Law
By Kevin Sack, NYTimes.com -- A federal judge in Virginia ruled on Monday that the keystone provision in the Obama health care law is unconstitutional, becoming the first judge to invalidate any part of the sprawling act and ensuring that appellate courts will receive contradictory opinions from below.
The judge, Henry E. Hudson of Federal District Court in Richmond, said the law’s requirement that most Americans obtain insurance exceeded the regulatory authority granted to Congress under the Commerce Clause. Judge Hudson, who was appointed by President George W. Bush, declined the plaintiff’s request to suspend the act’s implementation pending appeal, meaning there should be no immediate effect on its rollout.
But the ruling seemed likely to create confusion among the public and to further destabilize political support for a law that is under fierce attack from Republicans in Congress and in many statehouses. Party leaders, including the incoming House speaker, Representative John A. Boehner of Ohio, quickly used the opinion to reiterate their call for repealing the law.
In a 42-page opinion, Judge Hudson wrote: “Neither the Supreme Court nor any federal circuit court of appeals has extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market.”
Allowing Congress to exert such authority, he said, “would invite unbridled exercise of federal police powers.”
Compelling vehicle owners to carry accident insurance, as states do, is considered a different matter because the Constitution gives the states broad police powers that have been interpreted to encompass that. Furthermore, there is no statutory requirement that people possess cars, only a requirement that they have insurance as a condition of doing so. By contrast, the plaintiffs in the health care case argue that the new law requires people to obtain health insurance simply because they exist.
The insurance mandate is central to the law’s mission of covering more than 30 million people who are uninsured. Insurers argue that only by requiring healthy people to have policies can they afford to pay for those with expensive conditions. But Judge Hudson ruled that many of the law’s other provisions could be severed legally and would survive even if the mandate is invalidated.
Judge Hudson is the third district court judge to reach a determination on the merits in one of the two dozen lawsuits challenging the health care law. The other judges, in Detroit and Lynchburg, Va., have upheld the law. Lawyers say the appellate process could last another two years before the Supreme Court settles the dispute.
The opinion by Judge Hudson, who has a long history in Republican politics in Northern Virginia, continued a partisan pattern in the health care cases. Thus far, judges appointed by Republican presidents have ruled consistently against the Obama administration, while Democratic appointees have found for it.
That has reinforced the notion — fueled by the White House — that the lawsuits are as much a political assault as a constitutional one. The Richmond case was filed by Virginia’s attorney general, Kenneth T. Cuccinelli II, a Republican, and all but one of the 20 attorneys general and governors who filed a similar case in Pensacola, Fla., are Republicans.
The two cases previously decided by district courts are already before the midlevel courts of appeal, with the Detroit case in the Sixth Circuit in Cincinnati and the Lynchburg case in the Fourth Circuit in Richmond.
The Justice Department, which is defending the statute, is considering whether to appeal Judge Hudson’s ruling to the Fourth Circuit, which hears cases from Virginia and four other states. That would leave that court to consider opposite rulings handed down over two weeks in courthouses situated only 116 miles apart.
Administration officials emphasized that Judge Hudson’s opinion was just one among several and said they were pleased he had not stopped the law from going into effect.
“We are disappointed in today’s ruling,” said Tracy Schmaler, a Justice Department spokeswoman, “but continue to believe — as other federal courts in Virginia and Michigan have found — that the Affordable Care Act is constitutional.”
Ms. Schmaler added, “We are confident that we will ultimately prevail.”
The administration acknowledges that if the insurance requirement falls before taking effect in 2014, related changes would necessarily collapse with it, most notably provisions that would prevent insurers from denying coverage to those with pre-existing conditions or charging them discriminatory rates.
But officials said other innovations, including a vast expansion of Medicaid eligibility and the sale of subsidized insurance policies through state-based exchanges, would withstand even a Supreme Court ruling against the insurance mandate.
Some state officials said Monday’s ruling would reinforce calls by many Republican governors and lawmakers to slow down its implementation. “I think you might see some air taken out of the balloon nationwide,” said Jason A. Helgerson, the Medicaid director in Wisconsin, where Republicans are about to take control of both the executive and legislative branches.
Judge Hudson, who was previously best known for sentencing the N.F.L. quarterback Michael Vick to 23 months for his involvement in a dog fighting ring, had telegraphed his leanings in a series of hearings and preliminary opinions. But the ruling was nonetheless striking given that only nine months ago, prominent law professors were dismissing the constitutional claims as just north of frivolous.
The case centers on whether Congress can use its powers under the Commerce Clause to compel citizens to buy a commercial product — namely health insurance — for the purpose of regulating an interstate economic market. Absent that authority, the administration argued, Congress could use the taxation powers granted by the Constitution to justify the insurance requirement, because the fine for not obtaining coverage will be assessed as an income tax penalty.
While commending Congress’s “laudable intentions,” Judge Hudson shot down both arguments.
“At its core,” he wrote, “this dispute is not simply about regulating the business of insurance — or crafting a scheme of universal health insurance coverage — it’s about an individual’s right to choose to participate.”
The ruling is a political score for Mr. Cuccinelli, who filed the lawsuit on his own rather than joining the Pensacola case. It upstages a major hearing in Florida scheduled for Thursday.
“This case is not about health insurance, it is not about health care,” Mr. Cuccinelli said at a news conference in Richmond. “It is about liberty.”
Mr. Cuccinelli, who was elected in 2009, said he had filed on his own because Virginia passed a law this year aimed at nullifying the federal insurance requirement, giving the commonwealth a distinct constitutional claim. Others attribute the strategy to political ambition, suggesting that Mr. Cuccinelli did not want to share the spotlight and knew he could exploit the accelerated pace of judging in Richmond’s so-called “rocket docket” to raise his profile.
Mr. Cuccinelli filed the lawsuit minutes after President Obama signed the law on March 23 and has been discussing the case on cable television ever since. By late afternoon Monday, he had already posted campaign fund-raising advertisements online that cited his victory.
Even before Monday’s ruling, Mr. Cuccinelli and Gov. Bob McDonnell of Virginia, also a Republican, were seeking an agreement with the Justice Department to bypass the United States Circuit Court of Appeals and file for expedited review by the Supreme Court. That would have the effect of further marginalizing the Pensacola case. The Supreme Court rarely takes such requests, and the Justice Department has not publicly expressed an opinion.
Tuesday, November 30, 2010
Practical Matters: Time to evaluate Medicare Advantage plans
By Tammy Worth, Special to the Los Angeles Times -- Two years ago, Ruth Collins found herself in a quandary. The primary-care doctor she'd been seeing for 17 years was not covered by her Medicare Advantage plan, a private Medicare plan. Instead, her health insurer tried to send her to other physicians and the insurers wouldn't accept some charges by the provider. Luckily, there were other options for Collins. She switched to a different Medicare Advantage plan and can now see her doctor in San Bernardino, where she lives. She's happy with the change and has decided to stick with the same plan next year.
Happy or not, Medicare Advantage enrollees should make a habit of evaluating their options each year. Though experts say that beneficiaries won't be seeing a lot of changes this time — and what changes there are will mostly be for the better — it is a good idea for people to go through this annual drill before enrollment ends Dec. 31, just to make sure their plan choice remains a good one.
Private health plans have been available in Medicare since the 1970s. Their popularity has grown in recent years, more than doubling nationwide (from 5.3 million to 11.1 million) between 2005 and 2010, according to the Kaiser Family Foundation, a nonprofit health policy organization. In California, approximately 35% of Medicare enrollees are in these plans.
