Resources For Employers

COBRA & HIPAA Compliance

COBRA – Compliance requirements for groups of 20 OR MORE employees

Under the new regulations, the following is the minimum size requirement:

Part-time employees are counted based upon a full-time employee equivalent. The full time equivalent cannot exceed 8 hours per day or 40 hours per week.
Self-employed, independent contractors (and the employees of an independent contractor), and directors, even though they may have coverage under the group health plan, are excluded from the count.
Foreign employees under a controlled group are included.
A COBRA-subject employer is still defined as one with 20 or more employees on at least 50% of the working days in the preceding calendar year.

HIPAA – Compliance requirements for All Groups

These are the complex federal laws dealing with continuation and portability of health insurance coverage. The reporting requirements are terribly burdensome, and the penalties for non-compliance are steep. The minimum tax for non-compliance discovered after a notice of examination is generally $2,500. And with the IRS, the burden of proof lies with you. Plus, unnecessary COBRA claims are costly and often the responsibility of the employer rather than the insurance carrier.

HIPAA Employer Audits cause panic and frustration. The majority of employers are non-compliant. The Department of Labor has increased their audit personnel and their audit budget.

The IRS estimates that a large number of employers are out of compliance with COBRA regulations. What is the risk of non-compliance? Substantial penalties and excise taxes are assessed at $100 per day per violation. The maximum tax for “unintentional failures” is the lesser of 10% of the amount paid during the preceding tax year by the employer for group health plans, or $500,000. The IRS currently performs over a dozen audit procedures for COBRA compliance. The federal government has also charged the Department of Labor with the responsibility for COBRA compliance. Now that final regulations are published, there’s an active enforcement effort underway as the government continues to shift healthcare costs out of the federal budget.

These are just a few of the audit points you should review to see if your group health plan has a compliance risk.

Does your company have a written COBRA Procedures Manual that is consistently adhered to?
Can you provide proof of advising all of your active employees and their dependents of their COBRA and HIPAA rights?
Do you maintain documentation of any past requests for HIPAA certificates or COBRA coverage and/or details pertaining to related lawsuits?
Is your staff trained to answer attorney questions challenging your company’s position?
Has your staff granted extensions of the COBRA election period or payment deadlines?
Does your company have an established program for keeping up to date with legislative and regulatory changes in COBRA and HIPAA law?
Do you have proof that all 4 HIPAA notices (4) were sent to your employees upon becoming eligible for benefits and prior the renewal of the group medical plan? How is this documented?

Did you hesitate in answering any of these audit questions? It might be time to contact QSR insurance for a review of your COBRA and HIPAA compliance procedures. We’ll be glad to help you assess your situation.

Cobra Administrator

A full-service program that relieves you of the burdens of compliance and administration. Let us worry about new requirements, eligible employee notifications and all the other duties involved in complying with the ever changing laws. Don’t put yourself at risk! Our system retains complete control of COBRA. We adjudicate eligibility so accurately that we keep your COBRA COSTS and CLAIMS to an absolute minimum. We store each employee’s information in our system and also assume full liability for our work.

In 1985, Congress passed the Consolidated Omnibus Budget Reconciliation Act (COBRA) which was a potpourri of legislation affecting Medicare, Agriculture, Housing and numerous other Federal programs. For most employers, COBRA is the law that provides employees (or covered dependents) that have experienced a “qualifying event” with the right to continue their group health care coverage.

The law was ambiguous in its original form and therefore has been changed or clarified five (5) times. In its current state, the legislation places the following requirements on all employers with twenty or more employees that offer a group insurance program (with the exception of Churches and the Federal Government):

Services Provided

Initial COBRA Notification to all employees;
HIPAA notices – given to all employees upon becoming eligible for group benefits and prior to the renewal of the group medical plan
Notify employees who experience a “qualifying event”;
Notify dependents who experience a “qualifying event”;
Monitor COBRA election periods;
Monitor COBRA Participants time frames;
Collect funds for COBRA monthly premiums; and
Notify COBRA Participants of Conversion privilege.

Cobra Facts!

Companies employing 20 or more people on at least 50% of the working days during the preceding calendar year are subject to COBRA. Both full and part time employees are counted, irregardless if they are insured under the company group plan. Employers have 30 days to notify the Plan Administrator (TPA) of a qualifying event. The TPA then has 14 days to notify the beneficiary.
The following five situations constitute a qualifying event: Death of an employee-parent; Employment termination of the employee -parent; Divorce or legal separation of the parents; Medicare eligibility of the employee -parent; A child attaining maximum age for eligibility as a dependent under a group plan. It is the responsibility of the employer to notify both the employee and his/her spouse of their COBRA rights as qualifying events occur. COBRA requires to send a separate election notice to the spouse that resides at a different address. An employee must only be insured for one day under a group health plan to become eligible for COBRA.
COBRA continuation applies to all group health benefits and include: Major Medical, Prescription Drug Card; Dental & Vision Coverage. Qualified beneficiaries have either the option of continuing all of the benefits or just their “core” coverage. Core coverage is any health benefit other than the dental and vision benefit. Health plans offering packaged dental and vision care must calculate the costs separate for core and non-core benefits within the package. However, stand-alone Rx Card, dental and vision plans may be chosen by the beneficiary to be continued only, in the event the dental and vision coverages are independent from the medical coverages.
COBRA continuation is a federal law and applies to all states. COBRA 89 allows qualified beneficiaries with a pre-existing condition at the time of the qualifying event to continue their coverage under COBRA, and at the same time be enrolled in another group health plan, if the new plan includes any exclusions or limitations with respect to any pre-existing condition.

HIPAA Highlights

HIPAA stands for the Health Insurance Portability and Accountability Act. Passed by Congress in 1996, HIPPA helps to protect your rights to health coverage during events such as changing or losing jobs, pregnancy, moving, or divorce. It provides rights and protections for employers when getting and renewing health coverage for their employees.

The following information highlights the scope of HIPAA in the broadest sense. Keep in mind HIPAA is not an insurance policy.

HIPAA provides rights and protections for both group health plans and individual coverage. These rights and protections address:

Portability – Whether you can get new health coverage if you want to change coverage
Availability – Whether health coverage must be offered to you and your dependents
Renewability – Whether you are able to renew health coverage

Who does HIPAA protect?

HIPAA might protect individuals who experience the following life events:

Have lost or are changing jobs
Are recently married or divorced
Are gaining new dependents through birth or adoption
Are moving from one State to another
Have preexisting conditions or other health factors that make it difficult to get health coverage
Have had health coverage and are now being denied coverage
Want to renew your health coverage
Are a small employer and want to buy health coverage for your employees
Are an employer and want to renew health coverage for your employees

What does HIPAA NOT do?

