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The more I read, the more Health Care Reform is not about the reduction in costs, but the opportunity for more “players” to be involved.

We have had non-profit entities serve the community for many years, as advocates for people needing medical care, whether they are eligible for Medicare, Medicaid, or CHIP (Children’s Health Insurance Program).  These advocates are now being called Navigators or Assistors.   We, as insurance producers,  have answered those same questions for many people needing care, and are also advocates for people in need.  Brokers don’t get paid on Medicaid or CHIP enrollments.

Navigators now want to be involved in assisting people on individual/group health coverage because the broker is paid by the insurance carrier, and navigators don’t get paid in commissions by the insurance carriers but receive grant money, so are part of the savings solution with Health Care Reform?  Not so fast!

The Connect for Health Colorado (The Colorado Exchange) announced in the Denver Post  (dated Tuesday, May 7) $14 million (yes, you heard that right) in grant money would be available for “navigators” to walk new customers through receiving subsidy money.

Professional insurance brokers have done the same thing for many years.   Yes, we do get paid by the insurance carriers for what we sell to the tune of $25 per employee per month on group business, and about 5% of the premium for individuals in the first year.   Insurance brokers do not get paid in educating and advising.

Insurance is a complex system.  Insurance brokers have been servicing their clients for many years and offering many more services than just a rate with a plan attached to it.  You, the consumers, should have the best advice available.  You owe it to yourself to work with an insurance professional.

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Compliance

Employers are required to comply with the following federal legislation;
Immigration Reform and Control Act (Form I-9) (1 or more employees)
Colorado Affirmation form (1 or more employees)
USERRA (1 or more employees)
Fair Labor Standards Act (1 or more employees)
Americans with Disabilities Act (15 or more employees)
Age Discrimination in Employment Act (20 or more employees)
Family and Medical Leave Act (50 or more employees)
EEO-1 Reports (100 or more employees; 50 or more for federal contracts)

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Rewarding Your Employees

In today’s economic times, there are still lots of ways to reward employees without handing them money. We have shown you 51 ways:

1. Let the employee dump the one project they like least to you.

2. Use of the president’s office for a day.

3. The front parking spot.

4. A handwritten thank you note.

5. Name the conference room or lounge after them.

6. Inviting their spouse in for a lunch on the company.

7. A reserved parking spot.

8. A video game for the employee to give to their child.

9. A vacation day.

10. Brand-new desk, chair, or other piece of office furniture.

11. Bouquet of flowers.

12. Prepare a short video montage that celebrates the employee’s accomplishments.

13. A public thank you.

14. Send a birthday card to them at their home address.

15. Pay for them to take a fun class, such as cooking or skydiving.

16. Find something they like to collect, such as stamps or coins, and give them one for their collection.

17. Let them suggest a way they would like to be recognized.

18. Write a note to their family, sharing how important the person’s contribution to the company has been.

19. Keep the break room stocked with their favorite drink or snack.

20. Buy them tickets to a concert, show or other event.

21. Give them a small gift card from their favorite store.

22. Pick up a book or CD for them by their favorite author or artist.

23. Pick up the tab for them to have a family portrait taken.

24. Pay for their child to go to camp.

25. Buy a few extra boxes of Girl Scout Cookies from their daughter.

26. Give them a pair of movie tickets.

27. Help them with gas prices by giving them a gas card.

28. Provide them with a formal letter of appreciation for their personal file.

29. Create a “day pass” that they can turn in to take any day off, no questions asked.

30. Find a deal on a couple of three-day cruise tickets and set them up with a short vacation.

31. Allow them to be flexible with their hours.

32. Let them choose one day a week to work from home.

33. Have a birthday cake delivered to the office on their birthday.

34. Get each employee to write something positive about the person on a piece of paper, and give them the box of collected sayings, or frame them for the employee.

35. Start a company “Wall of Fame” and add them to it.

36. Find out what they are passionate about and give them a gift that relates to it.

37. Create and give them an award that they can keep and frame for a job well done.

38. Surprise them with an outdoor catered picnic.

39. Have a mobile car wash come to the business and clean their vehicle.

40. Get them a subscription to their favorite magazine.

41. Pay for a membership in a trade association of their choice.

42. Have a staff appreciation day once a month to provide them with a catered lunch.

43. Give them and their colleagues a catered breakfast.

44. Give them a new, improved job title.

45. Provide them with some one-on-one mentoring.

46. Institute a “playtime,” where employees can play games or shoot some baskets.

47. Host an annual award ceremony and give awards to employees for their contributions.

48. Celebrate the anniversary of their joining the company.

49. Allow them to dress casually on Fridays.

50. Have a massage therapist come to the office once a month and give a massage.

51. Create a relaxation room, where the employee (and other people you are rewarding) can go during the day, to read or even play a video game on their break.