These so-called Medicare Advantage plans provide benefits through insurance companies. They offer preferred provider organizations, health maintenance organizations and private, fee-for-service options. The plans are funded by Medicare and enrollees pay small premiums, averaging about $50 per month. They're preferred by many because they often are more robust than original Medicare, offering features such as coverage for dental and eye care.
Medicare Advantage has garnered a lot of media attention this year, much of it negative, because of rising premiums as well as insurance companies that allegedly misled consumers about providers that enrollees can access in their networks and medications that are covered in the plans.
And in October, Kaiser estimated that, nationwide, 13% of all Medicare Advantage plans would be leaving the market, leaving fewer options for enrollees. There are two reasons for this, says Cheryl Matheis, director of state affairs for AARP. The first is just business: Insurers drop from the market all the time. The second are rules that the Center for Medicare & Medicaid Services has created to make sure that all plans have an adequate number of physicians for enrollees. Those that didn't were discontinued.
Consider your needs
Despite bad press and shrinking options, consumers should consider their own situation when deciding whether to stay in, or enroll in, a new Medicare Advantage plan, said Peter Ashkenaz, a spokesperson for the Centers for Medicare & Medicaid Services: For some people, they can be a good deal. "Each beneficiary needs to look at their own options," Ashkenaz says. "What they are going to find … is that there is still going to be a wide range of plans."
Will that remain the case? Beginning in 2012, Medicare will begin lowering payment to Medicare Advantage providers to even the playing field between original Medicare and Advantage plans. But plans generally aren't leaving because of healthcare reform, experts say. The Centers for Medicare & Medicaid Services is offering bonuses to plans that perform well, which should soften the cuts and keep good providers in the marketplace.
Some facts and deadlines you should be aware of:
Anyone enrolled in plans that are terminating should have received notice by mail by Oct. 1. If these beneficiaries don't enroll in another plan, they will be automatically switched to original Medicare.
Beneficiaries who want to drop a Medicare Advantage plan and move to original Medicare have an extended time to do so — from Jan. 1 through Feb. 14. But there's a potential problem: Original Medicare doesn't offer drug coverage. There is no guarantee someone would be able to pick up Part D (drug coverage for Medicare) if they drop their Medicare Advantage plans, Matheis cautions.
All plans must begin covering preventive services at 100% in 2011. Many Medicare Advantage plans already do this, but there should be no deductible (meaning the portion of charges not covered by the insurance company) for enrollees getting services such as mammograms or physicals.
Changes to plans
Out-of-pocket maximums will be added next year, another protection for enrollees. Beneficiaries will not have to pay more than $6,700 on health expenses over the course of the year, says Elaine Wong Eakin, executive director of California Health Advocates, a nonprofit Medicare Advocacy organization.
Need help finding the right Medicare Advantage plan? In Collins' case, she found a plan that fit her needs by working with her physician's office, which has specialists who assist people in choosing and enrolling in Medicare Advantage programs. Though most doctors' offices don't provide this kind of service, there are a number of other ways to get help.
The first place to go is to the Centers for Medicare & Medicaid Services' website: Use a plan-finder tool you'll find there to help narrow options (www.medicare.gov/find-a-plan/questions/home.aspx). Ashkenaz says people shouldn't base their decision strictly on the premiums they will have to pay, but on their overall healthcare needs.
Hovannes Daniels, director of senior business for Blue Shield of California, says there are five things people should consider when looking for a plan.
First, make sure your doctor is in the provider network. Second, make sure the hospitals that are covered are ones that are convenient. Third, make sure your prescriptions are covered under the plan, especially if you take sustaining drugs for a chronic disease. Fourth, consider what your out-of-pocket costs will be. And fifth, go with a trusted insurance provider — one that has been in the market for a long time or that comes well recommended.
In addition to the Centers for Medicare & Medicaid Services site, insurers such as Blue Shield offer seminars on selecting a plan. Find out more by contacting the insurance company.
Those who don't have Internet access or a family member who can assist them can call organizations such as California Health Advocates (800) 434-0222, which provide Medicare counselors. Another resource is Health Assistance Partnership, a Washington, D.C.-based organization that works with state health programs on Medicare education. It can be reached at (202) 737-6340.
Finally, to underscore: Even if you intend to make no changes in your Medicare Advantage plan, Wong Eakin said it's good practice to reexamine your options each year — because plans can be tweaked annually, including changes to premiums, drug benefits or providers included in the network.
health@latimes.com
Copyright © 2010, Los Angeles Times
Changes in Medicare for 2011
by Irene Card, NorthJersey.com -- Our first concern is always the premium. We do not pay a premium for Part A but we do pay for Part B. Part B covers our medical expenses, laboratory, durable medical equipment, etc. If you sign up for Part B in 2011, your premium will be $ 115.40 monthly and it will be deducted from your Social Security check.
The premium is based on income and this premium is for people whose income is equal to or less than $85,000 if single and $170,000 if married.
If you are single and your modified adjusted gross income is greater than $85,000 and less than or equal to $107,000, your premium will be $161.50 and if married, it will be $161.50 per month, per person, if your income is greater than $170,000 and less than or equal to $214,000.
The premiums continue to increase based on your income and if your income is higher than what I quoted, you are welcome to call me for the exact number. Remember, this only applies to people signing up for Part B in 2011.
The "hold harmless" provision of federal law does not allow our Part B premium to increase more than that year's cost of living increase to your social security benefit. Inasmuch as there has been no increase in Social Security retirement income checks and there will be no increase in 2011, our premium remains the same as what you are paying in 2010.
For folks who were new to Medicare Part B in 2010, their premium will remain at $110.50 per month. The 2011 increase amounts to $4.90 per month.
Part A Medicare pays the hospital bill – all but the $1,100 deductible in 2010. In 2011, the in-hospital deductible will be $1,132. If you are out of the hospital for two months or more, you have to meet the deductible again, the next time you are admitted.
The deductible for Part B (medical expenses) is going up from $155 to $162 per calendar year. Depending on which Medicare supplement policy you have chosen, these deductibles will be covered in full. Some of you still have a group insurance policy from your former employer as secondary to Medicare and, depending on the coverage, they may pay a percentage of the $162 or all of it.
Part D (Medicare Prescription Drug Plan) premiums vary widely with so many companies selling Part D in New Jersey. You will find a list of the companies in the back of Medicare and You, 2011.
If you are on Medicare, you automatically receive a copy of this booklet every year from the Center for Medicare and Medicaid Services.
You can also go online to Medicare.gov for help with determining which Part D plan will be best for you. You can only change your plan once a year, during open enrollment, which is right now.
Open enrollment goes from Nov. 15 to Dec. 31 and the change becomes effective the first of January. Then you are locked in to whichever plan you chose for the entire year.
Irene Card and Betsy Chandler are both licensed insurance professionals working at MIC Insurance Services, a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call 973-492-2828.
Saturday, November 27, 2010
Administration Unveils MLR Rules
Politico (11/23, Haberkorn) reports, The Obama administration on Monday outlined rules to restrict health insurers' spending beginning next year, a key provision of the health care overhaul that aims to improve value for consumers. These "rules will have vast implications for how insurance companies spend money as well as for other aspects of the health care industry. President Barack Obama, in an email released Monday, said the rules 'will make our health care marketplace more transparent and ensure you get the best value for your premium dollars. And it is just one of the many parts of the Affordable Care Act that are already making our health care system stronger.' Meanwhile, HHS Secretary Kathleen Sebelius "on Monday said insurers' administrative costs, marketing and 'in some cases, rising salaries and bonuses' have grown far too much in recent years."