HIPAA does NOT:

Require employers to offer health coverage
Regulate the cost of health coverage
Regulate the types of benefits that must be offered
Provide protections when you wish to change from one form of individual coverage to another

HIPAA and Group Health Plans

Important HIPAA rights and protections for group health plans include:

Limits on preexisting condition exclusions
Prohibition of discrimination based on health factors
Requirements for special enrollment opportunities for people who lose other group health coverage or gain new dependents, such as a spouse or a child
Requirements for certificates of creditable coverage
Guaranteed availability of group health plans for small employers
Guaranteed renewal of all group health plans at the option of the employer

HIPAA and Individual Coverage

Important HIPAA rights and protections for individual coverage include the following:

HIPAA-eligible individuals are guaranteed the right to purchase individual coverage
Preexisting condition exclusions are not allowed for HIPAA-eligible individuals
Certificates of creditable coverage are required
Individual health insurance coverage is guaranteed to be renewed
Comparable coverage issued through a state high-risk pool

To learn more about HIPAA and other government legislation and programs related to health benefits be sure to go to the Centers for Medicare and Medicaid Services website.

Section 125 Plans (Cafeteria Plans)

Introduction To The Plan – Section 125 refers to the portion of the Internal Revenue Code that permits an employee to elect certain Health and Welfare benefits/expenses to be excluded from taxable gross income. You may elect to have dollars spent on group insurance premiums, un-reimbursed medical/health care expenses, and child or dependent care expenses deducted from pay prior to the calculation of any payroll taxes.

How Does The Plan Work? – You select the from the following benefits: Medical/Health Care Expense FSA, Child/Dependent Care Expense FSA, Personally Paid Health Insurance Premium FSA, Employer Health Insurance Conversion Account. You “pay for” these benefits by redirecting part of your salary in an amount sufficient to pay for each selected benefit. The advantage of redirecting part of your salary to pay for these benefits through the plan is that these amounts are not subject to income taxes and social security tax, they are completely tax-free. Without this plan, these benefit/expenses are paid for with after-tax dollars.

For Flexible Spending Account (FSA) benefits such as the Dependent/Child Care Account, the Health/Medical Reimbursement Account and/or the Personally Paid Health Insurance Account, any monies contributed are placed into a separate account for each benefit you elect. As you incur a qualifying expense, you submit a claim to the Administrator and are reimbursed from the money in your benefit account tax-free.

For employer insured health benefits, the amount you contribute is automatically used to pay the premiums for your coverage.

The primary benefit for participating employees in the Section 125 Cafeteria Plan (as illustrated in the example) is an increase of spendable income due to a reduction in payroll taxes.

To find out more on how you can benefit from a Section 125 plan, make sure to visit PayPro Administrators.

Should I Participate In The Plan? – If you pay a cost for insurance premiums through your employer – Yes! If you typically have, or know you will have expenses this year – Yes! Many employees have been faced with the same question, and have decided to join the plan because it made good sense to have a choice in benefits and receive a pay increase at the same time.

How Much Does The Plan Cost? – A minimal Employee Administrative and Claims Processing Fee is charged to each participant based on which and how many Accounts you participate in. The fee is deducted from your paycheck automatically each pay period and forwarded to Pacific Administrators by your employer. The fee covers all employee services provided throughout the plan year.

Employee administrative fees are also pre-taxed or paid for tax-free under the medical/health care FSA benefit. Please call Pacific Administrators 800/427-4549 or contact your benefits coordinator to find out what your fees will be.

How Do I Sign Up? – You make the elections on what and how much to pre-tax for each benefit once a year during the open enrollment period. Pre-Tax benefits usually offered are: Health/Medical Insurance Premium Conversion Account; Un-reimbursed (out-of-pocket) Medical/Health Care FSA; Child/Dependent Care FSA and Personally Paid Health Insurance FSA. You may pre-tax expenses for yourself as well as for all dependent family members.

The total amount elected in each category is divided by the number of pay periods in each year. Every pay-cycle the amounts elected are withheld pre-tax from taxable earnings and deposited into the FSA account.

As you incur eligible expenses for each category, you submit a claims voucher to the Administrator. After the claims are verified, and contributions are received, you are reimbursed within 7 days following the payroll cycle, with a tax free check.

For more information on how to benefit from a Section 125 plan, make sure to visit PayPro Administrators.

Flexible Spending Accounts “FSA’s”

Health/Medical Expense Reimbursement FSA – This category covers amounts you and your family spend for expenses your health insurance policy doesn’t cover. For example, if your policy has a co-pay or deductible which you pay for out of pocket, it is part of this benefit. Expenses for dental, vision, and other health related services or care, also fall under this category. Also prescription drugs (available only by prescription) are eligible, but over the counter medicines are not, with the exception of insulin.

Medical care is treating, alleviating, diagnosing, or preventing a disease, illness, abnormality, deformity or injury; or for the purpose affecting the structure or function of the body. For a partial list of eligible expenses, consult the Benefit Expense Worksheet or IRS Pub.502 “Medical Deductions”.

Child/Dependent Care Reimbursement FSA – You may pre-tax (pay tax free) child/dependent care expenses for qualifying children and/or dependents incapable of self care. Expenses must be incurred to allow you and your spouse, if married, to work or attend school (full time student). Childcare expenses are allowable for children under the age of 13. Costs for preschool & kindergarten are allowable. The care can be provided within or outside of your home, but services may not be provided by one of your dependents. Services provided by a licensed daycare provider must follow requirements for the State in which it is located.

You may pre-tax up to $5000/per plan year if Married and filing a joint return or if Single filing a single return. If you are married and file a separate return, the maximum allowable pre-tax amount is $2500. This amount may not exceed the income of either spouse (unless spouse is a full time student).

Why Should I Pre-Tax Child/Dependent Care Expenses? – The maximum child credit allowable if reported directly on your Income Tax Return is based on $2400 for one child and $4800 for two ore more children. Also depending in which tax bracket you’re in, the credit amount received could be substantially reduced.

By electing to pre-tax your child/dependent care expenses through this plan, the maximum tax savings are based on $5000 for one or more children/dependents. They are also free of all taxes including Social Security payments and there is no reduction in the amount of tax savings if you are a high income earner. IRS Form 2441 or Schedule 2 must be completed when filing your personal income tax return.

Personally Paid Health Insurance Premiums – Expenses for personally paid health related insurance premiums may also be eligible for reimbursement under this plan. The insurance policy must be owned by – and provide coverage for you and/or a dependent. Proof of premium payments and coverage is required. Personally paid disability insurance premiums do not qualify for this plan.

Medical Insurance Premium Conversion Account – Through your employer you may pre-tax the amount deducted through payroll for your cost of medical/health related insurance, including health, dental, cancer, disability, vision and group term life insurance (under $50K) premiums.