Money may not always be the best way to recogize your employee’s accomplishments. Something to think about.

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An employer may not discharge an employee nor threaten to discharge an employee who is called to jury service.

Employees must be paid their regular wages up to $50 per day for the first three days unless there is a mutual agreement between the employer and employee.

There are some circumstances; i.e., self-employed, small employer when paying compensation would cause the employer financial hardship.

Refer to your employee handbook for more detail.

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Dependent Audits

Is your company performing dependent audits on benefits?  Costs continue to rise on health coverage.  It is good business practice to review those members who are on your group benefit plans.   Do the members have dependents on the plan who don’t belong there?  Examples would include ex-spouses, grandchildren, common-law spouses. 

How to audit?  Employers are requiring employers to produce marriage licenses, birth certificates, and/or partial tax returns to prove their listed dependents are eligible for benefits.

To hear more tips on saving dollars, stay up to date with Trilogy Benefits, Inc., a Denver brokerage agency working with individuals, small, and large group accounts.  “Making a Difference in Benefit Solutions”

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Employers hiring new employees after February 3, 2010 and before January 1, 2011 may receive a tax break of 6.2% Social Security tax (up to $1,000). A new employee is identified as not having been employed for more than 40 hours during the 60-day period ending on the date employment begins, is not hired to replace another employee unless the other employee separated from employment voluntarily or for cause (including downsizing); and the new employee is not related to the company owner(s). Employers can take this credit on their 2011 tax return. See IRS Form W-11 for details.

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According to an independent study commissioned by the Department of Homeland Security (DHS), E-Verify, the online tool employers can use to check the work-authorization status of new hires, wrongly clears illegal workers about 54% of the time. The systems does not currently identify identity fraud and therefore, individuals are “getting through” by obtaining and utilizing another’s employment records.

E-Verify is currently voluntary for most U.S. employers however certain Federal contractor’s have been required to use this program since last year. Congress gave the DHS about $100 MILLION to spend on E-Verify in its 2010 budget but it’s not for certain which of these services will be “tweaked” or targeted for change this year.

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Customized Briefing for Jacquey Tabcum

October 2, 2009

Leading the News
Legislation and Policy
Public Health and Private Healthcare Systems
Uninsured
Also in the News

Leading the News

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Senate Finance Committee completes markup of health reform bill.

The New York Times (10/2, Pear, Calmes) reports, “After a marathon session that ran well past midnight, the Senate Finance Committee on Friday passed a major milestone in its work on legislation to remake the healthcare system and provide coverage to millions of the uninsured.” The committee finished the last of the amendments at 2:15 am, and “plans to take a final vote on the legislation next week, after getting a cost estimate from the Congressional Budget Office.”

        The move sends “President Obama’s top domestic policy initiative to a threshold that had eluded presidents since Harry S. Truman,” the Washington Post (10/2, Murray, Montgomery) reports. Sen. Max Baucus (D-MT) “said he has enough support to pass the package out of committee.”

        The AP (10/2) notes that “Democrats hold a 13-10 majority on the panel, and Sen. Majority Leader Harry Reid (D-NV), anticipating the outcome, has already announced a historic debate will begin at mid-month in the full Senate.”

        Senate panel votes to include state-based public options in healthcare reform bill. The AP (10/2, Espo) reports that “agreement by the Senate Finance Committee is now all but certain for the” healthcare reform bill proposed by Sen. Max Baucus (D-MT). Thursday, “after days spent largely turning aside Republican calls for changes in the bill, Senate Democrats coalesced behind two of their own that could alter the legislation in significant ways.” An amendment by Sen. Maria Cantwell (D-WA) “would allow states to negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid, the government healthcare program for the poor,” and “a second, still pending, would exempt millions from a requirement to purchase insurance that is currently in the bill.” The Hill (10/2, Young) reports that the first Cantwell measure would “enable states to form their own public options,” and notes that “all Democrats except Sen. Blanche Lincoln (AR) voted to support the Cantwell amendment and all Republicans voted against it.” The amendment passed 12-11 in a committee made up of 13 Democrats and 10 Republicans.