The AP (11/23, Alonso-Zaldivar, Murphy) reports, "The regulation unveiled by the Health and Human Services department calls for insurance companies to spend at least 80 cents of the premium dollar on medical care and quality. For employer plans covering more than 50 people, the requirement is 85 cents," and "insurers that fall short of the mark will have to issue their customers a rebate." Notably, "administration officials said it will prevent insurers from wasting valuable premiums on administration, marketing and executive bonuses. 'While some level of administrative cost is certainly necessary, we believe that they have gotten out of hand,' said...Sebelius."
The Washington Post (11/23, Goldstein) reports, "The Obama administration issued rules on Monday defining a promise to consumers in the new federal health-care law that insurers will spend at least $4 out of $5 they collect in premiums on medical services and other efforts to improve patients' health." These "rules say that, starting in January, insurers must reveal far more information than required in the past about how they allot their money." Sebelius said that they will "guarantee that consumers get the most out of their premium dollars."
The New York Times (11/23, A22, Pear) says that the regulations "will require many health insurance companies to spend more on medical care and allocate less to profits, executive compensation, marketing and overhead expenses." Notably, the "rules, intended to benefit consumers, vastly expand federal authority to direct the use of premiums collected by companies like Aetna, Humana, UnitedHealth and WellPoint. While some states have had such requirements, Monday's announcement is the first such mandate by the federal government and grows out of the new national health care law." Sebelius pointed out that because of the rules, "Millions of Americans will get better value for their health insurance premium dollar."
McClatchy /Kaiser Health News (11/23, Appleby) reports, "Millions of Americans might be eligible for rebates starting in 2012 under regulations released Monday, which detail the health care law's requirement that insurers spend at least 80 percent of their revenues on direct medical care." These "regulations closely follow recommendations that the National Association of Insurance Commissioners sent to the Department of Health and Human Services this fall after months of meetings and debate involving industry and consumer representatives." In response to the new rule, "insurers, who'd objected strongly to the recommendations in October, toned down their criticism Monday, saying the new rules 'take a first step' toward minimizing market disruption for plans sold to individuals," although "it remains possible that the rules could affect employer-offered coverage, America's Health Insurance Plans said in a statement."
Monday, November 22, 2010
New law's health insurance regulations could mean rebates for consumers
By Julie Appleby, Kaiser Health News (LATimes.com) -- Millions of Americans might be eligible for rebates starting in 2012 under regulations released Monday detailing the health care law?s requirement that insurers spend at least 80 percent of their revenue on direct medical care. Insurance plans covering more than 50 people must spend at least 85 cents of every dollar on care.
The regulations closely follow recommendations sent to the U.S. Department of Health and Human Services by the National Association of Insurance Commissioners (NAIC) after months of meetings and debate involving industry and consumer representatives.The government estimates that 45 percent of people who buy their own coverage are in plans that currently don?t meet the standard. If the law were in effect now, about 9 million would get rebates, either directly, if they buy their own coverage, or through their employers if they are in job-based coverage.
"This will guarantee that consumers will get the most out of their premium dollars," HHS Secretary Kathleen Sebelius said at a news conference Monday.
There are some exemptions:
-- Employers and insurers that offer "mini-med" policies, which often cap coverage or have limited payouts, will be given at least an extra year to gather data before falling under the requirement. -- States may apply to have the requirement adjusted if meeting the 80 percent spending require would destabilize their individual market, Sebelius said. Four states ? Maine, Iowa, South Carolina and Georgia ? have already said they would seek adjustments.
-- Some small plans will not have to provide rebates, at least for the first year.
During the debate leading to the NAIC?s recommendations, insurers pushed for the broadest possible definition of what constitutes medical spending, including the cost of paying claims, signing up doctors to their networks or running customer service call centers. The final recommendations are narrower, which is what consumer groups had urged.
The regulations allow, for example, insurers to include many quality improvement costs, along with payments to doctors, nurses, hospitals and other providers in their medical expense calculations but not the cost of broker commissions. Consumer advocates were pleased.
?Few Americans understand how much of what they spend on health insurance goes to administration,? said NAIC consumer representative Timothy Jost, a law professor at Washington and Lee University School of Law.
Currently, he said, insurers covering 20 percent of Americans spend about 30 percent of their revenue on administrative costs, a percentage that will result in rebates unless they reduce those costs.
When the NAIC sent recommendations to Sebelius in October, insurers objected. The recommendations, would "reduce competition, disrupt coverage and threaten patients? access to health plans? quality improvement services," America?s Health Insurance Plans president and CEO Karen Ignagni said in a statement in October.
Kaiser Health News is an editorially independent news service and a program of the Kaiser Family Foundation, a nonpartisan healthcare policy research organization. Neither Kaiser Health News nor the foundation is affiliated with Kaiser Permanente.
Companies urging employee health assessments
By Barbara Williams, The Record -- Do you smoke? Exercise? How many servings of vegetables do you eat each day? How many alcoholic drinks do you have in a week?
These are just a few of the questions found on health risk assessments that a growing number of North Jersey employers are asking workers to fill out if they want to be covered by the company health plan.
Some companies are offering financial incentives to those answering the queries. Others are raising the premiums for those employees who do not respond."We're seeing employers offering gift cards, raffles to win an iPhone, or lowering the premiums," said Michael McGuire, chief operating officer of UnitedHealthcare of New Jersey. "About 75 percent of the companies are offering incentives and about 25 percent are charging employees for not filling them out."
Health assessments are just one tool in the expanding effort to contain health costs. They help companies target what their employees need to become healthier — such as wellness programs that may include weight-loss coaching, health club discounts or yoga classes.
"For a lot of employers, a health assessment is the first step," said Christine Stearns, vice president of health and legal affairs at the New Jersey Business and Industry Association. "After they get those results, they know what they're dealing with in their population and what type of wellness programs they might want to implement."
Employers often have a financial incentive for getting workers to fill out the questionnaires: Health insurers like Cigna and AmeriHealth will lower a corporation's premiums if a certain percentage of employees fill out assessments or participate in wellness programs. By helping companies target their wellness programs, health insurers believe they will save on medical costs in the long run.
A nationwide trend
Those incentives have helped health assessments become a trend nationwide, experts said. According to the Society for Human Resource Management, the number of companies nationally that asked employees to fill out health questionnaires rose from 53 percent in 2006 to 73 percent in 2009.
SGS North America, a national testing and quality inspection company with headquarters in Rutherford, offers $150 to each employee and spouse who complete health assessments and have biometric screenings, which include tests for cholesterol, blood pressure, blood glucose levels, and a measurement of height, weight and body mass index.
"We want healthy employees and families," said Glenn Hasbrouck, benefits director of SGS.
"Employees find out about health problems and then take care of them," Hasbrouck said. "This results in reduced absenteeism, reduced days when people come to work sick and employees who are happier and more productive in their jobs. In the long run, it reduces disability and medical claims."
The questionnaires are tabulated by the health insurance companies or a third party. The employers are not given the results for individual employees, but do receive information such as: "50 percent of your employees smoke" or "35 percent have high cholesterol."
Some employees question the legality of asking probing health questions — and wonder whether the information will be used against them.
Marshall McKnight, a spokesman for the state Department of Insurance, said employees have some protections. "The law doesn't allow carriers to identify individuals," he said. "A company can't adjust premiums based on a health assessment."
Wellness discounts
This is true, but privacy laws change when a company offers wellness programs, said David Ritson, a management and labor attorney with the Hackensack firm Herten, Burstein, Sheridan, Cevasco, Bottinelli, Litt, Harz LLC.
"For example, if a company has a wellness program to lower cholesterol, then the employer can give a discount for employees that have a cholesterol count below a certain level or charge a higher premium if it's above," Ritson said. "Companies can't discriminate based on questions on a health assessment but they can once a wellness program is involved. The higher premium can be as much as 20 percent of the total cost of coverage, and that amount goes to 30 percent in 2014."