Estimating Your Benefit Expenses – By utilizing the Enrollment Worksheet you should be able to estimate the amount, by benefit category, that you/your family should contribute “pre-tax” for the plan year. Also, if you pay for any portion of your employer provided health insurance coverage, you should pre-tax that cost! (your payroll check will increase!)

Enrolling In The Plan – Once you’ve estimated your expenses on the Enrollment Worksheet, the total election amounts for each benefit will be transferred to the Enrollment Form by clicking on the “submit” button. After the benefit election amounts are transferred to the Enrollment Form, you will need to fill out the entire Enrollment Form including your name, social security number, date of birth and all other information required for you to be enrolled in the plan. If you need any help completing any of the forms, please call us at 800/427-4549 Extension 0. Before you are able to transmit the form, you must also complete the Disclosure Check List.

For more information on how to benefit from a FSA, make sure to visit PayPro Administrators.

FUTURE FLEX PLAN

Employee Example
Employee Plan Savings Example
		Without Plan	With Plan
	Gross Monthly Income (before tax)	$2,000	$2,000
	(less) Pre-Tax Benefit Expense
	Insurance Premiums	$0	$100
	Unreimbursed Health/Medical	$0	$50
	Child/Dependent Care	$0	$200
	Administration Fee	$0	$6
	Taxable Income	$2,000	$1,644

Estimated Tax Withholding
	Federal & State Income Tax	$217	$154
	Social Security Tax (FICA)	$153	$125
	(less) After-Tax Benefit Expense	$350	$0

Net After-Tax Income		$1,280	$1,365

Net Monthly Increase in Spendable Income			$85
Net Annual Increase in Spendable Income			$1,020
Example is based on a California Resident filing married and claiming one dependent.

