insurance


SHE SAYS:

Open enrollment is the time to enroll eligible employees who are not currently part of your group plan or to make changes from your current plan to a new plan.  Open enrollment changes become effective January 1, 2012 therefore, now is the time to review your current plan and make necessary changes.

The turmoil in the health care industry that started last year due to Obamacare continues as carriers and State Departments of Insurance are still trying to comply while balancing their bottom lines.  Some carriers are pre-emptively beginning to implement components of it in their Underwriting Guidelines in 2012 even though it won’t be mandatory until 2014.

Despite underwriting constraints, limitations and perhaps changes in how you will obtain health insurance that will come with the new health care laws, USFSB has a solution for you.  Through an enhanced relationship with one of its carriers, Capital District Physician Health Plan (CDPHP), USFSB is offering a wide range of health insurance plans with competitive prices to our members within 26 counties in New York State through CDPHP.   In addition to these CDPHP plans, we continue to offer quality plans with many other carriers.

As you begin to look for new options, please search for plans by going to www.usfsb.com where you will find all of the information you will need to facilitate a change.

Click on the Small Business Insurance Clearinghouse link and enter your zip code to view the plans available to you.  Select a plan and then to view and print a summary of benefits or application click on View Details or Fill out Application.

As always, we are here to help you! 

WHAT DO YOU SAY?

HE SAYS:

In today’s world many people think only of the cosmetic benefits of having nice white, straight teeth when they think of good dental health.   Even though our appearance is important and should not be overlooked, good dental health is much more than just having a winning smile.

In fact, poor dental health and untreated diseases of the mouth can have a significant impact on the quality of your life and the state of your health.   According to the Surgeon General, more than 75 percent of Americans are affected by some type of periodontal disease or gingivitis.   These infections of the gums cause oral and facial pain and can lead to tooth loss.

Even more distressing is that medical research has shown that the bacteria that causes infections and inflammation of the gums can dislodge and find its way into the bloodstream.   When this happens your arteries can become inflamed and greatly increase your risk of suffering a heart attack or stroke.   Many medical experts believe that gum disease is a more serious risk factor for heart disease than hypertension, smoking, cholesterol, gender and age.

Poor dental and oral health can lead to many other serious illnesses, including the obvious, oral cancer, and the less obvious, such as intestinal failure, Irritable Bowel Syndrome and other problems of the digestive process.

There is a proven link between your dental and oral health and the general state of your overall health.   Many diseases can be diagnosed in their early stages through an oral exam.   These diseases include diabetes, leukemia, cancer, heart disease and kidney disease.

Dental illnesses also cost your business money.  Each year, poor dental and oral health results in 100 million lost work hours, 6.1 million days of bed disability and 12.7 million days of restricted activity.

Everyone should keep their mouth healthy by seeing a dentist at least twice a year; however, more than half of all Americans do not visit a dentist on a regular basis.  Regardless of the cost, it may be wise to put your money where your mouth is and make sure you and your family enjoy good dental and oral health.

WHAT DO YOU SAY?

This is the final part of a three-part series on Medicare. The first two parts can be viewed here and here.

HE SAYS:

Medicare, Part C is, collectively, Medicare Advantage Plans (like an HMO or PPO) that are sold by private insurance companies that are approved by Medicare.  These Plans combine Part A and Part B coverage.  In most cases, Part C plans are a lower cost alternative to the Original Medicare Plan and usually provides extra benefits and includes prescription drug coverage.

Medicare, Part D is the prescription drug coverage insurance that is provided by private companies approved by Medicare.   Much like Part B, you need to enroll when you first become eligible to keep from paying a penalty cost later.

There are two ways to join the Medicare prescription drug plan.   The first is by adding it to your Original Medicare Plan (Part A) as a stand-alone coverage or as part of an approved Medicare Advantage Plan you purchase from a private insurance company such as an HMO or PPO plan (Medicare, Part C) that includes Part D coverage.   If you add it to the Original Medicare Plan, you will pay a separate fee or yearly deductible.  Most Part C private plans already include the prescription drug coverage.

This is the standard Part D drug prescription plan for 2011 measured as a yearly benefit period required by Medicare:

A.  You may be required to pay the first $310.00 of your drug costs as your yearly deductible.

B.  You then pay a co-payment until your co-payments and the portion paid by Medicare reaches a total of $2,840.00.

C.  Once you reach $2,840.00 you are in the coverage gap (or what is now famously known as the “donut hole”).   Previously, you had to pay the full cost of your prescription drugs during this gap; however, starting in 2011, you receive a 50% discount on covered brand name prescription medications.   The intent is that by 2020, the gap will be fully closed and you will only pay your co-payment.