Federal regulations require that if an employee, due to a medical condition, can't meet the wellness program goal he is still entitled to the discount just for participating. This includes smokers who attend smoking cessation classes but still can't kick the habit.
Still, some worry that employers having access to an individual's medical information in any form may ultimately be bad for workers. "The motive for health assessments is good," said David Knowlton, president of the New Jersey Healthcare Quality Institute, a non-profit health care quality policy group. "But people are hired at-will and can be fired at-will, which means a company can tell a smoker to stop smoking or a heavy person to lose weight and if they don't, they can be fired as long as they are not being discriminated against for age, sex, race and religion. But there's no category for being fat — a number of people have tried to sue and consistently lost."
Legal deterrents
Labor law experts said that although the federal laws do have loopholes that employers could potentially use to terminate workers, few would actually try it because the action would most likely result in a lengthy legal battle.
"Employers aren't supposed to vary medical benefits premiums or terminate employees based on health status, but theoretically, it's possible," said Christina Ho, assistant professor of law at Rutgers Law School in Newark. "But there would be a lot of legal risks if they did so."
Despite the concerns, health assessments can help both employers and their workers financially.
"Money spent on preventive care is peanuts compared to hospital costs," Stearns said. "Obesity alone can lead to so many complications.
AmeriHealth, an insurance carrier in Mount Laurel, encourages employers to provide wellness programs and offers companies a 1 percent premium discount if employees fill out health assessments.
"We're hearing strong, positive anecdotal evidence now regarding wellness programs and the evidence is clear that investing money, time and energy in these programs yields a positive result," said Paul Portsmore, AmeriHealth vice president of health services.
Cigna also offers discounts, ranging from 2 percent to 7 percent, to employers for implementing health assessments and a higher discount when employees go for biometric screening.
"About 35 percent of the companies in my area take advantage of the discounts and more and more are interested in wellness programs," said Jeff Berardo, a Cigna regional vice-president.
Another method
Some companies are tackling health care costs without using assessments. Hunter Douglas, a national window treatment company with an office in Upper Saddle River, provides a number of wellness programs and an annual health fair. The company offers lunch-and-learn programs on breast cancer and other diseases, walkathons and access to a fitness center.
"We have considered a health assessment, but you have to ask a lot of personal questions and it's not simple to implement," said Mindy Fabrikant, vice president of human resources. "Our programs are working. Our employees are enthusiastic and we have maximum participation. At this time there doesn't appear to be a need for health assessments."
E-mail: williamsb@northjersey.com
Sunday, November 14, 2010
Employers ready to raise the stakes for health incentives
by Lisa Zamosky, LATimes.com -- Your employer wants you to stop smoking and lose some weight. And the boss is willing to sweeten the pot if you succeed. There's a new twist to corporate wellness programs: Increasingly, employers want to see concrete results before they reward you with premium breaks on your health benefits or with cash and gift cards.
In a September survey of 466 large to midsize employers by the professional services company Towers Watson, 65% of respondents said that for 2011 they'll increase incentives to take part in these programs. And 62% said that by 2012, instead of offering employees incentives to participate in wellness programs like in years past, they'll only pay up after they see demonstrated action and results.Perhaps it'll be agreeing to work with a health coach to better manage your high blood pressure. It could be enrolling in a weight management program or seeing decreases in cholesterol levels or blood pressure over time because of your efforts.
The expectation is that by knowing there are rewards for action and results, employees will find it more attractive to engage in healthier behaviors — and the company's healthcare and productivity costs will decline as a result.
"Employers see unhealthy lifestyle as the biggest barrier to providing affordable healthcare coverage," says LuAnn Heinen, vice president of the National Business Group on Health, a nonprofit association of large U.S. employers. That perception seems justified. A study by Duke University published in October's Journal of Occupational and Environmental Medicine found that annual U.S. employee health and productivity costs associated with obesity alone are an estimated $73.1 billion. And there's no sign of that expense decreasing.
Wellness programs have, so far, mostly brought employers only modest cost savings, if that. A historically low level of employee participation is the main reason experts cite. "You launch programs, and 10% or 15% of the eligible population participates. If you get to 20%, you're doing really well," Heinen says.
Yet despite the less-than-robust returns, employers are redoubling their efforts for the upcoming year. "Even with the economy, there isn't a slowdown in these programs," says Sheri Pruitt, director of Behavioral Science Integration at the Permanente Medical Group Inc., a division of Kaiser Permanente in Roseville, Calif.
A number of factors are driving this. One is the fact that businesses with higher levels of participation in their wellness programs do achieve cost savings. "Some companies have gotten there, and it has had a payoff," says Mike Thompson of PricewaterhouseCoopers' Health and Welfare Practice.
Another is that health reform has placed an emphasis on wellness and prevention. Starting next year, small companies can receive grants if they begin wellness programs that target smoking cessation, nutrition, physical fitness and stress management. And by 2014, employers can increase employee incentives for participating in a wellness program from the current 20% to 30% of the total premium. This has encouraged some businesses to jump into the game or refine existing programs.
The types of activities and incentives employees will see are likely to expand next year. "But you'll have to do more to get them," Heinen says. "It's about doing something, rather than just taking a questionnaire."
For example: If last year you received a gift card or money for completing a health risk assessment (an evaluation of your health risks and the lifestyle activities that contribute to them), this year your employer may offer you incentives to join a program (for diabetes management, say). And, increasingly, employers will require you to achieve the outcomes intended by the programs.
A 2010 annual survey of 507 employers by Towers Watson and the National Business Group on Health found that 42% of large firms will require employees to complete health coaching or a disease management program in order to earn a financial incentive in 2011. And 17% said they either had in place or were considering plans in which employees would have to maintain a healthy body mass index (BMI), normal blood pressure or cholesterol levels, or show improvement toward those goals to earn their reward.
In addition, 40% of employers said that in 2011 they are offering incentives for so-called biometric screening, in which blood pressure, blood sugar, cholesterol and other health parameters are checked.
Increasingly, employers are tying not only health insurance premiums but also benefits packages to their wellness initiatives. Many are offering two levels of benefits. Employees who engage in and sustain good health or are willing to take actions to improve their health may enjoy lower health insurance premiums and have access to a more robust package with fewer out-of-pocket expenses in the form of lower copayments and deductibles.
With all of this nudging to get workers to take better care of themselves, employers are quite aware of the fine line they walk between offering support for healthy choices and making inappropriate demands, experts say. Wellness programs don't work if people think their employer is trying to get them to do things they don't want to do.
"I've seen extreme concern and fear over issues around discrimination when you start doing things like rewarding for certain amounts of weight loss or biometric screens," says Josh Klapow, chief behavioral scientist at Birmingham, Ala.-based ChipRewards Inc., which develops health incentive programs.
But will this new focus on results actually make employees more healthy? Some experts have their doubts. Pruitt, for one, thinks that rewarding people for an outcome without reinforcing all the steps needed to get there isn't likely to be effective. "There is a real lack of understanding among very smart people that there is a science of human behavior," she says.
Klapow agrees that by shifting rewards from participation to outcomes, employers are making a huge assumption that people will be able to figure out and engage in all of the behaviors that lead to the desired outcome. He argues that a successful program would reward people for every necessary step along the way to a goal.
His prescription for a stop- smoking program, for example: "Give points for enrolling, points for every time you participate in class, points for graduating, points for reporting nicotine-free," he says. Sure, give the most points for passing a nicotine breathalyzer — but don't save all rewards for just the breathalyzer.