        The New York Times (10/2, A22, Pear, Calmes) reports, “Under the bill…’the consequence for not maintaining insurance would be an excise tax,’ up to $1,900 a year for a family.” Sen. Chuck Schumer (D-NY) “offered an amendment to introduce the penalties gradually over three years. After discussions with” Sen. Olympia Snowe (R-ME), “Democrats said they had decided on a five-year transition, and they promised to eliminate the possibility of criminal penalties for people who went without insurance.”

        The Washington Times (10/2, Haberkorn) reports that “Baucus has kept his reform plan largely intact since the markup process began two weeks ago.” The Times adds that “during the long process that’s often gone until 10 p.m., he’s kept two small notes in front of him, he told reporters. One is a smiley face, to keep smiling, and the other, ‘Do not take the BAIT,’ to resist Republican talking points. So far, they’ve seemed to work.” Roll Call (10/2, Drucker, subscription required) also covers the story.

Legislation and Policy

Panel rejects GOP amendment to eliminate new taxes on those making under $250,000.

Bloomberg News (10/2, Donmoyer, Rowley) reports, “The Senate Finance Committee narrowly defeated a Republican attempt to exempt most Americans from tax increases to pay for the US healthcare overhaul, underscoring the friction over how to fund the legislation.” By 12 a to 11 margin, the committee voted “to reject what…Baucus warned was a ‘killer amendment’ by Idaho Republican Mike Crapo to shield households earning less than $250,000 annually from at least three levies contained in the bill, including a penalty for people who fail to obtain insurance.” As was the case with the Cantwell measure, Sen. Blanche Lincoln (D-AR) again sided with Republicans on the amendment, which “may aid Republican efforts to portray the legislation…as a tax burden for Americans.”

        The Wall Street Journal (10/2, Hitt, Adamy, subscription required) notes Republicans say the bill, as it stands, violates President Obama’s vow not to raise taxes on the middle class. The Washington Post (10/2, Montgomery, Murray) also reports the committee Republicans said the measure “is ‘riddled’ with measures that would violate…Obama’s pledge.”

        The New York Times (10/2, A22, Nagourney, Herszenhorn) reports, “First came the warnings that government would take over healthcare and panels of bureaucrats would decide when America’s elderly should die. Then came assertions that…Obama would force reductions in Medicare spending that would cut off the elderly from favored doctors and critical lab tests.” Now, “Republican leaders hoping to derail Mr. Obama’s healthcare effort have seized on a new line of attack: that the proposed overhaul is a vehicle for a barrage of hidden and not-so-hidden tax increases,” moving “the healthcare debate to ground that Republicans know well and have long exploited to their advantage.”

 
 

Sen. Reid signals final bill will include public option.

Politico (10/2, Sherman) reports, “Senate Democratic leaders signaled Thursday that their version of healthcare overhaul will include some form of a public option, but it may be limited in scope so they can secure 60 votes to break a Republican filibuster.” Senate Majority Leader Harry Reid (D-NV) “called the public option a ‘relative term,’ and Sen. Chuck Schumer (D-NY) said, ‘There is not one way to Rome; there are lots of ways to Rome.'” Politico adds, “None of the leaders discussed the specifics of what a watered down public option would look like.”

        The Las Vegas Review-Journal (10/1) reported that, in a conference call with constituents Thursday, Sen. Reid said that “there will be a ‘public option’ in whatever health insurance reform bill comes out of Congress.” He said, “We are going to have a public option before this bill goes to the president’s desk.”

        Pelosi rules out co-ops, trigger provisions. The Hill (10/2, Soraghan) reports, “House Speaker Nancy Pelosi (D-CA) has ruled out including cooperatives in the House version of the healthcare bill, putting the House further at odds with the Senate Finance Committee.” Pelosi said, “A state should be allowed to have a co-op. But it doesn’t take the place of a public option.” The Hill notes that “the Republican whom Democrats are courting most, Sen. Olympia Snowe (ME), has said she prefers making the public option a fallback option, triggered if reforms don’t lower healthcare costs. Last week, Pelosi ruled out including a ‘trigger’ in the bill.”

Various groups seen as supporting health courts for malpractice suits.