Federal Employment Laws

Wages, Hours & Conditions of Employment
Law, Exec. Order or Regulation	Coverage	Brief Summary	Primary Penalties	Enforcement	posting
Fair Labor Standards Act (FLSA)	Employers with 2 employees handling goods which have moved in “commerce” and annual dollar volume of sales of at least $500,000; certain employers have no ADV thresholds. Employers with <$500,000 ADV on 4/1/90 currently may be “grandfathered” as to overtime. Employers with <$500,000 and not a covered enterprise or “grandfathered” may be individually covered.	Minimum wage of $5.15; overtime after 40 hrs./week at 1.5 times the regular rate; accurate time records required for all non-exempt employees; child labor restrictions apply; retaliation prohibited; for tipped employees, maximum tip credit of $3.02/hr. after 9/1/97.	Civil: Employees (jury trial) or gov’t may sue for double back wages for 2-3 years; atty’s fees; child labor penalties up to $10,000/child; and penalties up to 1,000 for each employee for repeated or willful minimum wage or overtime violations. Compensatory and punitive damages available for retaliation. Opt-in class action available.	U.S. Department of Labor (DOL) Wage-Hour Division	Yes
Federal Contractors and Subcontractors
Law, Exec. Order or Regulation	Coverage	Brief Summary	Primary Penalties	Enforcement	posting
Migrant and Seasonal Agricultural Worker Protection Act (MSPA)	Most agricultural employers including forestry operators; farm labor contractors.	Requires disclosure of job terms, record keeping, payment of wages when due, housing /vehicle safety standards for migrant and seasonal workers; workers’ compensation arrangements; contractor licensing.	Civil money penalties, lawsuits by workers for greater of statutory or actual damages; criminal penalties, including imprisonment for willful violations.	DOL, Wage-Hour Division	Yes
Family and Medical Leave Act (FMLA)	Employers engaged in interstate commerce with at least 50 employees within 75 miles.	Requires up to 12 weeks (including intermittent leave) of unpaid, job-protected leave annually for certain family and medical reasons.	Employees/DOL can sue for back wages and benefits, reinstatement, atty’s fees and actual losses sustained. Double damages possible for willful violations.	DOL, Wage-Hour Division	Yes
Employment Practices
Law, Exec. Order or Regulation	Coverage	Brief Summary	Primary Penalties	Enforcement	posting
Title VII of the Civil Rights Act of 1964	Employers engaged in interstate commerce with at least 15 employees.	Prohibits discrimination because of race, color, national origin, religion, sex, pregnancy (incl. childbirth or related condition).	Employees/EEOC can sue for back wages, reinstatement, promotion, atty’s fees; for intentional discrimination, employees can sue for “capped” compensatory and punitive damages with jury trial allowed; Rule 23 class action available.	Equal Employment Opportunity Commission (EEOC)	Yes
Title I of the Americans with Disabilities Act of 1990 (ADA)	Employers engaged in interstate commerce with at least 15 employees.	Prohibits discrimination in terms, conditions, and privileges of employment against individuals with disabilities who, with reasonable accommodation if needed, can perform essential job functions.	Employees/EEOC can sue for back wages, reinstatement, promotion, atty’s fees; for intentional disability discrimination, employees can sue for “capped” compensatory and punitive damages with jury trial allowed; Rule 23 class action available.	Equal Employment Opportunity Commission (EEOC)	Yes
Section 1981, Title 42 U.S.C. (Civil Rights Act of 1866)	All private employers, including individuals, regardless of size or dollar volume.	Prohibits racial and ethnic bias in employment.	In addition to suits for back wages, reinstatement, promotion, and atty’s fees, allows jury trials and “uncapped” punitive and compensatory damages.	Private Lawsuits	No
Age Discrimination in Employment Act (ADEA) including Older Workers Benefit Protection Act (OWBPA)	Employers engaged in interstate commerce with at least 20 employees.	Prohibits age discrimination in employment, including benefits, for employees age 40 or over.	Employees or EEOC can sue for back wages with jury trial; atty’s fees; double damages if violation willful; opt-in class action available.	Equal Employment Opportunity Commission (EEOC)	Yes
Equal Pay Act of 1963 (EPA)	Generally, employers with 2 employees handling goods which have moved in interstate commerce and annual dollar volume of sales of at least $500,000; certain employers have no dollar volume thresholds.	Prohibits pay differentials on basis of sex in substantially equal work requiring equal skill, effort and responsibility under similar working conditions. No exemption for executive, administrative, professional and outside sales employees.	Employees or EEOC can sue for double back wages for 2-3 years; jury trial; atty’s fees; opt-in class action available.	Equal Employment Opportunity Commission (EEOC)	Yes
Employee Polygraph Protection Act of 1988 (EPPA)	Employers subject to the FLSA; exemptions for state and local governments and certain gov’t contractors and employers in the security and drug industries.	Generally prohibits the use of “lie detectors” and “lie detectors” results in private employment; limited exemptions apply for certain internal investigations.	Civil money penalties up to $10,000. Gov’t/employee can sue for lost wages, benefits, employment, reinstatement, promotion, and atty’s fees.	DOL, Wage-Hour Division	Yes
Uniformed Services Employment and Reemployment Rights Act (USERRA)	All employers.	Prohibits discrimination on the basis of uniformed service and guarantees the reemployment of veterans and other members of the uniformed services returning to their prior employment.	Employees/Atty. Gen. on behalf of employees can sue for loss of wages or benefits and atty’s fees; liquidated damages if violation is willful.	U.S. DOL’s Veterans Employment and Training Service	No
Immigration Reform and Control Act of 1986 (IRCA)	All employers.	Prohibits hiring of illegal aliens; requires verification and record keeping of work authorization documents.	Up to $10,000 fine for hiring violations; fines up to $1,000 for record keeping violations.	Dept. of Justice’s Immigration & Naturalization Service	No
Department of Transportation Drug Testing Regulations	All employers operating 15-passenger buses or vehicles over 26,000 lbs. and/ or moving hazardous materials; other Reg. Sections cover aviation, RR, shipping, and natural gas industries.	Requires employers to conduct drug tests of certain employees in compliance with strict regulations; provides education and minimal Employee Assistance Programs (EAP).	Penalties vary from agency to agency and range from monetary citation to loss of FAA certification.	Federal Highway Adm., U.S. Coast Guard, FAA, Federal Railroad Adm., Urban Mass Transportation Adm.	No
Worker Adjustment and Retraining Notification Act (WARN)	Employers with at least 100 employees.	With some exceptions, requires 60-day notice to employees and state and local governments before layoffs of 50 or more employees.	Payment of 60 days’ wages and benefits to employees; $500/day civil penalty paid to local government for up to 60 days.	U.S. DOL issues regulations, but WARN is enforced only by private suit	No
Protection of Juror’s Employment (28 USC § 1875)	All employers.	Employer may not discharge, threaten to discharge, intimidate, or coerce any permanent employee solely because of federal jury service.	Civil penalties up to $1,000 for each violation; court-appointed counsel may sue on behalf of employee for lost wages or benefits in accordance with employer’s policy, reinstatement, and atty’s fees.	United States District Court	No
Bankruptcy Code (11 USC § 525)	Private and public employees.	Prohibits termination or discrimination in employment against a covered debtor, bankrupt, or individual associated with such debtor or bankrupt solely because of such debtor or bankrupt status.	Suit for injunction and damages; lost wages, back pay, reinstatement, emotional distress.	Private lawsuits	No
Taxes, Insurance and Employee Benefits
Law, Exec. Order or Regulation	Coverage	Brief Summary	Primary Penalties	Enforcement	posting
Social Security Act (FICA)	Employers who pay over $50 per quarter in wages.	Employer and employee each must contribute 7.65% of wages up to $76,200 and 1.45% over $76,200 for 2000; wage base subject to annual adjustment.	Back taxes plus interest and penalties collectible by IRS.	U.S. Social Security Admin. and Internal Revenue Service (IRS)	No
Federal Unemployment Tax Act (FUTA)	Employers who employ 1 or more persons 20 or more weeks/year; also, any person who paid cash wages of at least $1,000 for domestic service during any calendar quarter in current or preceding calendar year.	Must contribute 0.8% (varies with credits for participation in state unemployment programs) of up to $7,000 of each employee’s wages.	Back taxes plus interest and penalties collectible by IRS.	Internal Revenue Service (IRS)	No
Employee Retirement Income Security Act of 1974 (ERISA)	Employers in interstate commerce.	Requires extensive pension and welfare plan reporting, plus disclosure to plan participants and beneficiaries; minimum participation, vesting, and funding standards for pension plans, including profit-sharing plan termination insurance for pension plans.	Employees, beneficiaries, or Gov’t can sue for benefits and to enforce rights; administrative fines up to $1,000/day for failure to file annual report; personal liability of up to $100/day for failure to provide timely information to participant.	DOL, Office of Pension and Welfare Benefits and Pension Benefit Guaranty Corp.	No