All agree that figuring out the best way to motivate employees to get healthy and thereby cut costs is going to take time — and trial and error. "I think this is an evolutionary process, and some companies are more mature in that process than others," Thompson says.
health@latimes.com
Copyright © 2010, Los Angeles Times
Friday, November 12, 2010
Health-Care Tax Relief for the Self-Employed
This year a new law will let solo business owners fully deduct health insurance premiums for the first time. Here's how it works. By Karen E. Klein, Businessweek.com
I heard that I can deduct my health insurance costs because I run my own business. Is this part of the health-care reform bill? How does it work? —P.J., Pasadena, Calif.
If you are self-employed and your business is a sole proprietorship, single-member LLC, or sole-owner S-corp, you can indeed deduct your health insurance expenses for 2010. This one-year provision is not a part of the health-care reform bill that passed in March, however. It was included in the Small Business Jobs and Credit Act that President Barack Obama signed into law just last month."In this economic climate, any kind of bottom line tax savings is helpful," says Kristie Arslan, executive director of the National Association for the Self-Employed, a Washington-based lobbying group. "This is one of the few small business provisions that's been passed where business owners will actually see lower taxes on Apr. 15, 2011."
Her organization has championed the deduction for more than eight years and unsuccessfully tried to get it included in the health-care reform law.
The new provision corrects what Arslan calls a fundamental unfairness: Self-employed individuals cannot deduct the full cost of health insurance premiums as a business expense on their payroll taxes, as other business entities can do.
Although the new law authorizes the deduction only for 2010, Arslan says it's "a foot in the door" for self-employed individuals, who pay both the employer and employee portions of the payroll tax—a self-employment tax totaling 15.3 percent. Employees typically pay half that amount (7.65 percent) and their employers cover the other half as part of their payroll taxes. The new deduction exempts solo business owners from paying self-employment tax on the portion of their income that they spend on health premiums. "This is a step in the right direction. We're hoping to extend it and make it permanent," Arslan says.
Make sure to ask your tax preparer about taking the deduction when you file your tax returns next year. In order to take advantage of it, you must buy your own insurance (rather than relying on a spouse's coverage or being uninsured) and you must pay self-employment tax on business income (rather than declaring a business loss). The deduction phases out above a $106,800 annual income limit. The provision is specifically geared for those who file a 1040 Schedule C business income tax form or a Schedule E earned income tax form, Arslan says.
Another important caveat: The new deduction does not apply to health insurance coverage that you may provide for any employees you have. There is a small business health-care tax credit, part of the health-care reform legislation, that you may be able to claim for that expense. More information on that tax credit is available at the IRS website.
Karen E. Klein is a Los Angeles-based writer who covers entrepreneurship and small-business issues.
If you are self-employed and your business is a sole proprietorship, single-member LLC, or sole-owner S-corp, you can indeed deduct your health insurance expenses for 2010. This one-year provision is not a part of the health-care reform bill that passed in March, however. It was included in the Small Business Jobs and Credit Act that President Barack Obama signed into law just last month."In this economic climate, any kind of bottom line tax savings is helpful," says Kristie Arslan, executive director of the National Association for the Self-Employed, a Washington-based lobbying group. "This is one of the few small business provisions that's been passed where business owners will actually see lower taxes on Apr. 15, 2011."
Her organization has championed the deduction for more than eight years and unsuccessfully tried to get it included in the health-care reform law.
The new provision corrects what Arslan calls a fundamental unfairness: Self-employed individuals cannot deduct the full cost of health insurance premiums as a business expense on their payroll taxes, as other business entities can do.
Although the new law authorizes the deduction only for 2010, Arslan says it's "a foot in the door" for self-employed individuals, who pay both the employer and employee portions of the payroll tax—a self-employment tax totaling 15.3 percent. Employees typically pay half that amount (7.65 percent) and their employers cover the other half as part of their payroll taxes. The new deduction exempts solo business owners from paying self-employment tax on the portion of their income that they spend on health premiums. "This is a step in the right direction. We're hoping to extend it and make it permanent," Arslan says.
Make sure to ask your tax preparer about taking the deduction when you file your tax returns next year. In order to take advantage of it, you must buy your own insurance (rather than relying on a spouse's coverage or being uninsured) and you must pay self-employment tax on business income (rather than declaring a business loss). The deduction phases out above a $106,800 annual income limit. The provision is specifically geared for those who file a 1040 Schedule C business income tax form or a Schedule E earned income tax form, Arslan says.
Another important caveat: The new deduction does not apply to health insurance coverage that you may provide for any employees you have. There is a small business health-care tax credit, part of the health-care reform legislation, that you may be able to claim for that expense. More information on that tax credit is available at the IRS website.
Karen E. Klein is a Los Angeles-based writer who covers entrepreneurship and small-business issues.
Monday, November 8, 2010
Retiring? What about your health insurance?
By Irene Card, The Record -- Approaching retirement requires planning. Next to your income, health insurance is the most important issue to explore because you certainly do not want to have a period in your life when you are not insured for medical care. Your options for health insurance depend upon your age.
Under 65
If you are under the age of 65 and planning to retire, you should first check with your employer to see if you are eligible to stay on the group health insurance plan; that is usually the least expensive way to obtain coverage. Depending on the employer and your years of service, you may be eligible to stay on the plan until your 65th birthday. Or, you may be eligible to continue your benefits under the COBRA law for 18 months. If this is not the case, and your employer tells you there is no health insurance coverage once you retire, you may wish to check with your spouse. If your spouse is employed you may be able to be added to that insurance plan.
If not, your only alternative is to purchase an individual health insurance policy to carry you through until you reach the age of 65. Individual health insurance is expensive. Premiums can range from $460 to well over a thousand dollars per month, depending on the type of coverage you select.
Approaching 65
If you plan to retire in the month in which you turn 65, you will be eligible for Medicare. Your employer may allow you to continue on the group plan, which will be secondary to Medicare. If your employer tells you that you cannot continue on the group health insurance plan, you must choose a Medicare supplement (also known as Medigap) to fill in the gaps and pick up where Medicare leaves off.
Depending on the Medicare supplement (also known as Medigap) you will have one 100 percent coverage. Or, when a person becomes eligible for Medicare, you may choose a Medicare Advantage plan in lieu of the traditional Medicare plan. This is good for a small group of citizens. With a Medicare Advantage plan, you usually have a copayment, you might have deductibles and you must go to providers who participate in the plan.
If you have a spouse, and your spouse is actively employed by a company with more than 20 employees, you may be able to continue health insurance benefits under your spouse's plan. If you do this, and if your spouse works for a company with more than 20 employees, you should refuse Part B Medicare until your spouse also retires.
If you will be 65 and not actively at work on a full-time basis, do not choose COBRA in lieu of signing up for Medicare Part B. I cannot emphasize this enough. COBRA does not count as creditable coverage when applying for Part B. If you have COBRA for 18 months and now you go to Social Security to sign up for Part B, they will tell you that you have to wait for open enrollment which is January through March and your Part B will become effective the following July. This is not good at all. Seek professional advice; without it you may end up paying a penalty for Part B Medicare.
Over 65
If you have been working since your 65th birthday and are now getting up in years and decide to retire, you have a few choices. If you have been actively employed by a company with more than 20 employees chances are you are on the group health insurance plan and Medicare is secondary or you have refused Part B Medicare. This is known as TEFRA. The TEFRA law simply stated, means that if you are 65 or over and actively employed by a company with more than 20 employees, your group insurance is primary and Medicare is secondary.