In his National Journal (10/2, subscription required) column, Stuart Taylor writes, “Our medical-malpractice lawsuit system is too capricious and too clogged with costs and delays to do justice for malpractice victims, or for wrongly sued doctors. It also does little to deter malpractice.” Even “worse, unless fundamentally reformed, malpractice law could greatly weaken efforts to control healthcare costs. The main reason, in the view of many experts, is that doctors’ fear of unwarranted malpractice liability helps spur many billions of dollars in unnecessary ‘defensive medicine’ costs.” Therefore, Taylor contends, some have proposed sending “malpractice suits to new, specialized health courts that have expert judges and no juries. By efficiently separating valid from invalid claims, health courts could award malpractice victims more-timely, more-certain compensation, with far lower legal and administrative costs.”

Physicians protest Finance Committee provision basing Medicare cuts on test frequency.

The Wall Street Journal (10/2, A5, Adamy, subscription required) reports that a provision in the Senate Finance Committee’s proposed healthcare reform bill is being contested by physicians for cutting Medicare reimbursements to those who administer the most tests and treatments. Under the bill, the HHS Secretary would inform physicians of how their levels of treatment compares to other physicians with similar patients. Physicians whose rate of testing ranks in the 90th percentile or above would suffer a five percent cut in Medicare payments. The measure is aimed at cutting waste, but physicians contend that it would discourage doctors from treating the sickest and oldest patients.

CHIP coverage better without health reform, study suggests.

CQ HealthBeat (10/2, Reichard, subscription required) reports that a study released by First Focus suggests that CHIP enrollees “would face higher costs if they are moved into plans offered by insurance exchanges created under leading healthcare overhaul proposals.” The study “compares the ‘actuarial values’ of plans in CHIP to those that would be offered in exchanges under leading House and Senate plans, said First Focus, which described itself as bipartisan.” Currently, “children in families earning up to 225 percent of the federal poverty level” have 98 percent of their medical expenses covered by CHIP, “exposing families to 2 percent of costs.” However, “comparable exchange plans in the House and Senate bills would expose children and their families to anywhere from 5 percent to 35 percent of the cost of covered services.”

 
 

Columnist urges Congress to pass reform, then work out details.

In her syndicated column, printed in the Seattle Times (10/2), Froma Harrop argues that “the ruckus over the public option is more about ideology than reality and, in many cases, is merely payback to the medical-industrial complex.” She adds that “the lesson from Massachusetts may be to pass universal coverage first, then work on the most controversial parts.” Harrop concludes, “Three-quarters of a century have elapsed since President Franklin D. Roosevelt first proposed national healthcare reform. If we need a few more months or another two years to get it right, so be it.”

Public Health and Private Healthcare Systems

CMS announces marketing of Medicare offerings.

CQ HealthBeat (10/2, Reichard, subscription required) reports that CMS “officials announced Thursday the start of marketing of private plans to its enrollees for 2010, saying they’ve weeded out some plans while maintaining a ‘robust’ set of offerings.” The agency also announced tougher oversight, including “stronger rules governing the commissions that can be paid to independent sales agents and new marketing guidelines around how Medicare Advantage plans identify themselves.” CMS also “said it will beef up efforts to detect marketing abuses.” Chairman of the House Ways and Means Committee Pete Stark (D-CA) said the “announcement by CMS makes clear to private insurers that the free ride at taxpayers’ expense is ending.”

        The Wall Street Journal (10/2, Zhang, Johnson, subscription required) notes that in an effort to address costs, Congress in 2008 approved a bill mandating that insurers offering MA private fee-for-service (PFFS) plans must institute provider networks starting in 2011. According to the Journal, Humana has already done so with networks designed to cover at least 80 percent of its PFFS enrollees; but CMS officials yesterday confirmed that several other insurers are discontinuing their PFFS plans. Medicare also announced that the premiums for traditional MA plans will increase by approximately $7 per month. The Journal quotes AHIP President Karen Ignagni, who released a statement decrying Medicare’s MA changes as indicative of the “impact that policy changes can have on the health security of seniors.” Overall, CMS says in 2010 there will be 3,500 MA plans, which is an 18-percent reduction from 2009.

        The Dallas Morning News (10/2, Moos) reports that in Texas, “19 insurers will sell 48” stand-alone Medicare Part D drug plans in 2010, which is “three-fewer insurers and five-fewer plans than this year.” However, many of the companies “will offer a basic plan and one or more plans with more extensive coverage.” Monthly premiums in Texas “will range from $21 for Aetna’s basic plan to $113.40 for Scott & White’s enhanced plan.”