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)	Employers involved in interstate commerce and claiming tax deduction for group health plan expenses or who have “highly compensated employees” participating in group health plans; exception if <20 employees in preceding year.	Requires continuation/coverage under employer’s group health plan to employees, spouses, and/or dependent children upon the occurrence of specified events, including termination of employment or reduction in hours.	Same as ERISA, plus personal liability up to $100/day for failure to timely employee or dependent with notice of commencement of coverage or election form.	DOL and Internal Revenue Service	No
Health Maintenance Organization Act (HMO)	Employers subject to the FLSA’s minimum wage provision with at least 25 employees, offering a health benefits plan, and with at least 25 employees in HMO service area.	Since 10/24/95 employer may offer membership in qualified HMOs voluntarily, but covered employers no longer can be required to offer an HMO option. However, an employer who voluntarily offers an HMO option (or who was obligated to offer and HMO option before 10/24/95) may not discriminate financially against those employees who enroll in an HMO.	Fines of up to $10.000 for every 30-day period when employer is out of compliance.	Dept. of Health &Human Services’ Office of Health Maintenance Organization	No
Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)	Employers subject to ERISA, Internal Revenue Code (IRC) or Public Health Service Act (PHSA) and who employ two or more employees; excludes governmental plans.	Prohibits discrimination based on health-related factors in providing group health insurance benefits; requires certification of participant’s periods of group health coverage; limits pre-existing condition exclusion periods; expands and clarifies COBRA coverage.	Employees or beneficiaries can sue for benefits and to enforce rights to benefits; tax of up to $100/day for violations of the law, minimum penalty $2,500 if discovered through IRS audit, maximum penalty $500,000.	U.S. Dept. of Labor (DOL), Department of Health and Human Services (HHS) and Internal Revenue Service (IRS)	No
Labor Relations
Law, Exec. Order or Regulation	Coverage	Brief Summary	Primary Penalties	Enforcement	posting
National Labor Relations Act (NLRA)	Employers in interstate commerce.	Employee rights to engage in protected concerted activity; organize or decertify union.	Cease-and-desist order; reinstatement of employees with back pay; injunction proceedings; NLRB orders enforceable in federal court.	National Labor Relations Board (NLRB)	Prior to election
Railway Labor Act	Airlines, RR’s, Express co’s, some related co’s.	Regulates co-union elections/ mandatory dispute-resolution processes.	Civil/ criminal; up to $20,000 and/or 6 month prison/ day of violation.	Atty. Gen,. or private federal court suits	Prior to election
Safety
Law, Exec. Order or Regulation	Coverage	Brief Summary	Primary Penalties	Enforcement	posting
Occupational Safety and Health Act (OSHA)	Employers in interstate commerce.	Employer must furnish safe employment according to designated workplace standards; record keeping, no retaliation against employees for exercising rights.	Civil penalties for violations of standards; Gov’t /employee can sue for reinstatement and back pay; possible criminal action.	OSHA, DOL	Yes
Garnishment
Law, Exec. Order or Regulation	Coverage	Brief Summary	Primary Penalties	Enforcement	posting
Consumer Credit Protection Act, Title III (Federal Wage Garnishment Law)	Employers under the federal Wage-Hour Law.	Restricts garnishment withholding to 25% or less of disposable income; allows larger deductions for support/ alimony garnishments; no discharge for one or more garnishments of single debt.	Gov’t can sue for excess withholding, reinstatement and back pay.	DOL, Wage-Hour Division	No
Student Loan Garnishments	All Employers.	No more than 10% of employee’s pay many be deducted to collect student loan payments without consent; employer many not discharge, refuse to hire or discipline because of student loan garnishments.	Employer can be held liable for amount it should have withheld, plus atty’s fees, costs, punitive damages; employee can sue for reinstatement, back pay, punitive damages, atty’s fees.	Dept. of Education or guaranty agency holding the loan	No
Privacy
Law, Exec. Order or Regulation	Coverage	Brief Summary	Primary Penalties	Enforcement	posting
Fair Credit Reporting Act (FCRA)	Employers in interstate commerce.	Requires prior disclosure of intent to use consumer report, signed authorization from applicant/ employee, and disclosures to applicant/ employee before and after adverse action if related to report.	Civil suit for noncompliance (actual and punitive damages); agency action for damages and for penalties up to $2,500 per violation; criminal liability for obtaining report under false pretenses (fines and up to 2 yrs. in prison).	Federal Trade Commission (FTC)	No
Walsh-Healey Public Contracts Act (PCA)	Employees, of employers W/fed. gov’t supply contracts in excess of $10,000, who work on gov’t contract.	Generally, employer must pay covered employees 1.5 times basic rate for all hours worked over 40 in a workweek in which any PCA work is performed by the employee.	Gov’t withholds funds and can collect back wages; $10/day fine each minor under 16 knowingly employed; debar from future contracts.	DOL, Wage-Hour Division	Yes
McNamara-O’Hara Service Contract Act (MOSCA)	Employers w/fed, gov’t service contracts in excess of $2,500 involving use of service employees.	Employer must pay specified minimum hourly rates and fringe benefits.	Gov’t can withhold funds and collect back wages; debar from future contracts.	DOL, Wage-Hour Divsion	Yes
Davis-Bacon Act	Federal public works contractor on contracts in excess of $2,000.	Employer must pay specified minimum hourly rates and specified fringe benefits.	Gov’t can withhold funds and collect back wages; debar from future contracts.	Contracting Agency and/or DOL, Wage-Hour Division	Yes
Copeland “Anti-Kickback” Act	Federal contractors, subcontractors, employers and foremen with respect to construction or repair of any public building or public work financed in whole or in part by loans or grants from U.S.	Federal contractors, subcontractors, employers, and foremen may not make deductions from pay (except for deductions permitted by 29 CFR Part 3 or pre-approved by Sec. of Labor) by force, threat, or intimidation; requires weekly reports of wages paid each employee on covered contract.	Fines of up to $5,000 or imprisonment for not more than 5 years.	Contracting Agency and/or DOL, Wage-Hour Division	No
Contract Work Hours and Safety Standards Act (CWHSSA)	Federal contracts for $100,000 or more, including construction, requiring employment of laborers and mechanics other than contracts subject to Walsh-Healey Public Contracts Act (PCA).	Employer must pay 1.5 times basic rate if the employees actually works more than 40 hours in a workweek on federal contracts or subcontracts.	Government can withhold funds and collect back wages; debar from future contracts; $10/day penalty for each day overtime worked without payment of proper overtime.	DOL, Wage-Hour Division	Yes
Executive Order 11246	Employers with gov’t contracts in excess of $10,000 in any 12-month period.	Requires anti-discrimination clause in contract plus written affirmative action plan for single contract of $50,000 and 50 employees.	Terminate contract; debar from contracts; collect back wages; prosecute for false statements.	DOL’s Office of Federal Contract Compliance Programs (OFCCP)	Yes
Rehabilitation Act of 1973, Section 503	Employers with gov’t contracts in excess of $10,000.	Requires affirmative action and nondiscrimination in employment of disabled persons. Written AAP required if 50 employees and a contract of $50,000.	Gov’t can withhold funds, collect back wages and require hiring, reinstatement or promotion; debar from future contracts.	DOL’s Office of Federal Contract Compliance Programs (OFCCP)	Yes
Rehabilitation Act of 1973, Section 504	Employer programs or activities receiving federal financial assistance.	Prohibits discrimination, denying benefits, or exclusion from participation, including employment , regarding any qualified disabled individual.	Gov’t can withhold funds and collect back wages; debar from future contracts; employee can sue for back wages and reinstatement or hiring; compensatory and punitive damages available.	Federal Agency responsible for providing financial assistance.	Yes (on EEOC’s consoli- dated poster)
Vietnam Era Veteran Readjustment Assistance Act (VEVRAA)	Employers with gov’t contract of $25,000 or more.	Requires affirmative action regarding Vietnam era veterans and disabled veterans; Written AAP Required if 50 employees and a contract of $50,000.	Gov’t can withhold funds, collect back wages, and require hiring, reinstatement, and promotion; debar from future contracts.	U.S. DOL’s Office of Federal Contract Compliance Programs (OFCCP)	Yes
Executive Order 12989	Federal contractors and subcontractors.	Dept. of Justice will receive complaints, investigate federal contractors or subcontractors for compliance with INA’s employment provisions.	Debarment form federal contracts for 1 year for “knowingly” employing illegal aliens.	Dept. of Justice	No
Drug-Free Workplace Act of 1988	Employers with federal contracts of $25,000 or more; all federal grant recipients.	Establish drug-free awareness program and make good faith effort to carry out; requires penalties or rehabilitation for employees convicted of workplace drug offenses.	Debarment from future contracts/grants.	Federal agency that contracts or provides assistance	None, but require distribution of certain information to all employees.