Many people that fall into this category find that they do not need Part B Medicare until they retire. The same holds true if you are eligible for benefits under the plan that your spouse has because your spouse is still working. When you receive benefits beyond age 65 under your spouse's plan, it is known as the DEFRA law. So, if you don't have a spouse, and you are now getting ready to retire, well beyond your 65th birthday, you will have to make sure that you get enrolled in the Medicare program if you were TEFRA eligible. Find out if your employer will allow you to stay on the group plan as secondary to Medicare.
If not, you will have to purchase a Medicare supplement. It is very important that you get a certificate of insurance if you are on the group plan to prove that you were continuously insured and that you are no longer eligible to remain on the group plan. With a certificate of insurance (a document from the insurance company showing the dates you were covered) you will be able to purchase a Medicare supplement from any company selling them with no waiting period for pre-existing conditions.
You will have to contact Social Security and let them know that you are going to retire and will need Part B Medicare. There will be penalty and you do not have to wait for open enrollment because you can prove that you were TEFRA eligible (covered by a group plan with more than 20 employees). This is the most important step to follow.
If you have been working for a very small company beyond the age of 65, Medicare is primary and you may or may not have a Medicare supplement. There might be a waiting period for pre-existing conditions when you go to purchase a Medicare supplement if this is your situation.
Long term care insurance: The need for long term care is the single greatest threat to your financial security as you get older. Long term care insurance will help protect your assets when you require someone to take care of you, whether you have someone coming to your home, or if you become institutionalized, use an adult day care center, or an assisted living facility, etc. You should certainly explore the financial ramifications of purchasing long term care insurance when you retire if you have not already done so. We will be happy to help you with this.
Irene Card and Betsy Chandler are licensed insurance professionals working at MIC Insurance Services, a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call 973-492-2828.
Saturday, October 23, 2010
How FSAs, HRAs & HSAs are impacted starting 1/1/2011
The Patient Protection and Affordable Care Act (PPACA) of 2010 will change the rules for purchasing over-the-counter (OTC) medicines or drugs using Flexible Spending Accounts (FSA), Health Reimbursement Accounts (HRA) or Health Savings Accounts (HSA).
The popularity of accounts like FSAs is driven by tax-saving benefits for both employees and employers. A typical employee can expect to save $420 annually* while the financial benefit for employers is avoiding the 7.65% FICA tax on employee wages diverted to an FSA. While the motivating tax benefits will remain intact under the new reform law, careful communication on how OTC medicines or drugs qualify for reimbursement will be key to continuing to benefit from tax advantages.
What will qualify as a tax-free & reimbursable FSA, HRA or HSA expense?
Starting January 1, 2011 expenses for medicines or drugs will qualify as tax-free and reimbursable by an employer-provided health plan, including an FSA, HRA or HSA, only if:
• the medicine or drug requires a prescription
• is an over-the-counter medicine or drug and the individual obtains a prescription; or
• is insulin
Therefore, for OTC medicines and drugs to be reimbursable an individual must obtain a prescription.
How will FSA, HRA and HSA debit cards be impacted?
These debit cards may not be used to purchase OTC medicines or drugs.
Since OTC medicines and drugs must be substantiated before a reimbursement can be made, individuals must pay out-of-pocket at the time of purchase and then submit a reimbursement claim along with a copy of the prescription.
Note: Debit cards may continue to be used for OTC items that are not considered a medicine or drug (ie. bandages, contact lens solution)
Friday, October 8, 2010
Working While Sick: An Epidemic?
By Kaitlin Madden, TheWorkBuzz.com -- Yesterday, a group of leaders in the food service industry gathered in Washington, D.C. to discuss the alarming findings of a new survey. The study, conducted by Restaurant Opportunities Centers United, found that two-thirds of restaurant workers go to work when sick.
While the study sheds light on some serious underlying issues in the food service industry — nearly 90 percent of workers reported they get no paid sick days and 60 percent said they did not receive any form of health insurance — the study also poses an obvious problem for the restaurant consumers who eat the food handled by sick workers.
June Lindsey, a Detroit woman with more than 30 years’ experience in the food service industry, knows a lot about going in to work sick. She shared the following story in the study:
“[One day] I had a really bad cold. My nose was running, I was sneezing, [and] I had a bad cough and a fever. I could not call in sick because no work meant no money and I couldn’t afford it at that time. My kids were very young, so I went to work to see if I can make it through the day. Half way through the day, the sneezing, coughing and runny nose got worse. I asked the manager, ‘I am really sick and need to go because I could make others sick and I am dealing with food.’ She laughed and told me ‘try not to cough then.’ So I had to work that day sick, and who knows how many customers I got sick because I couldn’t go to the back and leave the counter to wash my hands after every sneeze or nose wipe. Later on all of us got sick one by one, and all this came from another worker that came to work sick like me, but was not allowed to leave work!”
While food service is the most recent industry to address the problem, it’s not a problem that’s exclusively theirs. According to the website for MomsRising, a group that pushes for reform on issues like maternity leave, fair wages and paid family illness days, 55 percent of workers in the retail industry and 48 percent of workers employed in the general private sector don’t receive paid sick days.
Though coming in sick means there’s a good chance your co-workers and customers will catch your irksome illness — in some cases, passing on your poor health can cause potentially life-threatening situations.
Take the case of Amy*, for example. As the mother of a young son who is currently being treated for a blood disease — the recovery from which depends on his avoidance of illness — Amy pays vigilant attention to those who enter her son’s room at the renowned children’s hospital where he is staying. This past weekend, the poor health of one of the hospital’s staff members compromised the well-being of Amy’s son: “On Saturday, as I woke up, I noticed that our nurse was sick,” she says. “No one is supposed to be allowed on our floor if they are sick and definitely not in our rooms. This is a nurse whom we really like and who has been with us from the beginning. When I wouldn’t allow him back in the room, he explained that the hospital does have a policy that the nurses have to call in if they are sick. Unfortunately, the hospital has another policy that causes nurses to be written up if they call in sick. It’s a catch 22 that puts kids at risk.” Amy and her family are currently trying to get the hospital policy changed, since she says it caused “a good nurse to make a poor choice.”
While Amy’s incident may seem like it would be an isolated one in the health care field, a recent study by the Journal of the American Medical Association says otherwise. This summer, the AMA published the findings of a survey of 537 medical residents from around the country, in which 57 percent of residents said they’d worked while sick, the Kansas City Star reports.
With flu season rapidly approaching, it can be tough to know what to do in a situation where you know you are too sick to go to work, but are worried about the repercussions of skipping a day. Here are a few ideas to help you find a better alternative to working while you’re sick:
1. Switch shifts: If you work in a restaurant, hospital or retail environment where workers are scheduled in shifts, try switching hours with a co-worker. Create a list of all your co-workers phone numbers and keep it at home. That way, if you’re feeling too sick to work, you can call a colleague and ask if they can cover your shift. Just make sure that you offer to cover one of theirs in return, or to repay the favor when a co-worker isn’t feeling well.
2. Get a doctor’s note: Though asking your doctor for a note may make your feel like you’re back in the fifth grade, doing so will lessen your chances of being reprimanded — and provide you proof of your illness should your employer think you were “playing hooky.”
3. Work from home: If you have a desk job or another occupation that doesn’t necessarily require your physical presence, working from home can be a good alternative for those who don’t want to — or can’t — take a sick day. It will prevent you from spreading your condition to colleagues and clients, and will also allow you to recuperate while still getting your work done.
4. Check out the legalities: While the Healthy Families Act — which would require employers to provide employees with one hour of paid sick leave for every 30 hours worked — has recently been reintroduced to Congress, it has yet to pass. In the meantime, many occupations do have guidelines when it comes to working while sick — which means you have the right to, or may be required to — take the day off if you’re not feeling well. Most large employers, for instance, must legally allow workers to take up to 12 weeks of unpaid sick leave per year, under the Family and Medical Leave Act.
