• 7 health insurance myths debunked
• Rock-a-bye recession
• The eyes are the windows to wellness
• Employer brings simplicity to specialty pharmacy benefits
• Counting calories at work
• Strength in numbers
• The grass is always greener
• Smile safety: Mercury fillings' risks cited by the FDA
• Exercise Corner: Neck Deskercises
• Recipe Corner: 10 Healthy Kid Lunch Box Tips & Ideas

Think that insurers are what make coverage so expensive? Think Canadians have it better or that your company's plan is the cheapest for you? Think again.

Hearsay and bad information often fuel people's misunderstandings of health insurance. When was the last time someone snuggled up with a cup of coffee and her insurance policy?
According to the Life and Health Insurance Foundation for Education and the Henry J. Kaiser Family Foundation, the following myths are alive and well in the minds of most folks.

1. It's cheapest to buy health insurance through an employer's group plan.
If your employer offers a group health plan, you're likely experiencing annual increases in premiums, reductions in what's paid for by your employer, increases in your out-of-pocket expenses and the possibility that you're paying for lots of benefits you don't want or need.
An individual health plan (the kind you buy on your own), especially for someone who's healthy and young, can offer significant savings. Unlike individual plans, group health plans must abide by state health insurance mandates, which can require coverage for everything from autism to hearing aids and from contraceptives to in vitro fertilization.

Although an individual health plan can deny your application based on your health status, Matt Tassey, a spokesman for LIFE, notes that if you're eligible the plan can be customized to meet your specific health care needs.

"If you're a man, you have no need to see an obstetrician. But if they have an employer-sponsored health plan, they are still paying for (the obstetrics coverage)," he says.

2. Health insurance is expensive because health insurance companies are driven by profit.
Brenda Weigel, a spokeswoman for the National Association of Health Underwriters, says this is a common misconception. "The fact that health insurance is expensive is because health care is expensive. Or there's the common misconception that Medicare administrative costs are lower than private plans, when in fact there is quite a bit of cost-shifting," says Weigel.

When patients use a government insurance program (such as Medicare), providers of health care shift more costs to people who have insurance. The result is higher premiums for people who purchase their insurance on the individual market and workers who receive insurance through their employers.

Tassey notes that rising prescription drug costs also fuel increases.

3. If you're young and healthy you don't need to pay for health insurance.
Then what happens when you break your leg in a snowboarding accident or blow out your knee while playing soccer? If you find that your tonsils need to be removed, the cost of a tonsillectomy can start at $5,000, with an additional $1,500 per day for an overnight hospital stay.

"There is this idea that if they need to be hospitalized they can just go to the emergency room because they have to take you," says Tassey. "We like to call them 'young immortals.' A problem arises when they have to be stabilized or, worse, have to stay in the hospital for an extended period of time. What happens if they have to be transferred somewhere else for care or have to see a specialist? The cost could reach $100,000 once you add everything up, and starting out their lives in serious medical debt can have a long-term repercussions on their financial future."
Tassey says young people rarely think about health insurance until it's time to have a baby.

4. The highest numbers of uninsured people are under age 25.
The fastest-growing group of uninsured Americans is age 50 to 64. The difference between the younger and older people is accessibility to health insurance. While younger people who are not covered by an employer's health plan may find it easy to acquire affordable individual coverage on their own because of age and health status, older people do not have the same advantage.

According to recent estimates from the Kaiser Commission on Medicaid and the Uninsured, middle-aged and older adults under age 65 (and not yet eligible for Medicare) are fast becoming the largest group of Americans without health insurance.

In fact, 19 million Americans from age 50 to 64 were uninsured or underinsured in 2008. Members of this group are more likely to arrive at a doctor's office with a number of chronic medical conditions, making it difficult or impossible for them to buy individual health insurance. As baby boomers reach age 65, the sheer number of people in need of coverage has the potential of overwhelming the Medicare system.

"This is a serious problem as the baby boomers age and the cost of health care skyrockets. If you drive an old car, you have to do repairs to keep that car moving. Just imagine having 75 million old cars coming into the Medicare system -- that is exactly what we are looking at in the next several years," says Tassey.

5. COBRA is very expensive, and a short-term health plan would be cheaper.
The federal COBRA law allows you to continue buying your former employer's group health plan if you are laid off. The catch is that the employer no longer has to contribute to the premiums. One alternative is buying a short-term health plan on your own.