Long-Term Care Facts

What is long term care?

Long term care is the type of care that a person receives when they can no longer care for themselves. It includes a wide range of mostly non-medical services that are designed to help people maintain the maximum level of independence. Care can be custodial, intermediate or skilled in nature and can be provided in the home, community or institutional setting. Long term care can be provided in a formal or informal manner. Formal long term care refers to services that are paid for while family or friends provide informal care.

What is long term care insurance?

Long term care insurance indemnifies the insured for the costs associated with receiving care when they can no long take care of themselves. Long term care is designed to pay expenses that typically arise when someone is chronically ill. The three generic types of coverage are typically called nursing facility, home care and comprehensive, which includes both nursing and home care coverage. Mandated benefits vary by state of domicile. Check the policies in your areas for specific outlines of coverage.

Why does my client need long term care insurance?

Asset protection. Most people work hard all of their lives to build a nest egg. Unfortunately, when they get older and need long term care, they are often forced to liquidate or spend-down their assets due to the catastrophic costs of long term care. Due to the high cost of care many individuals are forced onto the welfare rolls and lose their independence. Many spouses of such individuals also suffer a diminished lifestyle.

Long term care insurance provides the liquidity necessary to pay for the high cost of caring for someone when they can’t take care of themselves.

The Health Insurance Association of America reports that the primary reason people purchase long term care insurance is asset protection, maintenance of the spouses standard of living, choice, quality of care, welfare avoidance, and peace of mind.

If my client has high assets why do they need long term care insurance?

People purchase various forms of insurance coverage to protect specific assets. They buy casualty insurance to protect their property, medical insurance to pay the bills when they get sick, disability insurance to protect their income if they become unable to earn a living and life insurance to provide liquidity for their survivors or to pay taxes. In each case they’ve chosen to pay for insurance coverage because it represents a low cost way to protect their assets against highly probability events. In fact they recognize the fact that insurance benefits represent a discounted dollar.

With the exception of death, the probability of needing long term care is higher than for the other risks that most people insure. Statistically more than 50% of us will eventually need long term care. The numbers are rising as we live longer.

Therefore, given the high probabilities and costs associated with the need for long term care, why would someone choose not to pay pennies on the dollar to protect their assets? If their rationale is that they may not need to use the coverage or that they can self-insure, then they ought to drop all of their insurance policies except their life insurance.

Doesn’t Medicare pay for long term care?

No. Medicare is designed to pay for the services associated with acute medical conditions. Medicare pays for a very limited amount of skilled care that is provided after a 3-day prior hospitalization. The care that Medicare covers includes skilled care only in a facility (less than 1% of all care provided in a nursing home) and some limited home health care designed to rehabilitate someone after a hospitalization. This rehabilitation is limited to skilled services such as respiratory, speech or physical therapy. Home health care does not include services associated with independent living such as housekeeping, meal preparation, shopping, etc.

What has to happen to my client to qualify for benefits?

Today, all long term care insurance policies pay benefits to the insured when they either suffer the loss of two of the activities of daily living or are diagnosed with a severe cognitive impairment (e.g. Alzheimer’s or dementia) such that they require some level of assistance in caring for themselves (contractual language varies from state to state). Some companies still offer a third benefit trigger, medical necessity, in their non-tax qualified policies.

The activities of daily living include eating, bathing, dressing, continence, toileting and transferring. In California non-qualified policy forms include ambulating.

What does the claims process look like for long term care insurance?

Generally, once the insured has suffered the loss of two activities of daily living or is diagnosed with a severe cognitive impairment, the insured, insured’s doctor and family and the insurance company enter into the case management, assessment and plan of care process. The insurance company either contracts with or employs case management professionals that assist the insured and their family in determining the care needs of the insured. This assessment process looks at the functional incapacity of the insured and from this a plan of care is created. This plan of care, or prescription for care, outlines the insured’s needs. The insurance company will base its claims payment on this plan of care and will periodically request that a new assessment be performed in order to assure that the insured is receiving the levels of care that they require.

Once the insured qualifies for benefits what will a long term care insurance policy pay for?

If the insured needs to go to a nursing home or some other institutional setting, the long term care insurance policy will pay for the expense associated with that stay up to the limits of the policy. In a home or community setting the policy will typically reimburse for such things as: adult day care, home care services (using the telephone, managing medications, assistance with moving about outside, shopping for essentials, laundry and light housekeeping), home maker services, hospice and respite care. These items can vary from state to state.

What is the best age to purchase long term care?

The 50s appear to be the best time to purchase long term care insurance. Premiums for people in their 50s are more affordable and the insurability issues facing insureds in their late 60s and early 70s are not typically a problem. Finally, many people in their 50s are business owners. Because of this they may be able to tax deduct some or all of their long term care insurance premiums.

What is the difference between tax qualified and non-tax qualified long term care insurance?

Tax qualified long term care insurance was created by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). It provides some levels of tax deductibility of premiums depending upon the insured’s status as a taxpayer. It also guarantees that the benefits, when paid, will be tax free.

Non-tax qualified long term care insurance policies exceed HIPAA guidelines for tax qualified plans. The premiums are never tax deductible and Congress has not yet determined the taxability of non-qualified benefits.

There are some who feel that tax qualified policies are not as comprehensive as non-tax qualified plans. For an in-depth discussion of this issue refer to my article on the subject entitled; Tax Qualified vs. Non-Tax Qualified: The Final Word?

Should an employer group consider offering long term care insurance to their employees?

The worksite is a great place to offer high quality individual long term care insurance to employees. It allows them to purchase programs at a lower premium than if they were buying it directly. A number of companies offer endorsed group discounts to employer groups, sometimes as much as 15%.

Additionally, owners of closely held C-Corporations can purchase tax qualified policies on a tax-favored basis for themselves and key employees.

What is the best long term care product?

This is the most frequently asked question. The answer is, it depends. The agent needs to answer many other questions before he/she gets the answer. We always look at a company’s financial ratings. In light of the fact that most insureds will not make a claim for 15 to 30 years from now, you want to put your clients with a company that is financially sound and isn’t playing games with low-ball rates and overly aggressive underwriting.

The next question that needs to be answered is who is my client. Companies typically niche their products by age of insured and by health. This means that carriers focus their rate structure on specific age bands. Also, some are only preferred risk carriers while others are more aggressive and willing to consider special risks.

Finally, what benefits to you wish to offer? Some companies offer basic benefit packages. Others highlight certain “bells and whistles” that may appeal to other clients. Therefore, before you ask who is the best company you need to answer the question, who is my client.

What is the California Partnership for Long Term Care Insurance?

The California Partnership for Long Term Care Insurance (CPLTCI) is a partnership between state government and a handful of insurance companies. The primary purpose is to encourage people to protect their assets by purchasing a specially qualified long term care insurance policy. The inducement for the buyer is protection against Medi-Cal asset spend-down.

CPLTCI policies typically meet or exceed traditional policies in terms of benefits with the added advantage of asset spend-down protection. While they may not be for everyone anytime an agent in California proposes anything less than lifetime benefits, they need to advise their client of the CPLTCI option. It is usually in the client’s best interest to consider a Partnership plan because of the spend-down feature.