5. Ask for a substitute duty: If you feel you must go to work while sick, talk to your employer about alternative duties. Instead of working directly with customers at a retail store, for example, ask if you can work in the stockroom instead. If you work at a hospital, ask to cover a floor that won’t put you in contact with patients that have compromised immune systems.
Click here to read the article on TheWorkBuzz.com
Tuesday, October 5, 2010
CBHCare offers free community screening program
Posttraumatic stress disorder (PTSD) has been receiving greater attention in recent years as reports of the high incidence of the disorder among soldiers returning from deployment in Iraq has increased awareness and research of this condition. However, soldiers are not the only people who can develop PTSD. PTSD affects approximately 8 percent of the United States population, with between a quarter and one-third of people who experience a significant trauma developing PTSD.
Significant trauma is considered any event that is dangerous or upsetting, such as an assault or violent attack, combat, natural disaster or vehicle crash. Symptoms of PTSD, which can occur anytime after the event, include re-experiencing the event, such as having recurring nightmares, avoiding reminders of the event, being less responsive including feeling detached and less interested in life activities, and increased arousal, such as having angry outbursts or difficulty sleeping.
The good news is if you or someone you know has been experiencing symptoms such as those described above treatment is available. CBHCare offers you the opportunity to take a screening for PTSD as well as other common mental health conditions. The screenings are free, anonymous, and only take a few minutes. To take the first step, click here.
Friday, October 1, 2010
First Wave of Insurance Reforms Go into Effect
On Sept. 23, 2010, the first set of consumer protections in health insurance included in the Patient Protection and Affordable Care Act (federal health care reform) went into effect. These protections include:
• Prohibiting denials or limits on coverage or benefits for children under age 19 who have a pre-existing condition. This will benefit children living with mental illness who are covered by their parent's plan.
• Prohibiting lifetime dollar limits on most health insurance benefits, including mental health benefits, in all policies issued or renewed after Sept. 23, 2010. This will help protect enrollees, particularly those who experience multiple hospitalizations or have chronic and intensive mental health care needs.
• Extending dependent coverage for adult children up to age 26 in all individual and group health insurance policies. This will make it possible for young adults--at a time when many first experience mental illness--to be covered under a parent's plan.
• Bans on cancelling (“rescinding”) insurance coverage due to honest mistakes or omissions in insurance applications. Insurance companies will have to prove fraud to justify cancelling insurance policies.
• New rights to appeal adverse insurance decisions, such as denials of care. For most plans, plan holders must be provided a copy of the rationale for any denial of coverage and, importantly, there will now be an independent external appeals process in all states and for most plans.
Additionally, many plans will now offer certain preventive services, dependent on age, with no cost-sharing or deductible. For example, individuals will now be covered for blood pressure, diabetes and cholesterol tests.
To find out more about these and other insurance reforms going into effect today, visit www.healthcare.gov.
The federal health reform law contains many other provisions that will make an impact on health and mental health care. These changes will be implemented over the course of the next few years. For a list and timetable of these changes, go to http://healthreform.kff.org/timeline.aspx
Wednesday, September 8, 2010
Employees Are Paying a Larger Share of Health Insurance Coverage
According to a new survey by the Kaiser Family Foundation, workers are paying on average 14%, or $482, more toward the cost of family health coverage in 2010 than they did in 2009.
Since 2005, workers' contributions to premiums have gone up 47 percent, while overall premiums rose 27 percent, wages increased 18 percent, and inflation rose 12 percent.According to the survey, Many employers are also raising the annual deductibles workers must pay before their health plans begin to share most health care costs. A total of 27 percent of covered workers now face annual deductibles of at least $1,000, up from 22 percent in 2009, the survey finds. Among small firms (3-199 workers), 46 percent face such deductibles. Click here for more information.
Secretaries Sebelius and Duncan Announce National Coalition to Enroll Uninsured Kids in Health Care
U.S. Department of Health and Human Services Secretary Kathleen Sebelius and U.S. Department of Education Secretary Arne Duncan highlighted last Friday the Connecting Kids to Coverage Challenge to enroll five million children in Medicaid and CHIP within five years. Since Sebelius announced the Challenge last February, the Centers for Medicare & Medicaid Services (CMS) have built an unprecedented coalition of partners, ranging from state governors to national advocacy organizations, who have stepped up to the challenge to enroll kids and educate families.Although health coverage is currently available to children in families with incomes up to about $45,000 per year in nearly every state, an estimated five million uninsured children are eligible for Medicaid or CHIP but not enrolled.
Secretaries Sebelius and Duncan were joined by Genevieve Kenney of the Urban Institute, whose new report Five Million Eligible But Uninsured: Who and Where Are the Children Yet to Enroll in Medicaid And The Children's Health Insurance Program? was released in Health Affairs on-line today along with a Health Affairs Commentary by Secretary Sebelius, Rising to the Challenge: Tools for Enrolling Eligible Children in Health Coverage. Click here to view the report.
Saturday, August 28, 2010
Small Businesses Skip the Health-Care Tax Credit
by David Lerman and Liz Smith, Businessweek.com -- Sales are off by 20 percent this year at Image Computer, which repairs printers in suburban Detroit. So President Steve Olis is worried about whether he can continue paying the $71,000 a year it costs him to provide health insurance for his employees.
The Obama Administration's answer for Olis and other small-business owners: a tax credit of as much as 35 percent of the insurance premiums they pay for employee medical coverage, a signature part of the health-care reform bill signed into law in March. Image Computer, however, doesn't qualify for the credit because Olis pays his 15 employees an average of $55,600 annually, and companies with average salaries above $50,000 aren't eligible. "At some point I can't do this any longer," Olis says of his rising health-care premiums.
Eager to promote the new small-business tax credit, the government this spring mailed 4 million eligible companies postcards with highlights of the program. The response has been tepid, according to insurance brokers who sell small-group policies. The reason, they argue, is that the credit starts to phase out for companies that pay average annual wages of more than $25,000 or employ more than 25 workers. The value of the benefit declines quickly, so many business owners in high-cost states get no tax break, and those elsewhere often say the credit is too small to make much of a difference. Sales of health plans have gotten "very little traction so far," says James Stenger, director of business development for BenefitMall, which sells small-group plans in New Jersey.
Stenger says most of his clients pay their workers more than $25,000 a year, so the average tax credit he's seeing for the few who qualify is about 10 percent of the cost of the policy. That's less than $200 per worker—not enough to spur many business owners to start providing coverage. Brokers across the country report a similar response. JLBG Health in Warrenville, Ill., contacted 460 small businesses about the tax credit. Roughly 40 percent were eligible, though only seven of those companies qualified for the full benefit. Not one of the 400 New England employers served by Hampstead (N.H.)-based Landmark Benefits is eligible, the broker says. The legislation "is just not doing what we had hoped," says Steven Selinsky, the incoming president of the National Association of Health Underwriters.
U.S. Small Business Administration chief Karen Mills says complaints about the tax credit are premature. "This is all still in anecdote land," Mills said in an interview. She maintains that the income cap was needed to keep a lid on the cost of the tax credit and that the people with the greatest need—low-paid workers at the smallest companies—will be able to get coverage. Companies "want to provide health insurance [because] they're losing good employees when they don't," Mills says. "The math says [the program] is likely to be positive."