Medicare policy change seen as likely to curtail use of Avastin for treatment of AMD.

The New York Times (10/2, B5, Pollack) reports that under “a new policy that may sharply curtail the use of the cancer drug Avastin [bevacizumab] as a treatment for eye diseases,” Medicare “would pay more for an alternative to Avastin,” the drug “Lucentis [ranibizumab], a drug approved to treat” age-related macular degeneration (AMD). Avastin has been used “off-label” as an AMD treatment, because it “costs only about $30 to $50 per shot,” as opposed to Lucentis, which “costs about $2,000 per injection.” Under Medicare’s new “special reimbursement code just for the smaller doses of Avastin” required to treat AMD, reimbursement for the drug “dropped to about $7.20 for the dose typically used in the eye” effective Oct. 1. This means that “eye doctors — who purchase Avastin and then are reimbursed when using it on patients — would lose money administering the drug,” and would have “a financial incentive to switch to” Lucentis.

 
 

Judge denies 18 Washington hospitals’ bid for additional Medicare reimbursements.

The AP (10/2) reports, “Large hospitals in Washington state have lost a bid to have the federal government give them millions of dollars in additional reimbursements for certain low-income patients.” A district judge ruled that the patients at the University of Washington Medical Center and 17 other large hospitals “were not included in a complicated formula that determines Medicare reimbursements to hospitals.” The hospitals received “some money for treating those patients, who aren’t eligible for Medicaid or Social Security, but the hospitals contended that the federal government should have paid more.”

Uninsured

HHS awards Maryland $1.18 million for uninsured children.

The Baltimore Business Journal (10/1) reported Maryland “will receive $1.18 million from the federal Health and Human Services Administration to provide healthcare services to uninsured children, state health officials said Thursday.” The award “is part of $40 million in grants in 41 states that HHS Secretary Kathleen Sebelius announced Sept. 30.” Currently, 150,000 children in Maryland “are uninsured. Approximately 100,000 of these children are eligible for either the Maryland Children’s Health Program or Medicaid, but have not enrolled.”

Also in the News

Swiss official recounts country’s healthcare reform.

In an op-ed in the Los Angeles Times (10/2), Ruth Dreifuss, former head of the Swiss Department for Home Affairs, writes on Switzerland’s healthcare reform which took place in 1994. The Swiss reform “guaranteed universal health insurance coverage” and “featured many provisions now being considered in the United States, including a mandate on individuals to purchase health insurance, the elimination of preexisting-condition restrictions and a ban on charging higher premiums based on age or gender.” She notes that though debate was “very intense” and a referendum vote was “extremely close,” today, “15 years later, no one in Switzerland questions the need for universal coverage.” She concludes, “In reforming healthcare, the most important action is to dare to make credible change, knowing that it can be perfected over time.”

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I was just floored when I read an article published by the American Heart Association and I had to share.

Standing burns twice as many calories as sitting. It also can increase “good” cholesterol and stimulate enzymes that burn fat. The rates of obesity and heart disease also double for people who are sedentary and sit for long periods of time. Since we tend to “pace” when we’re standing and waiting, we then automatically move more and therefore burn calories. Makes sense, doesn’t it.

It you work at a desk, stand up and take frequent breaks if possible (and okay with management, of course). Other ways to get on your feet:  Stand up when you talk on the phone; stand at children’s sport events; hide the remote control and get up and change channels when watching TV (this I think will be the hardest to implement).

Good luck and enjoy taking a different view of the world by standing more often!

Jacquey Tabcum, Vice President
Sales & Marketing
Trilogy Benefits, Inc.

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In the Los Angeles Times (4/27) Opinion LA blog, Jon Healey wrote, “Paying more doesn’t guarantee getting better healthcare; in fact, there may be no relationship at all. Just look at the United States, which spends far more than any other country on healthcare, but still trails in some key indicators.” Yet, he noted, this “wide variation in the cost of healthcare also creates opportunities for those willing to travel in search of a better deal.” For instance, “WellPoint is conducting a pilot with Serigraph, Inc., a specialty graphics company with operations in Wisconsin, Mexico and Asia, that gives US employees the option to travel to India to have surgery on a non-emergency basis.” Notably, “the India option makes sense for Serigraph…given that a number of its employees come from that country.” In addition, the “cost of care is about 80 percent lower, largely because of dramatically lower charges for labor, drugs, and medical devices.” And, WellPoint contends “that the results of the care were at least as good.”

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