D.  Once your out-of-pocket costs, including your deductible and co-payments, reach a total of $4,550.00 your coverage gap ends and Medicare will then pay most of the costs of your prescription medication for the remainder of the year.

There are many decisions to make when entering the world of Medicare and you should explore all of your options so that so are ready to make your choices when you turn 65.

WHAT DO YOU SAY?

This is the second part of a three-part series on Medicare.

HE SAYS:

Unlike Part A, Medicare, Part B is elective and is not free.  You pay a monthly premium which may change on January 1st of each year.   The monthly premium for 2011 is $110.50 unless your annual income is over $85,000 for individuals or $170,000 for couples.   The monthly premium may be even higher if you did not choose Part B when you first became eligible at age 65.   In fact, the cost of Part B may go up 10% for each twelve month period that you could have had Part B but did not sign up for it.

You can sign up for Part B any time during a 7 month period that begins 3 months before you turn 65.   If you choose to have Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payments.   If you do not receive any of these retirement payments, Medicare will bill you for the premiums.

Medicare, Part B, helps pay for Doctor’s services; outpatient medical and surgical services and supplies; diagnostic tests; ambulatory surgery center facility fees for approved procedures; durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers; and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care, when these services are medically necessary.  Medicare, Part B, does not pay for prescription drugs, cosmetic surgery, and routine physical exams.

You may go to any Doctor or hospital that accepts Medicare and a fee is charged each time you receive a service.   Medicare pays its portion of the fee and you pay the balance of the fee.   If you go to a Doctor or hospital that does not accept Medicare, you will have to pay the full charge and Medicare will send you its share of the costs.

The portion paid by Medicare, Part B, is measured by a Benefit Period which is based on a calendar year.  The portion not paid by Medicare, Part B, is paid by you as a deductible.   The Medicare, Part B, deductibles for 2011 are as follows:

1.  Medical and other Services: Once each calendar year, you pay a deductible of $162.00 and, then, 20% of all Medicare approved amounts after the deductible.

2.  Outpatient Hospital Services: You pay a co-insurance or fixed co-payment which may vary according to the service, but never higher than the Part A deductible of $1,132.00.

3.  Home Health Care: You pay nothing for Medicare approved services, if you meet certain conditions established by Medicare.

4.  Durable Medical Equipment: You pay 20% of the Medicare approved amount.

5.  Outpatient physical and occupational therapy: You pay 20% of all costs.

6.  Most Diagnostic Tests: You pay 20% of the cost after the $162.00 deductible.

One important right you have with both Medicare, Part A and Part B, is that you can obtain emergency care when and where you need it.   You do not need approval from your health plan.   If you think your health is in serious danger because you have severe pain, a bad injury, sudden illness, or an illness quickly gets worse, you can get emergency care anywhere in the United States.

The next installment will be about Medicare, Part C and Part D.

WHAT DO YOU SAY?

Today we present the first part of a three-part series on Medicare. It will run on Mondays.

HE SAYS:

We all realize that as we age not only does the risk of illness increase; but, also, we must face the prospect of increasing health care expenses.   With this in mind, the Federal Government created the Medicare Program in an effort to help with the health care expenses we will all face as we grow older.

Medicare, Part A, also known as the Original Medicare Plan or “fee-for-service”, is automatically available to you, without cost, when you turn 65 years old if you or your spouse worked and paid Medicare taxes.   If you or your spouse did not pay Medicare taxes while working, you still may be able to buy Part A coverage when you turn 65 years old.

Medicare, Part A, helps pay for care in hospitals as an inpatient, critical access hospitals, skilled nursing facilities, hospice care, and some home health care.  You may go to any hospital that accepts Medicare and a fee is charged each time you receive a service.   Medicare pays its portion of the fee and you pay the balance of the fee.

Medicare, Part A, helps pay for hospital stays in a semi-private room and includes, general nursing and other hospital services and supplies.  It does not cover private duty nursing, telephone or television expenses or a private room, unless medically necessary.

The portion paid by Medicare, Part A, is measured by a Benefit Period which begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any facility for 60 days in a row.  

The portion not paid by Medicare, Part A, is paid by you as a deductible.   The Medicare, Part A, deductibles for 2011 are as follows:

1.  Hospitalizations:  During any Benefit Period, you pay $1,132.00 for the first 60 days; $283.00 per day for the 61st through 90th day; $566.00 per day for the 91st through 150th day; and all of the expenses after the 150th day.