If you are relatively healthy, a short-term plan could bridge the gap between other insurance plans, but if you have a pre-existing condition, or need maternity care or prescription drug coverage, you may not be able to find a short-term plan.

Also, short-term plans generally require you pay high deductibles before coverage begins. This deductible can vary from $250 (for very healthy policyholders) to well into the thousands. When you consider the cost of meeting the deductible before the plan pays for medical care, COBRA may be the better choice, especially if you have a pre-existing condition. In addition, a typical short-term policy lasts a maximum of six months, and the insurer is not obligated to renew your policy.

Under the American Recovery and Reinvestment Act that went into effect in February, you can receive a 65% subsidy of your COBRA premiums for up to nine months. In return, the federal government reimburses the employer with a payroll tax credit.

6. Large employers always offer health insurance to workers.
The Kaiser Family Foundation points out that one in five workers in firms with 500 or more employees is uninsured because many companies do not offer health insurance.

When workers are offered health insurance, they take it. According to the Employee Benefits Research Institute, less than 5% of those workers who are eligible for health benefits is uninsured.

7. Canada has a better health care system than the U.S.
The debate rages on. Canada's universal care system is fine, but there's a limit on what you can get. For example, if you happen to be a Canadian age 70 or older and need bypass surgery, the government won't pay for it.

"Universal health care isn't better; it's just different," Tassey says. "One of the largest hospitals in the U.S. is the Henry Ford Hospital in Detroit. Many Canadians come over to Detroit for care -- not because it's better; it's because they can get it (in the U.S.). There is no rationing (in America) of any sort, so they can just write a check."

Americans may complain about the high cost of health care in the U.S., but Tassey points out that people are rarely denied care for any reason.

"People in the U.S. demand care and demand it immediately. They also think we can cure anything," notes Tassey. "Unfortunately, it costs a lot of money to treat the number of fatal diseases that need a cure. We already have a semi-Canadian system for those who are 65 and older -- it's called Medicare, and it's going bankrupt."

Source: http://articles.moneycentral.msn.com, August 29, 2009

Maternity benefits can go a long way to recession-proof retention, women's family plans

Results from a poll conducted earlier this year by Gallup Organization for the American College of Obstetricians and Gynecologists show that 14% of women age 18 to 44 in the United States say the economy has had a negative impact on their plans to have a baby.

Such stats indicate that maternity benefits are at an even higher premium during tough economic times, making such offerings - particularly paid leave - even more important in attracting and retaining workers.

However, paid maternity leave long has been a benefits sore spot. The United States is one of only four nations that doesn't legally provide for paid leave after childbirth, according to a Harvard University survey of 168 nations. The other three: Papua New Guinea, Swaziland and Lesotho.

It's left to employers to fill the gaps - and gaps persist.

"What employers need to recognize is that the outdated model of assuming that mothers are not in the workplace is no longer the reality," says Heather Boushey, a senior economist with the Center for American Progress.

"I think we're going to see increasing pressure on employers and policymakers to adapt and ... enact policies that make it easier for employees to address work- family conflict, especially vis-à-vis new children."

Currently, 75% of Fortune 100 employers offer some type of leave for new mothers, generally in the form of temporary disability leave, according to the Joint Economic Committee. Only 15% offer paid maternity leave other than what's covered by short-term disability, according to the Society for Human Resource Management.

Under temporary disability leave, women are granted six weeks leave for a normal delivery and eight weeks for women who have undergone a C-section. Despite the recession, these benefits have remained intact, experts say, mainly because they come out on the right size of a cost-benefit analysis.

"To change something big and important, but not costly - as is a short-term disability plan - is pretty unusual and is hard to do," says Helen Darling, president of the National Business Group on Health. "It would be complicated administratively; you'd have to spend a lot of money communicating and you'd have to go back to your disability carrier. It's not so easy that you would do it, even in a recession like this." Darling notes that disability leave is not a big-ticket item, accounting for less than half of 1% of payroll.

Since they can provide maternity benefits without breaking the bank, not only are employers retaining the benefits, they often are adding to them, Darling says. One such company is Cigna. The insurance provider offers new mothers six weeks paid leave for a vaginal birth, eight weeks for a C-section and also provides a private onsite lactation room. Further, Cigna offers flexible scheduling options and telecommuting for new parents.

