• Companies could help lagging spirits with better wellness programs
• Group long term care insurance: The missing link
• Co-pays discourage women from getting mammograms
• Health care in the 21st century
• Dental benefit solutions in an era of increasing demand
• Kids program saves $7.3M in health care costs
• Keep life and disability insurance relevant
• Employees need to be educated on health insurance terminology
• Health costs rise faster than insurance premiums
• Health insurance a top priority for employees
• Exercise Corner: Promoting and Prescribing Exercise for the Elderly
• Recipe Corner: Marbled Strawberries - A great treat for Valentine’s Day

A surprisingly low percentage of employees indicate a desire to exercise, making it all the more important that employers promote wellness programs at their worksites, according to a new study released this week by ComPsych.
The study, based on responses from more than 1,000 clients, reveals that just 23% of employees report feeling highly motivated to exercise. Forty-two percent report being highly motivated to eat right, and another 67% say they would be likely to use an employer-sponsored wellness program, if offered.
“[W]e are still seeing a general lack of accountability for achieving personal health,” remarks Richard Chaifetz, chairman and CEO of ComPsych, a Chicago-based provider of EAPs, behavioral health and work-life services.
Chaifetz indicates workers are seeking outside professional health services on an increased basis, such as the guidance of personal trainers. Nonetheless, employers should strive to improve their corporate wellness programs, he states.
“For lasting health improvement,” says Chaifetz, “wellness programs must coach and inspire workers to take responsibility for their lifestyle choices and give them the tools to self-manage their health.”
Other findings of the report include:

• Employees said a personal coach was the No. 1 motivator to help them improve their health and lifestyle, more so than days off work.
• 87% said they were interested in an employer-sponsored wellness program.
• Appearance, not health, was the most important motivator for both eating right and exercising.
• Employees reported having low levels of energy and longing for physical activity during the day to help boost energy levels.
• 74% said health and lifestyle had a significant impact on productivity, and lack of energy was reported as the No. 1 hindrance to productivity.

Source: January 24, 2008

By Allan Checkoway
Disability Services Group/ElderCare Publishing Inc

When employers begin to look at the value and cost of their benefit packages in 2008, regrettably, their focus will again be almost exclusively on the cost of medical insurance. A recent news story headlined that General Motors spends more these days on employee benefits than for the steel that goes into their automobiles. I’ve had other clients say the cost of their benefit program represents one of the two or three largest vendors they pay money to.

It’s understandable that when one of the top three line items on corporate financial statements is “health care,” CFOs agonize. They can monitor and manage the expense of office supplies and other business-expenses insurance but not the cost of their medical insurance.

The utilization of higher co-pays, deductibles and passing on increasing premium rates to employees is now commonplace. Employees wait for the next cut in medical benefits and/or added costs that will now shift to them. Employers look for positive ways to present the bad news.

So why state the obvious to employee benefit brokers who would rather not be reminded of what they already know?

Augmenting benefits packages

My purpose is to stress that over the last decade, we’ve seen limited innovation and expansion of benefit packages; an employer’s focus on their balance sheets leaves little room for being open to spending corporate dollars on adding new benefits.

Naturally, the focus on the cost of medical insurance continues to be the primary attention getter for corporate employee benefit advisors as well. Regrettably, too many of us in the benefit advisory community have limited motivation to seek out other (new) employee benefits. As a consequence, corporate America is not delivering expanded benefit packages to the detriment of their employees. Therefore, don’t we, as professional advisors, still have an obligation to our clients to better develop our creative resources?

What can we be doing better?

Today’s employee benefit programs are missing the most important link to the asset preservation of future retirees. During the working years, a sound benefit package offers a balance of medical, dental, life and disability coverage; these benefits are all tied to active full-time employment.

Medical benefits terminate when replaced by Medicare. Disability insurance, both long (LTD) and short term (STD), insures our earnings prior to age 65. When earned income stops, the need and ability to insure those earnings against the risk of long term disability does not continue. However, please keep in mind that 70-plus percent of retirees today continue working without disability insurance — they can’t afford to do it any other way.