Resources For Employees

Eye Care -Laser Correction

Lasik
Laser in-situ keratomileuis (Lasik) is a laser refractive procedure in which a portion of the outermost layer of the eye is temporarily pulled away to allow a laser beam to make direct contact with the stroma of the cornea. The laser beam is used to reshape the cornea so that it focuses light properly into the eye. The outer layer of the eye is then replaced. Recovery time after a Lasik procedure is usually very short, often a matter of hours, and patient satisfaction with the procedure is very high. The procedure is nearly painless, and it can be used to treat myopia, hyperopia, and astigmatism. Lasik was introduced in the mid 1990’s, and is now the most commonly performed laser vision correction procedure.

PRK
Photorefractive keratectomy (PRK) was one of the first laser refractive surgery procedures performed to correct vision defects. In PRK, the outermost layer of the eye is removed, and then a laser beam is used to reshape the cornea. PRK can be used to correct myopia, hyperopia, and astigmatism, and results are fairly predictable. The removal of the outermost layer of the eye can result in significant discomfort, long recovery time, and the need for steroid drops to reduce inflammation in many patients. PRK was introduced in the early 1990’s.

RK
Radial keratotomy (RK) was introduced in the 1980’s as a surgical technique to correct myopia. RK involves surgical scarring of the peripheral cornea to change the curvature of the cornea. Small incisions are made at even intervals around the surface of the eye. As the incisions heal, scar tissue develops and causes the cornea to reflect light at different angles. RK outcomes are often unpredictable and rely heavily on the individual surgeon performing the procedure. It also introduces the possibility for serious eye damage and compromises the integrity of the eye. Since the introduction of the laser refractive procedures, RK has rarely been performed in the United States.

AK
Astigmatic keratotomy (AK) is a variation of RK that corrects astigmatism. In AK, incisions are made in the eye at angles instead of at even intervals. AK, like RK, is rarely performed in the United States due to the significant potential for complications and the introduction of laser refractive procedures.

Back Care Tips

Here are 20 tips for maintaining a healthy back:

1. Know your limits. Don’t lift heavy objects. Ask for help.

2. Stop and think. When lifting and carrying objects, keep feet apart for balance, bend knees to lower yourself, and lift objects close to your body. Remember to let your legs do the lifting, not your back.

3. Pivot. Your shoulders, feet and hips should face forward at all times when you are lifting or carrying. Pivot with your feet — don’t twist!

4. Push instead of pull. Whenever you can, push instead of pull objects. You have twice as much power and less chance of injury.

5. Balance. Your lower back and stomach muscles help to form good posture. Therefore keep them equally strong.

6. Sitting. Avoid sitting for long periods of time. Change positions and walk around often.

7. Standing. Vary your positions, keeping knees slightly bent. Alternate feet, resting one foot on a higher surface when you stand for long periods of time.

8. Sleeping. A firm mattress provides the best support for your back. Avoid sleeping on your stomach.

9. Driving. Move the car seat forward and sit with your knees higher than your hips. Be sure your back is fully supported — a small pillow or rolled towel works best.

10. Stay active. Participate in an active lifestyle to improve your tolerance to back pain and stress.

11. Strengthen and stretch. A regular exercise program will strengthen key muscle groups and increase your flexibility. A strong, flexible back will reduce your risk of injury.

12. Stomach muscles. Eighty percent of all back problems are the result of weak stomach muscles. Don’t neglect them. A strong stomach provides a “brace” that keeps your back stable.

13. Before you begin. Consult your doctor before beginning a new exercise program, especially if you already have a back problem.

14. Caution. When you feel back pain, tingling, numbness or weakness in your legs — STOP your activity!

15. Shoes. Avoid high heels. Focus on comfort and support, not price savings or fashion.

16. Relax. Release all tension from your back muscles. Recognize and feel your muscles in their relaxed state. Deep breathing, massage and stretching will help you relax.

17. Weight control. Maintain recommended body weight. Excess weight increases the stress on your lower back.

18. Good posture. It starts in the lower back. Use your stomach muscles to give you a lift. Stand and sit tall with your shoulders in line with your hips to avoid headaches, neck and upper back pain.

19. Common sense. Taking care of your back is mostly a matter of awareness, prevention and good habits.

20. Still need help? For additional information, ask your physician.

Social Security Statement

Go to the Social Security website and request your updated statement today by clicking here.

Health Savings Accounts (HSAs)

HSA Health Savings Account

What is a Health Savings Account?

An HSA is a savings account that you use to pay for your routine health care expenses.
HSAs contain funds that are owned and controlled by you, the account holder.
HSA savings rollover every year for your health care expenses and/or retirement.
An HSA is portable, the funds remain with you regardless of employment.

What power does an HSA give you?

The power to choose the health care professionals, services, and products that are best for you.
The power to save money by purchasing a lower-cost, high-deductible insurance plan. HSA funds pay for your qualified and routine health care expenses; insurance kicks in when you have extraordinary health care expenses.
The power of financial security and retirement planning with HSA contributions that are tax deductible and earn interest tax deferred.

To open an account and receive more information you can call HSA Bank at (800) 357-6246 or go to their website at www.hsabank.com

Feel free to call our office for further assistance.

General
Resources

Government Agencies

Agency for Health Care Policy and Research (practical health care information and research to help consumers make informed decisions about health care issues).

www.ahcpr.gov

Bureau of Labor Statistics

www.bls.gov/blshome.htm

California Department of Insurance

www.insurance.ca.gov

Centers for Disease Control (CDC)

www.cdc.gov

Constitution

www.house.gov/Constitution/Constitution.html

Consumer.gov (a “one-stop” web site to access multiple federal consumer information resources).

www.consumer.gov

Consumer Product Safety Commission Washington, DC 20207 (800) 638-2772 toll-free hotline (800) 638-8270 toll-free hotline for hearing impaired email: info@cpsc.gov

www.cpsc.gov

Department of Education

www.ed.gov

Department of Justice

www.usdoj.gov

Department of Labor

www.dol.gov

Department of Transportation

www.dot.gov

EEOC

www.eeoc.gov

Federal Unemployment Compensation

www.doleta.gov

Food and Drug Administration, Office of Consumer Affairs FDA/HFE-88 5600 Fishers Lane Rockville, MD 20857 (800) 532-4440 or (301) 443-3285 (301) 443-9767 fax

www.fda.gov

Health and Human Services (HHS)

www.hhs.gov

HealthFinder – a gateway site to help consumers find health and human services information quickly

www.healthfinder.gov

Internal Revenue Service

www.irs.ustreas.gov

Mammography – listing of FDA certified facilities providing mammography

www.fda.gov/cdrh/faclist.html

Medicare

www.medicare.gov

Medline – published medical information coordinated by the National Library of Medicine

www.njm.nih.gov

National Institute on Aging – covers a wide range of topics including specific diseases, health conditions, treatments and research