"The benefit is so much more than just the leave - it's everything. It's all [the resources and benefits] you get before you're pregnant, while your pregnant and immediately after the birth, and the benefits continue. The benefit is more than the leave, it's the whole package," says Mary Bianchi, manager of Cigna's Healthy Life Program.

The majority of HR/benefits professionals recognize this to be the case. In October 2007, World at Work asked pros how important maternity benefits were to attracting individuals to and retaining employees in the organization.

Seventy-four percent answered that those benefits were of moderately-to-high importance to the organization's recruiting image, while the same percentage said they were of moderate or high significance regarding retention of employees.

"There's a real need for this: It helps women establish breast-feeding, it makes it possible to get to those early doctor appointments, [for newborns] to bond with their parents, and helps [mothers] recover from childbirth. The lack of pay makes it difficult for a lot of workers to take that leave," says Karen Minatelli, director of work and family programs at the National Partnership for Women and Families.

"Once employees feel that they are given the space to bond with a new child, that gives them increased loyalty to the employer and makes them feel better about the work that they're doing and want to give more back."

Bringing the U.S. up to speed legislatively

The United States is one of only four nations that does not provide for paid leave after childbirth, but two bills currently in Congress would bring the nation's policies more in line with other advanced nations.

Federal Employees Paid Parental Leave Act

The bill, which passed the House in June, demands paid maternity and paternity leave benefits for federal employees, providing up to four weeks of paid leave.

Family Leave Insurance Act

This measure, if approved, would be the paid leave bookend to the Family and Medical Leave Act, giving all employees 12 weeks paid time off. The leave program would be funded by workers and employers and would cost .2% of an employee's salary - on average, $7 per month.

Maternal health care in the workplace

Cigna's Healthy Babies, Healthy Business program follows female employees before and throughout their pregnancies and after they give birth - providing health coaches, extra dental coverage and covering the cost of generic prescription prenatal drugs 100% - while encouraging health risk assessments. The program has yielded savings of more than $6,000 per pregnancy for their employees participating. The investment in the program is worth it, according to CIGNA:

>> Nearly 13% (more than a half-million) of all babies born each year in the United States are born prematurely.

>> The costs related to prematurity add up to $26 billion a year, according to the Institute of Medicine.

>> Premature babies spend on average nearly 12 days longer in the hospital during the 12 months following birth than full-term babies. Employers pay half of the total hospital costs for pretem birth, costs that tend to escalate after discharge. Premature babies also require significantly more outpatient visits and prescription drugs during their first year of life, all contributing to higher costs for employer and employee.

>> Twenty-five percent of the earliest and smallest babies live with chronic conditions, such as cerebral palsy and blindness.

>> Maternity care costs - including prenatal care, delivery and three months postpartum - are nearly $4,000 higher on average for mothers with complicated deliveries than women who had a normal deliveries. And these costs don't even account for the costs of short-term disability and lost productivity during this time.

>> Mothers of premature babies spend an average of 29.1 days on short-term disability leave over the six months following delivery, while mothers of full-term babies spend only 18.9 days on average, cites a 2004 Thomson analysis.

Along with their Healthy Babies, Healthy Business, Cigna provides the 14 Steps, a free resource to employers that includes educational materials for employees.

Says Dr. Jeff Kang, Cigna's chief medical officer: "Each of us can and must take steps within our own organizations to support and improve the health of parents and their babies. Healthy mothers who deliver healthy babies are healthier employees. And, ultimately, healthy employees contribute to a healthier business."

Source: Employee Benefit News, August 1, 2009

Vision benefit plans can pay extra dividends through prompting action on diabetes, hypertension, cholesterol

Routine eye care facilitated by employee exploitation of vision care benefits can be a vital adjunct to standard employee health promotion efforts, helping to detect and address serious clinical conditions beyond those pertaining exclusively to eye care, recent research shows.

The new data, which covers both clinical issues and their financial implications for employers, adds a new twist to the existing robust body of evidence of the adverse economic impact of vision-related health conditions. It points to the importance of careful design of vision benefit plans, as well as the effective promotion of such plans to employees so that both health and financial benefits can be gained by employees and employers alike.

The study, performed by Human Capital Management Services, a Wyoming-based data analytics and consulting firm, and commissioned by VSP Vision Care, focused on the detection of diabetes, hypertension and high cholesterol by optometrists before those conditions were identified by other health care providers, particularly patients' primary care physicians.