Now that our 65-year-old worker is joining the ranks of the nation’s retirees, what’s missing? Have they made the mistake of waiting until retirement time to consider purchasing long term care insurance for the first time? Yes, almost always!

Aren’t we all actively seeking ways to keep competitors out of our accounts? Then why, in 2008, are more than 90 percent of employee benefit advisors nationally still not actively recommending long term care insurance to our clientele? Now, we know that 72 percent of retirees today can expect to need long term care in their lifetimes. And, the average duration of an extended caregiving “event” in 2008 is projected to cost over $300,000. How many of us can afford to self fund a $300,000 risk?

So, our mission is, as professional benefit advisors, to help employees begin to insure this risk now, during their working years. We also want to help them lock in group long term care rates for the rest of their lives. So, how do we accomplish this, by offering a benefit that’s readily affordable to the employer?

In a 100-life group, an employer can offer a “core” long term care plan with a minimal $2,000/month benefit for only $25 per month per employee. Yes, a $2,000 per month benefit with two-year duration is inadequate. But each employee now has the right to buy up to $6,000 per month in coverage without medical evidence of insurability.

Source: ProducersWeb.com, January 16, 2008

A Brown University study of Medicare participants indicates that many older women pass on having annual breast cancer exams because of the percentage of the cost or co-pay for the procedure.

In fact, although the cost of the co-pay is sometimes as small as $10, mammogram screening rates were more than 8 percent lower among women required to pay a co-pay compared to those with full coverage, according to reports.

The study of approximately 367,000 women between the ages of 65 and 69 — all participating in Medicare managed health plans between 2001 and 2004 — finds that the number of women covered by plans requiring co-pays for the exams increased from less than 1 percent to more than 11 percent throughout the years studied.

As a result of these findings, researchers conclude that Medicare should consider dropping co-payments for these exams, as they have proven beneficial in detecting cancer early on — when it’s most treatable.

Source: ProducersWeb.com, January 24, 2008

As we enter 2008, “do it yourself” seems to be the new trend — we’re far less dependent on other people than we were just a few years ago. Thanks to a number of technological advancements, we’re now able to pay at the pump, check out our own groceries, and develop our own photos. ATMs can perform most of the services we previously needed a bank teller for, and similar machines now help us avoid the painfully long lines at the post office.

We are a mobile society, as well. Cell phones are no longer just for emergencies. In fact, many people don’t even have a home phone anymore. And today’s cell phones can do much more than just make calls. Our mobile phones also serve as our address book, calendar, camera, calculator and e-mail device. And when we do need a real computer, laptops with wireless connections allow us to do our work almost anywhere in the world.

All this technology is great, but like a kid with too many toys, we run the risk of getting spoiled as we get more and more used to all of the conveniences we now enjoy.

Nearly 20 years ago, Frasier Crane asked, “If we can put a man on the moon, why can’t we put metal in the microwave?” As a society, we don’t seem to have a lot of patience with things that don’t work the way we feel they should.

Perhaps that’s the reason people are so frustrated with our health care system right now. Prices continue to rise at an alarming rate, in large part because of amazing advancements in health care, yet there are still a number of obvious inefficiencies that drive up costs and annoy both patients and providers. Perhaps a story will help to illustrate this.

Arnold, who works for a printing company with about 50 employees, has just learned that his employer, in an attempt to get the employees more involved in their health care decisions, is replacing their traditional PPO plan with a high-deductible plan and an up-front health reimbursement arrangement, or HRA. This fund, Arnold is told, is used to pay for routine medical expenses like doctor visits and prescriptions, but when the money is gone he will be responsible for additional expenses until he meets his deductible, so it’s in his best interest to shop around for his health care. Arnold will receive both an ID card and a debit card, and he is told to present both cards when he goes to the doctor or picks up prescriptions. Arnold’s a pretty bright guy, so to him the plan sounds like a piece of cake. He’s happy with the company’s decision.

Not too long after he receives his cards in the mail, Arnold develops a weird rash and decides to seek medical attention. Because he doesn’t have a dermatologist, he goes to the insurance company’s Web site to find a doctor. No problem at all — the site is easy to use and there are a number of providers right in his area. The problem is, Arnold has no idea how much the doctor visit will be and can’t seem to find this information anywhere on the Web site. But the rash is beginning to itch, so Arnold heads to the doctor anyway, now as worried about the cost of the visit as he is about his medical condition.