www.nih.gov/nia

National Senior Citizen Law Center

www.nsclc.org

National Technical Information Service (NTIS) – part of the Department of Commerce, this site has information on US government products that deal with health and safety

www.ntis.gov

NIH – access point to the consumer health resources of the National Institutes of Health

www.nih.gov/health
NIOSH (National Institute of Occupational Safety and Health) 4676 Columbia Parkway Cincinnati, OH 45226 (513) 533-8328

www.cdc.gov/niosh/homepage.html
Occupational Safety and Health Administration

www.osha.gov
OSHA (Occupational Safety and Health Administration) Information and Consumer Affairs (202) 219-8151

www.osha.gov

Pension Benefit Guaranty Corporation

www.pbgc.gov

Social Security Administration

www.ssa.gov

Social Security Handbook

www.ssa.gov/OP_Home/handbook/handbook-toc.html

State Payroll Tax & Revenue

www.payroll-taxes.com/websites.html

Women’s Health Information Center – a ‘gateway’ site that has attempted to organize information on health issues for women, including links to government clearinghouses and many private sector organizations (800) 994-WOMAN

www.4woman.org

Additional Insurance Terms

Co-insurance

The amount you must pay for medical care in a point-of service plan (POS) or preferred provider organization (PPO) after you have reached your deductible. It is often a percentage of bills charged.

Co-payment

A charge you pay for medical services. Your health care plan covers the remaining medical charges. As an example, you may pay $10.00 for an office visit or a prescription.

Deductible

The amount of money you must pay each year for coverage to your medical care expenses, before your insurance policy begins to pay.

Exclusions

Specific conditions or circumstances in which the policy will not offer benefits.

Fee- for- Service

Payment agreements for health care in which the provider is paid for each service, rather than a pre-negotiated amount for the patient.

HMO- (Health Maintenance Organization)

Prepaid health plans for which a premium is due each month. The HMO covers your cost of care to see a doctor within their working network at pre-negotiated rates. You are required to choose a primary care physician who takes care of you and makes referrals to any specialists you may need. If you, as an HMO member, do not use the doctors, hospitals and clinics that do not participate in your plan’s network, you may be required to pay the cost of those medical services.

IPA (Independent Practice Association)

An independent group of physicians who unite with an HMO to offer services for the HMO members.

Lifetime Maximum

The maximum percentage of benefits available to a member during their lifetime, in which, all benefits served are subject to this limit unless stated as unlimited.

MSA (Medical Savings Account)

A tax-advantaged personal savings account used along with a high deductible health policy. You may deposit money into this account on a pre-tax basis to set aside money for medical care and expenses that qualify, including annual deductibles and co-payments.

Out-Of-Pocket Maximum

The highest amount of money you will pay in a year for deductibles and coinsurance plus regular premiums.

Point-Of-Service (POS) Plan

A certain managed care plan combing features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). You may choose whether to go to a network provider and pay a flat dollar amount or to an out-of-network provider and pay a deductible and/or coinsurance charge

Pre-existing Condition

A health problem that existed or was treated before your insurance became in effect. Most health insurances have a pre-existing condition plan that describes under what conditions they will cover medical expenses that relate to a pre-existing condition.

PPO (Preferred Provider Organization)

A network of health care providers that offers medical services to health plan members at a discounted cost. PPO members usually make their own decisions about their health care instead of going through a primary care physician like an HMO member. The costs to use physicians within the PPO network are less than using a non-network provider.

Premium

The amount you must pay in exchange for health insurance coverage.

Primary Care Physician

Under a health maintenance organization (HMO) or point-of-service (POS) plan, a primary care physician is often the first contact for health care. It is usually a family physician, internist, or pediatrician. A primary care physician makes referrals to specialists if necessary.

Provider

Any person (doctor or nurse) or institution (hospital, clinic, or laboratory) which is certified, that provides medical care.

Well Baby

Health services, which include immunizations provided by the member’s participating medical group, up to a certain age as specified by the carrier. This benefit is usually provided in HMO plans and/or POS plans. The level of benefit will vary for PPO plans if specified as a benefit.

Financial Calculators

Make sure to single-click the following links for easy to use financial tools and on-line calculators to help you answer many of your financial questions.

Click here to find useful calculators and articles regarding you finances, spending, and planning.

Click here to find useful calculators specific to your life insurance needs. You will be able to quickly find answers to any of the following questions:

How much life insurance do I need?
What is my return on a whole life policy?
What is my return on a universal policy?
What is my return on a variable life policy?
Which is better: term or whole life?
Which is better: term or universal life policy?
Which is better: term or variable life policy?

Credit Union

A credit union is a nonprofit financial institution organized to provide checking and savings accounts, loans and other financial services to its members. It is both owned and controlled by its members, with each member having an equal vote and the opportunity to serve on the board of directors. Credit unions are either state or federally chartered. State-chartered unions are supervised by a state regulatory agency. Those with federal charters are supervised by the National Credit Union Administration. Much as bank deposits are guaranteed for up to $100,000, credit union accounts are insured for up to $100,000 each by the National Credit Union Share Insurance Fund.

How can I join a credit union?

Technically, membership in a credit union is limited to people who share a common bond, such as the same employer or the same industry. But membership rules have been greatly loosened over the past several years. Contact the Credit Union National Association, P.O. Box 432, Madison, WI 53701, for the address of your state’s credit union association. The state association, in turn, can provide you with the names of credit unions in your area that you may be able to join.

Are savings and borrowing rates better at my credit union than elsewhere?
Credit unions often offer very competitive rates on everything from savings accounts to auto and home loans, in part because they are nonprofit agencies and have no taxes to pay and no investors to satisfy. They also have lower marketing costs and overhead than commercial institutions. Thus, they can pay their members above-average rates on deposits and charge below-average rates on loans and credit cards.

Are savings at a credit union insured by the FDIC?
Although credit unions generally pay higher rates on savings accounts and other types of investments than banks and S&Ls do, those higher rates don’t necessarily translate into higher risk. That’s because each account is insured for up to $100,000 by the National Credit Union Share Insurance Fund, the credit union’s equivalent of the Federal Deposit Insurance Corp.

Request Group Benefit Quote

Group Quote Form

Request Quote

Casualty Insurance

What really does a homeowners policy cover?

Request Commercial Quote

Resources

Resources For Employers

COBRA & HIPAA Compliance

HIPAA Highlights

Section 125 Plans (Cafeteria Plans)

FUTURE FLEX PLAN

Federal Employment Laws

Wages, Hours & Conditions of Employment

Federal Contractors and Subcontractors

Employment Practices

Taxes, Insurance and Employee Benefits

Labor Relations

Safety

Garnishment

Privacy