Given the fact that many employees and their dependents have these conditions without being aware of it in their initial stages, the more health care professionals (whatever their medical specialty) who have an opportunity to detect them, the better. For example, nearly one-fourth of the 24 million Americans believed to have diabetes are oblivious to that fact, according to the Centers for Disease Control and Prevention. From an eye disease perspective, diabetes causes a condition known as diabetic retinopathy, damaging the retina leading to vision impairment if left untreated.

Similarly, hypertension and high cholesterol, with their potentially deadly consequences, are often unknown to those who have the conditions. Optometrists routinely detect them, according to optometrist Dr. Michael Johnson, of Eagle Vision Eye Care in Sacramento, Calif.

Proper eye exams, he says, include examination of blood vessels of the eye. "Diabetes," he says, "would most easily be seen by bleeding in the back of the eye.

"For early onset, we'd see small 'dot hemorrhages' - just a little pinpoint of blood. Where it's located in the eye would determine the level of referral that is needed. If you see it just in the periphery of the eye, that would be something we'd watch. As it gets closer to the macula, that would require referral."

Hypertension, he adds, is evident to an optometrist through detection of "tortuosity of the blood vessel - it looks like a kinked hose," he says. "We also look for how the blood vessels cross each other;" certain patterns can reflect the damaging impact of high blood pressure. (Eye exams may also be accompanied by standard blood pressure checks, Dr. Johnson notes.)

And optometrists can see evidence of high cholesterol levels, according to Dr. Johnson, "because people with high cholesterol throw off plaque from their carotid artery, and often it will get stuck in the bifurcations, or forks, of the blood vessels in the back of the eye. We'll see a bright refractile material stuck in that bifurcation." Doctors may also see a grayish-white ring around the cornea called arcus senillis or corneal arcus.

The potential of eye exams to flag fundamental health problems is perhaps even more compelling when viewed in the broader context of workforce demographic trends and their implications for employees' eye care needs. The aging of the baby boomer generation, for example, is expected to lead to a doubling of the number of people experiencing vision-related problems, with consequences not only for their health, but boomers' productivity at the workplace. And, because the eyes are the only place on the body through which blood vessels can be viewed, the opportunity to identify other health issues is further perpetuated.

Visual stress

And simple "visual stress," according to the American Optometric Association, "is a common occurrence in today's visually demanding world" - and not just for older workers. Manifestations of "visual stress" include regular headaches, diminished focusing power, intermittent blurring and loss of concentration, according to the AOA.

The negative business and personal impacts of these problems have, of course, encouraged most midsized and large employers to make vision benefits available to their employees. A study by Prevent Blindness America, for example, estimated the national annual price tag for adult vision problems at $51.4 billion. That 2007 study included the impact of diabetic retinopathy, the condition optometrists often identify to alert patients to its broader health implications.

Eye doctors' clinical skills that allow them to identify health issues such as diabetes, hypertension and high cholesterol is one matter. But ensuring that patients connect with their primary care physicians to address these conditions, of course, is critical to having a positive outcome. Sophisticated imaging equipment can play a useful role towards that end, according to Dr. Johnson.

"The nice thing about having the kind of equipment I have," he says, "is that I can show patients what I'm seeing, like blood in their back of their eye. It makes it more real to them."

It is the responsibility of patients to take appropriate steps with the primary care provider to address the medical issue identified in the eye exam. But Dr. Johnson says that if he has any concerns about what will happen after the patient leaves his office, he will contact that patient's primary care physician. Relaying clinical information to other health care providers is facilitated, he says, by automation.

"We use a system that makes it very easy to communicate" essential clinical information both to patients and other health care professionals. "We can print it out and give it to the patient and fax it to the primary care doctor, and know that they're getting all the information they need to move forward."

The benefits of this kind of communication, according to the HCMS study, can be substantial - especially considering the high human and economic cost of diabetes, hypertension and diabetes. The study, using a HIPAA-compliant process, compared clinical and financial claims data of patients with VSP coverage, to a broader patient universe.

VSP Eye Health Management Program

In 2005, VSP launched a program called the VSP Eye Health Management Program, which requires the eye care professionals in its provider network to report patients with early signs of diabetes, diabetic retinopathy, hypertension, corneal arcus (a symptom of high cholesterol), macular degeneration and glaucoma.

The study concluded that, of all early detections, these optometrists identified 20% of diabetes cases, 30% of hypertension cases and 65% of high cholesterol cases, before they were identified by patients' other care providers, and before the employee self-reported the condition in a personal health assessment survey.