2.  Skilled Nursing Facility Care: During any Benefit Period, you pay none of the approved expenses for the first 20 days; $141.50 per day for the 21st through 100th day; and all of the expenses after the 100th day.   You must meet Medicare’s requirements, including having been in a hospital for at least three days and entered a Medicare approved facility within thirty days after leaving the hospital.

3.  Hospice Care:   As long as your doctor certifies that you are terminally ill and you elect to receive these services, you pay none of the approved expenses, except for a very limited co-insurance for outpatient drugs and inpatient respite care.

As you can see, even though helpful, Medicare, Part A, still leaves you with potentially devastating health care costs if you are ill and hospitalized for any length of time.

In the next installment we will outline the benefits of Medicare, Part B.

WHAT DO YOU SAY?

SHE SAYS:

We are currently in the midst of USFSB’s open enrollment process.   This is always a difficult time for USFSB’s employees since we, by necessity, become the messenger that has to convey to our Members the insurance carriers’ ever increasing premiums which, of course, tend to make our Members upset.

The Open Enrollment Period is when the insurance carriers assess their products and benefits, make changes and issue their new annual rates.   It is also when our Members have the opportunity to change insurance plans or carriers.   This period, for USFSB, begins in October when we start to meet with our insurance carrier representatives to discuss their proposed plans, benefits and rates for the coming year.  At that time, we also determine which of their available new or existing plans we can offer.  In November, we receive the new rates and open enrollment culminates in January when all of the changes are finally completed.

This is the busiest and most stressful period of time for our employees.  Once we have decided on the insurance plans and received the new rates everything must then be organized and entered into our computer system both for billing purposes as well as to update the Insurance Clearing House section of USFSB’s web site.   This can be a difficult and arduous process since, in many cases, the insurance carriers are not able to provide the new rates until the last minute. This puts USFSB in the position of having to scramble to get everything entered in time so that we can notify our Members by December 1st of the new rates and their options if they want to change plans or carriers.

Our custom computer system makes the job a little easier then it was in years past and we are able to provide our Members with a custom grid that gives them all of their options in a very clear and organized fashion.  Then the real fun begins as our Members call with their questions and concerns which we take pride in answering with the best information possible so that they can feel comfortable with their current plan or make a well reasoned decision to move to a different plan or carrier.

Even with these helpful tools and all of the efforts of our employees, open enrollment often feels like a runaway train that might fall off the tracks at any moment.   However, we manage to keep everything under control even if we are a bit frazzled by January. 

The biggest problem for me is that every year the premiums go up and USFSB is always put in the position of being the bearer of bad tidings, during the holidays no less.   We do everything we can to help our Members get through open enrollment as painlessly as possible and try to be the one safe port in this storm of ever rising insurance premiums.

WHAT DO YOU SAY?

HE SAYS:

Insurance is one of those ironies of life.   You know you should buy it; but, you hope you will never need to use it.

There are many types of insurance that are designed to cover many types of risks.   Life Insurance, of course, is unique in that you will only use it once and never for your own benefit.   Property & Casualty Insurance as well as Auto Insurance is, primarily, meant to protect your assets from damage or from the claims of those you may have injured.

Arguably, the most important type of insurance is Health Insurance.    It has been said that of all of the things we may possess, good health is our most prized possession.    Since most of us are not so wealthy that we can afford to risk the expense of long and costly health care, health insurance becomes an important safeguard to have in place.

Yes, it is true that Health Insurance premiums continue to increase at an alarming rate making it almost impossible for some small businesses to obtain adequate health insurance coverage for their owners and employees.    However, we must accept the fact that there is always a price to pay to get what we need; and, it is hard to argue that we do not need Health Insurance.

Whether we are young or old; active or sedentary; come from a good gene pool or have a family history working against us, we all run the risk that we or a family member will become seriously ill or injured sometime during our lives.  Short of an unlimited source of money, we can only protect ourselves from such an unfortunate circumstance with Health Insurance.

Health Insurance not only provides the obvious benefits to you and your family, it can also help keep you in business.   Without Health Insurance, the expenses of any extended health care and treatment could wipe out your savings and force you to lose both your personal and business assets.   Further, many Health Insurance Plans provide for the costs of preventative health care which can go a long way to reduce absenteeism and boost the productivity of you and your employees.

It is becoming nearly impossible to live with the rising cost of Health Insurance; but, can we really live without Health Insurance.   Time will tell if health care reform helps or only serves to make matters worse.

WHAT DO YOU SAY?

Next Page »