One company that has had success selling policies under the program is Blue Cross and Blue Shield of Kansas City, which launched a marketing push to promote the tax credit when the law was enacted. Although less than a quarter of small businesses in the Kansas City area qualify for the credit, the ad campaign paid off. Blue Cross has sold 227 plans to small businesses in the past three months—80 percent more than in a typical three-month period, says Tom Bowser, chief executive officer. Now, Blue Cross affiliates in other states are hoping to replicate the Kansas City marketing strategy—a combination of print ads, radio spots, and direct mail explaining the program's advantages. The success "is tangible evidence that this legislation is having some effect," Bowser says, "and we're cashing in on it."
The bottom line: Many small businesses can't take advantage of a tax credit designed to reduce the cost of providing health insurance.
Lerman is a reporter for Bloomberg News. Smith is a reporter for Bloomberg News.
Friday, August 6, 2010
Health coverage doesn’t alter tax status
The Record -- Last spring's overhaul of health care coverage has spurred recent tax-related questions. Here with answers is IRS tax specialist Jesse Weller.
Q. Under the new health care reform plan, I was told you will be able to cover your dependents up to age 26. Will I now be able to claim "Head of Household" on my federal income taxes for my dependents up to age 26? Currently, I can only claim them up to age 23.
As a result of changes made by the recently enacted Affordable Care Act, health coverage provided for an employee's children under 27 years of age is now generally tax-free to the employee, effective March 30, 2010.
The Affordable Care Act also requires health plans that provide dependent coverage of children to continue making the coverage available for an adult child until age 26. The extended coverage must be provided for health plan years beginning on or after Sept. 23, 2010. Please see IRS news release IR-2010-053 (Tax-Free Employer-Provided Health Coverage Now Available for Children under Age 27) at www.irs.gov/newsroom.
This provision of the Affordable Care Act does not amend the tests used to determine dependency or tax filing status. For more information, see IRS Publication 501 (Exemptions, Standard Deduction and Filing Information). It's available from the IRS website (www.irs.gov) or can be ordered by mail by calling 1-800-TAX-FORM (829-3676).
Q. I have been told by my accountant that there will be a new W-2 form next year. The change will add the cost of your employer-provided health care to your gross income. Therefore, we will now be taxed on a higher gross income.
Since this is not earned income, how can this be true?
Please clarify the reality of this happening.
The IRS has not yet published details regarding the 2011 Form W-2.
You may wish to refer to information on the White House blog: www.whitehouse.gov/blog.
Editor's note — On May 25, the White House blog noted that e-mail rumors were circulating that since health benefits will be reported on W-2 forms, federal taxes will go up.
"This claim is simply false," according to the blog post by White House special projects assistant Stephanie Cutter.
"Here are the facts: Next year, your W-2 form will ... show the value of the health-care benefits that you have received, so you can know more about your benefits and [be] an empowered consumer."
But, Cutter added, "you will absolutely not pay taxes on these benefits."
How to Choose an HMO or PPO plan
Bizjournals.com -- The quality of a company's health insurance plan can be a key factor in retaining employees, but providing medical coverage is a significant expense - especially for companies with 50 or fewer employees.
A survey by America's Health Insurance Plans, an industry trade group in Washington, D.C., found small-group coverage in 2006 averaged $312 per month for single coverage and $814 per month for family coverage.
Helen Darling, president of the National Business Group on Health in Washington, D.C., said that when evaluating plan options, employers should consider the quality of care provided to its members and not just the premium prices.
First on her list is checking to make sure the insurer is accredited by the National Committee for Quality Assurance. Next would be reading through the plans' HEDIS (Health Plan Employer Data and Information Set) scores, which the NCQA accumulates to track plans on various performance measures.
"You can find out things like what percentage of their members receive a beta-blocker after suffering a heart attack," Darling said. "I'd also make sure the physicians in the plan are, with very few exceptions, board certified. And I'd want to see that the plan has a 'centers of excellence' program for certain procedures such as organ transplants and cardiovascular care."
When evaluating premiums, Darling suggested businesses ask for a breakdown of all prices to determine whether it might be cheaper to outsource certain part of the plan, such as prescription pharmacy benefits.
Among the various types of employer-sponsored health insurance plans, managed-care options dominate the landscape.
In its national survey of employee-sponsored health plans, the consulting firm Mercer Human Resource Consulting found that preferred provider organizations (PPOs) were the most popular option in 2006, at 61 percent, followed by health maintenance organizations (HMOs) at 24 percent.
Both HMOs and PPOs have contracts with networks of physicians, hospitals and other health-care networks. Members pay less for services provided "in-network," but typically have the options of paying higher "out-of-network" fees to going to providers not in the network.
HMOs are more restrictive by having members select a primary-care physician who must approve visits to specialists. PPOs typically carry slightly higher deductibles and co-payments, but no restrictions on visits to specialists - making the option generally more favorable to members.
In order to hold down premiums, managed care plans are increasingly offering customers a tie red pricing plan for pharmaceuticals. Members pay the least for generic drugs, slightly more for brand-name products in the plan's formulary of approved drugs, and the most for brand names drug not on the formulary list.
Traditional indemnity coverage, which accounted for about 50 percent of employer-sponsored plans in the early 1990s, has steadily plunged during the past decade and hit just 3 percent last year according to the Mercer survey.
The newest option is consumer-directed or consumer-driven health plans, abbreviated as Chaps, which feature high deductibles along with health savings accounts or health reimbursement accounts. With such plans, employees and employers can make a pre-tax contribution to a health savings account, which is used to pay for routine medical care. Any funds left in the account at the end of the year can be used in subsequent years. If the fund is depleted, the employee's coverage converts to a high-deductible managed-care plan.
Proponents of Chaps say they help people become better health-care consumers because their own money is involved. Critics fear people will put off necessary treatment to avoid emptying their accounts.
"They are not the right choice for every employer or every employee, but they can help both employers and employees save money," said Jessica Waltman, vice president of policy and state affairs for the National Association of Health Underwriters in Arlington, Va.
Waltman said some younger, childless employees decide to opt out of an employer's plan because they typically don't get sick or even go to a doctor's office.
"A consumer-directed plan is a way to entice younger workers to go into the company health insurance plan," she said, noting the feature that allows people to rollover unused funds for future health-care services.
"There really are a wide array of health plans out there, but most people (in employer-sponsored plans) end up with a PPO product because of pricing," Waltman said.
Waltman also said employees are attracted to PPOs because they allow members the ability to go to any doctor in the plan's network without a referral.
"Employers will gravitate to what employees like," she said.
Sunday, July 11, 2010
OSHA proposes revisions to the walking-working surfaces and personal protective equipment standards for General Industry
Sunny Corona, CSP
Custom Safety Services
The proposal describes revisions to the current Walking-Working Surfaces and Personal Protective Equipment ( Fall Protection Systems) standards for General Industry. For example, the current Walking-Working Surfaces standard, for General Industry, allows employers to provide outdated and dangerous fall protection equipment such as lanyards and body belts. Use of this type of equipment can result in workers suffering greater injury from falls from elevations. Among other revisions, body belts will be strictly prohibited.
The current Walking-Working Surfaces standards also do not allow OSHA to fine employers who let workers climb on certain ladders without fall protection. Under the revised standards, this restriction would be lifted, allowing OSHA inspectors to fine employers who jeopardize their workersʼ safety by allowing them to climb these ladders without fall protection.
In summary: OSHA believes that the proper use of personal fall protection systems can protect employees from injury and death due to falls to different elevations. The proposal increases consistency among construction, maritime and general industry standards and eliminates duplication.
About the Author
Sunny Corona is a Managing Member of Custom Safety Services, LLC and is a Certified Safety Professional with 30 years in the safety field. Custom Safety Services LLC is a safety consulting / training firm specializing in OSHA compliance, fleet safety, office/industrial ergonomics, anti-harassment and workplace violence awareness training.
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