A potentially key factor in this result is the fact that workers with vision benefits receive eye exams more frequently than they receive annual preventive exams. Specifically, only 21% of adults receive an annual preventive health exam, but 61% of Americans with vision coverage receive annual eye exams, according to a study reported in the Annals of Internal Medicine.

Impacts of early detection of these health conditions by the eye exams, according to the HCMS study, include the following:

• Health care and pharmacy costs and comorbid conditions were significantly lower in the early detection group, perhaps because later care and treatment typically is more costly.
• Lost-time costs for short-term disability, long-term disability and workers' comp generally were lower for the early detection group.
• Early detection group members were half as likely to terminate their employment during the year following detection of the heath issue. One possible cause of this result may be later detection of health condition leading to increased comorbidity and more extensive treatments, ultimately leading to loss of employment.

Pennies on the dollar

HCMS analysts estimated the purely economic benefits (measuring medical costs, lost time and human capital costs) of providing this type of vision benefits equate to 94 cents of additional value for every dollar spent on vision exams. The biggest savings, according to the study, resulted from the early detection of diabetes.

The overall savings figure suggests that the net cost of every employer dollar invested in a vision benefit - assuming the eye care professionals participating in the plan provide comprehensive eye exams and report relevant findings to primary care providers, along the lines of the VSP program - might be as low as 6 cents.
But employees must take advantage of vision benefits in order for them and their employers to reap the potential health and financial rewards.

While employees with common vision impairments, such as myopia,typically don't need to be encouraged to take advantage of a vision benefit plan, others often do; ignorance on eye health is widespread. For example, a 2006 survey by the National Eye Institute revealed that only 8% of respondents were aware that glaucoma has no early warning signs.

Such data suggests that many employees who don't perceive that they have a need for eye care might fail to appreciate the importance of routine examinations.

The following approaches can significantly increase employee participation in vision benefit programs:

• Provide employee workshops. Use vision plan materials to educate employees on the importance and value of vision care for themselves and their dependents. Use available materials to host a brown-bag or workshop session on the vision benefit. 
• Partner with your representative. If possible, bring in a vision plan representative to discuss the value of their benefit with the employees and answer their questions about coverage. 
• Remind employees that these benefits are pretax. This reminder increases savings over vision exams and materials purchased without a plan.

Maximum employee participation in vision benefit plans, coupled with a system enabling eye care professionals to communicate easily and effectively with plan members and their primary care providers when conditions such as diabetes, hypertension and high cholesterol are evident, can ensure a high return on employers' investment in vision benefits.

Source: Employee Benefits News, August 1, 2009

Although specialty pharmacy medications are expensive and treat complex conditions like cancer, multiple sclerosis and hemophilia, managing them does not have to break the benefits budget or be as complicated as the conditions they treat.

Helping employers get back to the fundamentals of managing specialty drugs was Keith Bruhnsen, assistant director of benefits at the University of Michigan, as he offered cost-containment tips at EBN's 21st annual Benefits Forum & Expo.

Overall, the university's specialty drug cost is about 16% of its total pharmacy cost, which represents about 1.6% of its population. The average national trend for specialty drugs about 12%, according to pharmacy benefit manager Express Scripts.

At UM, however, yearly trend is about 8%, said Bruhnsen. The university employs about 35,000 workers and has 7,000 retirees. According to Bruhnsen, last year the institution, which covers about 86,000 beneficiaries, spent around $250 million on health care with $70 million going toward prescription drugs.

He noted, however, that from January to June the percentage of total drug spending on specialty drugs grew from 14.8% to 16.2%. "That's a pretty dramatic increase," Bruhnsen explained.

In 2001, UM convened a taskforce to benchmark data and best practices for specialty pharmacy benefits. The taskforce recommended the institution move to a self-insured and self-administered drug plan.

"We carved out our prescription drugs from our medical plan in 2003," Bruhnsen told attendees. The university had worked with a large, traditional pharmacy benefit manger, but decided to move over to SXC Health Solutions, which provides services for claims and pharmacy administration.

"We did this because we really thought we needed a fully transparent arrangement, one that focuses on providing us maximum control and flexibility" in designing the benefit, he said. The program focuses on providing best-valued drugs and trying to eliminate expensive brands that offer no superior value over low-cost generic drugs, explained Bruhnsen. "It's been successful for us both financially and clinically."