When he gets to the doctor’s office, he signs in and is asked to fill out a medical health history page. He explains that he has filled out a similar form in the past. Can’t his family doctor just e-mail the information to them? Nope. He’s told that they just have paper records — he’ll need to fill out a new form.

Fifteen minutes later, Arnold returns to the window with the health history sheet complete. He is asked for his insurance information, so he hands over both of his cards. The admin person photocopies both and calls his insurance company to verify benefits, which takes her almost 10 minutes. Finally, Arnold gets the green light and a few minutes later is called back to see the doctor.

The doctor is friendly enough, and after a three-and-a-half minute visit, he prescribes a cream for Arnold’s rash. Arnold is directed to the payment area, where he encounters another admin person. How would you like to pay?, she asks. He says that she should use his HRA debit card and asks her how much the visit will cost. She explains that she doesn’t have that information; she will have to charge the full retail price right now but will send the bill to the insurance company to be re-priced. When Arnold receives his EOB, or Evidence of Benefits, in the mail, he will need to call the doctor’s office to request a refund for any overcharge.

Source: ProducersWeb.com, January 1, 2008

By Brian Watts
First Dental Health

Today, most Americans understand the importance and value of going to the dentist. And, employers understand the popularity and value of providing their employees with dental benefits. These two facts should make selling dental plans a snap, right? Unfortunately, the law of supply and demand is making it more difficult for employers to afford dental benefits. But, by recognizing the current dynamics of the dental industry, brokers can provide better and more affordable dental care options for their group clients.

Demand for dental care is up

When I was growing up, going to the dentist was something you did only if you “had to.” Today, adults go to the dentist voluntarily for a number of aesthetic services such as teeth whitening, which is one reason why cosmetic dentistry is the fastest growing segment of the dental care industry. Kids with braces, who used to be called “copper choppers” or “metal mouth,” now consider orthodontics a fashion statement and actually get excited for their monthly orthodontic appointment to change the color of the bands on their braces.

Add these factors to dentistry’s latest technologies, such as dental implants, that provide better — but more expensive — solutions; throw in our country’s image consciousness fueled by T.V. shows like Extreme Makeover, and demand for dental care is greater than ever and still increasing.

After all these years of begrudgingly going to the dentist, we’re now inundated with research that shows that good oral health can help our overall health in many ways.

The supply of dentists is down, but prices are up

The availability of dentists is shrinking even as ¬¬the public’s demand for dental care is rapidly increasing. In 1982, the number of dental school graduates peaked at 5,750. In 2003, that number fell to 4,440 as several dental schools closed and others reduced their class sizes. Furthermore, the American Dental Association forecasts that the number of retiring dentists will outnumber graduates for at least the next decade.

Increased consumer demand for dental care in the face of shrinking dentist availability has resulted in dental care costs rising at a faster rate than general inflation. According to a Price Index Communication report in 2007, dental care inflation rose 27 percent from 2002 through 2006 — nearly double that of general inflation. And, today general dentists earn as much or more than family medical practitioners while working far fewer hours. It is literally the golden age of dentistry — for the dentists, that is.

Solutions in an upside-down market

Finding affordable dental plans in a market facing a shrinking supply of dentists and rapidly rising fees requires utilizing the most cost-effective dentists and the medical industry can show us the way.

Four years ago, the California Public Employees Retirement System (CalPERS), the second largest health care plan in the country, made a bell-weather decision by choosing to drop a large number of hospitals from their medical plan because they were not cost effective. Their decision ended a decade of purchasing decisions based upon an “access is king” mentality and introduced — or re-introduced — the “cost is king” priority for health care purchasers.

Since cost is the number one reason people don’t go to the dentist, the CalPERS decision should be instructive. The best way to reduce dental plan costs is to promote the most cost effective dentists — just as CalPERS did — and utilize plans that provides employees with incentives to use those dentists.