Basics on specialty Rx

There are really two main strategies with managing specialty pharmacy, said Bruhnsen. "You want to get the best pricing out there in the market, and you want to manage for appropriate use. That means getting the right drug in the right amount at the right time for the patient."

Employers also need to decide which drugs will go on the medical side and which ones will go on the pharmacy side, he said. Organizations will most likely have specialty medications in both the medical benefit and pharmacy benefits.

"One of the things plan sponsors need to do is to evaluate their data to look at the cost as to which products can be self-administrated and which ones can be acquired cheaper through the discount you are going to get under the pharmacy plan," Bruhnsen noted.

Move those drugs from the medical plan over to pharmacy to get the improved pricing and employ some therapy management, which focuses on optimal patient care as an objective, he added. "Virtually every patient that is taking a biotech drug represents a complex case, so side effects are common, and they need additional guidance in terms of managing the drug."

Employers also need to coordinate with their health plans to make sure there is not an overlap or duplication of drugs on both the medical and pharmacy sides.

Additionally, model the cost and utilization by reviewing claims from the pharmacy benefit manager, Bruhnsen advised. "You want to look at any new discounts that you are going to get. The data also allows you to follow the trends and see what is going on in the market."

The plan design should address each drug and its appropriateness by using evidence-based decision-making and clinical guidelines, such as prior authorization, that focus on safety and ethical costs.

Employers should also consider using the Food and Drug Administration's labeling and communication tools for the drugs, which will help patients in managing the usage of the drugs.

Equally important, plan sponsors need to look closely at cost-sharing approaches. "If you use a coinsurance, annual cap, lifetime cap or deductible, they can sometimes unintentionally impact on whether a member obtains the drugs or is compliant with his or her therapies," explained Bruhnsen. "Finding the right balance of cost-sharing and tier placement is really important for your design."

At the university, copays are $7, $14 and $24. "But based on some research that we have conducted, we are going to change that for 2009 to $5, $15 and $30 to get a better spread between the tiers and to get some behavioral changes," said Bruhnsen.

"Sometimes there are copay challenges to the members if you have a coinsurance model. I have heard from many specialty pharmacy experts that about $50 is where people start having some difficulties in managing the cost," Bruhnsen said.

Plan sponsors need to know beforehand how their members are going to respond to copays on specialty drugs. Medco, a PBM, reports that the increase in specialty drug utilization has slowed. In 2006, utilization hit 7.3%, while in 2007 that number was 3.9%, according to Bruhnsen. "There some indication that there is some leveling out," he said.

The future cost trend in specialty drugs, however, is predicted by most large PBMs to double that of traditional drugs. "There is some speculation that pharmaceutical manufacturers will be shifting cost increases to the specialty side to make up for some loses that they are getting from seeing more generic dispensing going on," Bruhnsen said.

Source: Benefits News, September 8, 2009

When menus and menu boards at job-site cafeterias are labeled with calorie and nutrition information, workers will likely select healthier food and snack options, reports the University of California at Berkley’s Center for Weight and Health.

The center studied five Kaiser Permanente cafeterias to see how calorie-menu labeling influenced food selection among customers, including employees, at hospital cafeterias.

Researchers examined patrons’ lunchtime purchases before and after the cafeterias instituted menu labeling. They analyzed cash register records at two cafeteria sites and made direct observations at the others.

The study involved one of three menu labeling scenarios: calorie labeling on menu boards and placards at the point of purchase, a wall poster with both calorie and detailed nutrition information and no information.
From August to November 2008, more than 500 patrons completed cafeteria exit surveys four weeks after labeling was introduced at the various hospitals, researchers report. Two-thirds of the respondents at the menu board sites noted that the calorie information altered their purchase.

“This research showed that posting calorie counts changes patron food selections,” says Karen Webb, co-author of the study and researcher at the center. “Based on the changes we observed on patrons' lunch choices, and the frequency with which patrons go to the cafeteria over the course of a week, this kind of intervention could prevent up to five pounds of unwanted weight gain per year, provided people don't compensate by eating more calories at other meals, or in other settings,” she adds.

Given the study's results, Kaiser Permanente will post calorie information on menu boards in the cafeterias it operates in California, Oregon and Hawaii. Where the health care provider does not operate its own cafeterias, the programs will be phased in over time. “We are pleased to set an example that will encourage healthier choices for our employees and communities,” says Dean Edwards, vice president and chief procurement officer at Kaiser Permanente.

Source: Employee Benefits News, August 11, 2009

New state partnership plans offer yet another open door for employee education about long-term care insurance

As baby boomers begin to retire, the want and need for long-term care insurance benefit plans will doubtlessly grow. But employers often have reservations about this expensive and complicated benefit offering.

As of January 2009, more than half of all states (34, to be exact) have new LTC programs that intend to expand the reach and lower the cost of LTC. These opportunities, part of a program called Partnership, have been in existence since the late 1980s, but have only recently begun to make significant inroads in the LTC marketplace, with 19 state plans active by the end of 2008.

“The partnership is the greatest opportunity for the long-term care marketplace to penetrate the millions of cost-conscious consumers who have done some retirement planning and would benefit from this added protection," comments Jesse Slome, the executive director and co-founder of the American Association for Long-Term Care Insurance.

What is partnership?

Partnership plans allow LTC policyholders to add the value of their policy to the minimum asset spend-down required to be eligible for Medicaid benefits, thus protecting personal and family assets in the case that a long-term care policy has been exhausted prior to end of life.

According to a white paper by the Center for Health Care Strategies, authored by Mark R. Meiners, Ph.D. at George Mason University in Virginia:

"The goal of the Long-Term Care Partnership model is to use Medicaid's safety net feature as an incentive for middle income people to buy private long-term care insurance and, by doing so, encourage them to prepare for the risk of needing long-term care. This, in turn, will help delay or avoid the need for Medicaid to pay for their long-term care. In the Partnership model, states offer the guarantee that if benefits under a partnership policy do not sufficiently cover the cost of care, the consumer will qualify for Medicaid under special eligibility rules that allow a prespecified amount of assets to be disregarded. The consumer must also meet other Medicaid eligibility rules."

For example, if the maximum personal asset allowed to qualify in one's state for Medicaid is $50,000, a person with a $300,000 long-term care insurance policy in a partnership state would only have to spend down assets to $350,000 before qualifying for Medicaid.

Someone without a partnership policy or in a nonpartnership state would have to spend down assets to $50,000 before qualifying.

More partnership details

Partnership plans also differ from other long-term care insurance offerings by the manner in which they are bought and utilized.

Plans are typically offered to employers and employees in one of three manners: true group plans, which are generally used by large employers across multiple states; multilife plans, which can be sold to any size employer and are essentially individual policies under a single underwriting umbrella; and individual policies, purchased by the employee through a voluntary worksite benefit or on the open market.

At present, partnership plans are not available in the true group marketplace (see "Partnership not always the answer" below) but are generally available to multilife and individual participants, depending on the state in which the plan is sold and the needs of the purchaser.

Because partnership plans require automatic inflation protection purchase options versus the more commonly seen future purchase-option-style benefit offered under true group-style plans, many brokers and advisers have been slow to bring to the table these offerings.

The typically recognized value in true group-style plans (always combined with future purchase-option-style plan purchasing) is the availability to purchase a guaranteed-issue benefit, wherein all employees, regardless of health status, are able to buy in to a benefit.

Automatic inflation protection plans are in general significantly more expensive at purchase for the employee, but over time they provide a steady amount of benefit and a lower risk of default than future purchase option plans.

However, future purchase option plans, which start out costing just a few hundred dollars each year, can easily spring to tens of thousands of dollars by the time the plan participants reach their 60s, the age at which many first long-term care insurance claims are made.

Benefit advisers and other sellers of LTC benefits are at odds over which method of purchase is actually most beneficial to employees.

Legal issues

No employer wants to be sued over a benefit.

Benefit adviser Brad Winnekins, of Legacy Services in Wisconsin, says that these long-term care plans are a "legal time bomb waiting to happen," but other experts are less aggressive on the topic.

Phil Beiluch, a private actuary based in Connecticut, acknowledges that "some companies have a natural aversion to automatic increase [style plans] because they have a very high potential liability moving forward."

While he recognizes that the "issue of litigation is a growing field," he says that the issue of partnership is only one of "many aspects" that makes long-term care a potential legal pitfall.

"I don't think employers are fully aware of what can go wrong in long-term care," he says, adding that "employees don't necessarily understand that long-term care insurance is insurance to begin with."
Many legal issues, he states, can stem from the fact that employees may mistakenly assume that all claims made on an LTC policy are automatically paid, which is not the case.

Rules and exceptions exist for long-term care coverage, just like any other insurance-based benefit.