Source: ProducersWeb.com, January 11, 2008

Source: ProducersWeb.com, January 14, 2008

Employers are rightfully concerned that the cost of health coverage cuts into their bottom lines. As employers shift more costs to employees, workers also have great reason to be concerned about escalating medical premiums.

But in all the hoopla over health care outlays, we cannot miss opportunities to help a large number of Americans secure the life and disability coverage they need to help protect their lifestyles and their loved ones.

The industry has sponsored events during national awareness months for both life (September) and disability (May) insurance to focus attention on how we can help Americans. For all of the consolidated efforts to spread the word about income protection and replacement, health care costs continue to remain front and center in the spotlight with little to no mention about the value of life or disability insurance.

Medical insurance deserves the special attention. But as almost anyone dependent on a paycheck who has suffered a major health crisis can tell you, medical coverage is only a piece of the puzzle needed to safeguard employee well-being and give families peace of mind.

There are concrete steps we can take to help consumers understand that medical is important but life and disability insurance remain pivotal. To identify solutions, we must first address some of the challenges and then target key influencers and stakeholders who can help change attitudes and ultimately actions.

There is definitely a need for protection products such as life and disability insurance.

For example, according to LIMRA figures, 48 million households either don’t own a life insurance policy and believe they should, or think they need additional coverage to supplement what they have.

Despite the realization of a need a divide exists between consumer needs versus consumer actions. Some of the inaction can be attributed to confusion about employee benefits and income protection products. Guardian research shows that almost half of Americans spend less than an hour each year reviewing their benefits. While insurers want to make the selection of benefits easy, less than an hour each year is clearly not enough time to make informed choices. By contrast, consumers spend nearly three hours preparing for Thanksgiving and close to five hours on holiday shopping.

A gap in understanding also occurs when consumers purchase products in financial silos as opposed to taking a holistic approach. Workers often don’t fully understand the difference between group and individual coverage. According to a Guardian survey, 70 percent of employees said they had a sound grasp of the difference between group and individual life insurance coverage. But, 23 percent of the respondents thought group programs were more expensive, which is generally not the case. A significant number — 46 percent — were under the false impression that group underwriting required medical screening in the form of a checkup.

Study after study also shows that employees often overestimate the amount that they will have to pay for individual or voluntary workplace coverage. They extrapolate the cost of medical insurance onto other products and don’t realize that they can secure group life and disability insurance for less than what they spend on coffee each month.

Target one: The media

Press coverage can be a boon to any industry — a wide net that can reach an audience of millions within minutes. Personal finance stories are indeed a chance for us to spread the word about the solutions that we offer, but a recent Guardian disability insurance media study shows that there are opportunities for improvement. We think the same can be said about life insurance as well.

The good news is that our study showed that most stories on disability insurance did a respectable job in presenting the topic to readers and provided some cursory insight on the subject. There is still an opportunity, in many cases for reporters to delve further into the subject matter and unearth critical details such as the difference between worker’s compensation, Social Security benefits and disability insurance or specifics such as the effect taxes have on an insured’s payout.

Source: ProducersWeb.com, January 1, 2008

In ’07, Americans saw more media coverage over the issues of health insurance. Yet, research shows most consumers with medical coverage don’t understand basic health insurance terminology.

For example, 36% of adults admit to struggling with understanding the acronym HMO (health maintenance organization), while 20% report the term PPO (preferred-provider organization) sometimes is difficult to grasp, despite PPOs as being the most common type of health insurance provided by employers. What’s more, 11% of consumers indicate the acronym HSA is confusing as well.

California-based eHealth, Inc., an online health insurance provider, commissioned the survey, which questioned 1,010 adults on health insurance terms and their own policy.

While nearly 25% of adults report that they knew what the terminology used in their health insurance policy meant, only 50% of respondents were certain how much they paid for their monthly health insurance premiums and 45% on annual deductibles.

The research also finds Americans believe measures, such as side-by-side comparisons of policies (71%), live assistance with questions (65%) and a glossary of health insurance terms (57%) would help increase understanding of health insurance terminology and policies.

“It’s clear Americans lack a basic understanding of health insurance terms, which may prevent them from selecting the health plan best suited to their individual needs,” said Sam Gibbs, senior vice president of eHealth, Inc. “But as costs increase and responsibility for coverage shifts to the
individual, these terms are becoming increasingly relevant to consumers’ daily lives and their well-being.

Source: Employee Benefit Advisor, January 8, 2008

Total U.S. private health insurance premium expenditures increased more slowly in 2006 than overall national health expenditures increased.

Researchers with the Office of the Actuary at the Centers for Medicare and Medicaid Services have included figures supporting that conclusion in a health care spending report published in Health Affairs, a health policy journal.

The analysis of the 2006 figures is the latest analysis available from the CMS Office of the Actuary.

Spending on private health insurance premiums rose 5.3% in 2006, to $722 billion, the researchers at the office report.

Total U.S. health care spending increased 6.7%, to about $2.1 trillion, up from rate of increase of 6.5% in 2005, the CMS researchers write.

The 2006 health care spending total averaged $7,026 per person and amounted to 16% of the
U.S. gross domestic product.

Despite reports about employers trying to shift more responsibility for paying for care to employees, consumers’ out-of-pocket health care spending increased just 3.8% in 2006, to about $256 billion, according to the CMS researchers.
America ’s Health Insurance Plans, Washington, says the new national health expenditure report shows health insurance premiums grew at their slowest rate in 2006 since 1997.
In addition to holding down premium increases, “health insurance plans … are making significant progress in maximizing the value of employers’ and individuals’ health care dollars, as evidenced by the smaller increase in out-of-pocket and administrative costs compared to the increase in total health spending,” AHIP President Karen Ignagni says in a statement.

Other expenditure report findings:

- The CMS researchers found disturbing evidence of belt tightening at health research laboratories.

Excluding the cost of research on prescription drugs and durable medical equipment, health research expenditures increased just 2.9% in 2006, to $42 billion, down from 4.8% in 2005 and down from an average rate of increase of about 10% that has prevailed since at least the 1970s.
- In part because of implementation of the new Medicare Part D prescription drug program, Medicare spending soared 19%, to $401 billion.

The Medicare drug program may have contributed to an 8.5% increase in prescription drug expenditures, the CMS researchers write.

Drug expenditures increased only 5.8% in 2005.

Source: National Underwriter Life & Health, January 30, 2008

A poll commissioned by the Center for State and Local Government Excellence finds that most Americans prioritize features such as health insurance and job security when searching for a new job.

Given a list of 15 benefits and characteristics that may be important in choosing a job, 84 percent of American adults ranked health insurance as most important, followed by job security and clear corporate policies, according to findings.

Meanwhile, researchers report that 76 percent of respondents named a retirement plan or pension as a priority, and 71 percent cited a flexible, family-friendly workplace.

Finally, researchers report that pay ranked tenth in importance, with 65 percent citing it as a priority, according to reports.

Source: January 4, 2008

Promoting and Prescribing Exercise for the Elderly
Regular exercise provides a myriad of health benefits in older adults, including improvements in blood pressure, diabetes, lipid profile, osteoarthritis, osteoporosis, and neurocognitive function. Regular physical activity is also associated with decreased mortality and age-related morbidity in older adults. Despite this, up to 75 percent of older Americans are insufficiently active to achieve these health benefits. Few contraindications to exercise exist, and almost all older persons can benefit from additional physical activity. The exercise prescription consists of three components: aerobic exercise, strength training, and balance and flexibility. Physicians play a key role in motivating older patients and advising them regarding their physical limitations and/or comorbidities. Motivating patients to begin exercise is best achieved by focusing on individual patient goals, concerns, and barriers to exercise. Strategies include the "stages of change" model, individualized behavioral therapy, and an active lifestyle. To increase long-term compliance, the exercise prescription should be straightforward, fun, and geared toward a patient's individual health needs, beliefs, and goals.

Regular exercise has been shown to decrease mortality and age-related morbidity in older adults. Despite this, up to three fourths of the older adult population do not currently exercise at recommended levels. The relative risk (RR) for cardiovascular disease caused by sedentary living has been estimated to be 1.9, compared with other modifiable risk factors such as hypertension (RR = 2.1) and cigarette smoking (RR = 2.5), but it occurs at a much higher prevalence. Fewer than 10 percent of women over age 75 smoke cigarettes while greater than 70 percent are insufficiently active.5
By the year 2030, 22 percent of the U.S. population will be older than 65 years, a total of 70 million people. The fastest growing segment of the elderly population is the group older than 85 years, classified as "old old." Because activity levels generally decline with advancing age, the absolute number of inactive older Americans will most likely increase dramatically.
As the population of older adults increases, it will become vitally important for family physicians to counsel sedentary patients to become physically active.
Benefits of Exercise
As is the case in younger adults, regular exercise has been shown to provide a myriad of benefits in older adults (Table 1). Improvements in cardiovascular, metabolic, endocrine, and psychologic health are well documented. Cardiovascular fitness, although not directly correlated with health benefits, is a determinant of functional independence. Up to one third of the age-related decline in aerobic capacity (VšO2 max) can be reversed with prolonged (six months or more) aerobic training.1

TABLE 1
Benefits of Exercise in Older Adults

Cardiovascular Improves physiologic parameters (VšO2 max, cardiac output, decreased submaximal rate-pressure product) Improves blood pressure Decreases risk of coronary artery disease Improves congestive heart failure symptoms and decreases hospitalization rate Improves lipid profile Diabetes mellitus, type 2 Decreases incidence Improves glycemic control Decreases hemoglobin A1C levels Improves insulin sensitivity

Osteoporosis Decreases bone density loss in postmenopausal women Decreases hip and vertebral fractures Decreases risk of falling Osteoarthritis Improves function Decreases pain Neuropsychologic health Improves quality of sleep Improves cognitive function Decreases rates of depression, improves Beck depression scores. Improves short-term memory

Cancer Potential decrease in risk of colon, breast, prostate, rectum Improves quality of life and decreases fatigue Other Decreases all-cause mortality Decreases all-cause morbidity Decreases risk of obesity Improves symptoms in peripheral vascular occlusive disease

Regular exercise and/or increased aerobic fitness are associated with a decrease in all-cause mortality and morbidity in middle-aged and older adults.2,3 Subgroup analysis of the Harvard Alumni study found that modest increases in life expectancy were possible even in those patients who did not begin regular exercise until age 75. Mortality rates were also lower in those patients who did not begin regular exercise until late in life compared with patients who were active only in younger years and then subsequently stopped exercising.11 Thus, it is never too late for patients to benefit from physical activity.

The health benefits of exercise follow a hyperbolic dose-response curve. Those patients who go from none to some exercise receive the greatest health benefits, while further increases in activity levels bring progressively smaller improvements. Physicians can have the greatest overall impact by helping their sedentary patients to become active.

Source: American Family Physician

Strawberries dipped in white and dark chocolate make for a striking presentation and a delicious after-dinner treat. The white chocolate can also be colored with candy coloring if you want your berries to match a specific color scheme or table setting.

INGREDIENTS:

• 8 ounces dark chocolate
• 1.5 lbs (24 ounces) white chocolate
• 2 pints strawberries, stems on

PREPARATION:

1. Prepare a cookie sheet by lining it with waxed paper or aluminum foil.
2. Rinse the strawberries well, and pat them dry with paper towels. It is very important that they are completely dry, or else the chocolate might seize and become unworkable.
3. Temper both chocolates and keep them warm by wrapping the bottoms of the bowls in warm towels or placing them on a heating pad set to “low.”
4. Using a spoon or spatula, drizzle thin lines of dark chocolate in the bowl of white chocolate.
5. Hold a strawberry by the stem and drag it through the white and dark chocolate, moving in one direction and then rotating the strawberry and moving in the opposite direction to ensure the front and back are both covered. Hold the berry above the chocolate to allow the excess to drip down, and then place it carefully on the prepared baking sheet.
6. Repeat with remaining berries. Once finished, place the tray in the refrigerator to allow the chocolate to set (about 5 minutes). Berries should be eaten within a few hours for optimal taste and texture.