Partnership not always the answer

Like most benefits offerings, partnership plans aren't always the right answer for your company.

Employers already offering true group-style plans are often not eligible to buy in to partnership offerings because carriers don't offer the option.

Dennis Healy, vice president of group long-term care for John Hancock, says that his company won't consider offering partnership-style plans until "we get an understanding of how the policies will work" on a nationwide basis.

Right now, he says, state-to-state reciprocity is an issue for many employers, in addition to the fact that 16 states don't currently offer partnership options.

"We want to offer a program where employers can offer equal benefits to employees in all states," he says.
When time comes that plans are available in all 50 states, Healy says that Hancock will probably move forward with a partnership option.

Reciprocity is practiced by most states with partnership plans, but it must be noted, says Meiners, that Medicaid eligibility rules are not reciprocal.

If an employee is planning to retire in Florida, a state that may have stricter Medicaid laws than say, Virginia, the benefits under a partnership plan may be less than if the employee had simply retired in his or her state of employment.

For higher-wealth individuals, partnership-style plans may not be the best use of finances, says Doug Lubenow, president of the Lubenow Agency.

Partnership plans are an excellent way to protect assets of those with $400,000 or $500,000 in assets before those individuals tap into Medicaid, but those with $2 or $3 million in assets may never reach a the minimum assets needed for Medicaid.

What it comes down to, says Slome, is education.

"I always tell [employees] that you serve yourself best by getting information and possibly shopping around."

The end need, says Meiners, is that more work needs to be done on the part of state and national governments to make sure that lingering questions are cleared up before partnership plans can be available to all employees.

Issues of reciprocity, individual state benefits and Medicaid spend-down will remain key factors in determining the attractiveness of partnership options on an individual basis.

Source: Employee Benefits News, January 1, 2009

• Save 11,082,971 pounds of paper. 
• Avoid the release of 105,709,380 gallons of wastewater. 
• Save 4,105,889 gallons of gas. 
• Avoid the release of 31,581,675 pounds of greenhouse gases into the atmosphere, equivalent to 112,329,703 miles not driven, 1,345,379 trees planted and 13,756,978 square feet of forest preserved.

Source: Employee Benefits News, July 1, 2009

Long-standing questions over the safety of mercury-containing dental fillings may be answered within a year.
The latest salvo in the decade-old battle over mercury amalgams occurred earlier this summer when the Food and Drug Administration agreed to settle a lawsuit brought against it by opponents of the dental material. Under the agreement, the FDA must decide by July 2009 how it will regulate mercury amalgams and what warnings dentists should give patients about the filling's use.

Moms Against Mercury and other plaintiffs filed suit against the FDA in 2006 in an effort to push the federal government into formally classifying encapsulated mercury amalgams, which would require an analysis of their risk and make them subject to certain controls. Anti-mercury advocates hope this action will lead to elimination of amalgam use.

As part of the legal settlement, the FDA also agreed to change the safety information on its Web site regarding mercury amalgams, noting for the first time that they may be harmful to certain individuals.
"Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses," the agency states.

It goes on to say that "[p]regnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner."
Evolving position

The FDA's new cautionary statements reflect evolving thinking by dental experts on mercury amalgams, according to Jed Jacobson, senior vice president of professional services and chief science officer at Delta Dental of Michigan, Ohio and Indiana. Jacobson is a former researcher who has closely followed the mercury amalgam controversy.

"Many people have misinterpreted this as the FDA reversing or at least backsliding on its position. That is not the case," he says. "They're saying amalgams may cause problems, not that they do.

"The FDA and the American Dental Association state that amalgams are safe, with possible exception," he continues. "Since 2002, we've been trying to identify those exceptions, if any, and inform the public."

In 2002, the FDA proposed reclassifying mercury amalgams as Class II medical devices but never issued a final rule. The purpose of the mercury opponents' lawsuit was to force the agency to do so, since "Class II" indicates that a product carries some element of risk and is subject to certain controls.

When it initially proposed Class II status for amalgams, the FDA suggested that controls include materials testing to confirm strength and determine the amount of mercury vapor released by the devices and cautionary labeling for dentists and patients. The agency asked for additional public comment on these issues in June; the comment period ended in mid-July.

Removal not recommended

The FDA is not recommending that amalgam fillings be removed, saying that the decision is between the patient and the dentist.

"If you are concerned about the possible health effects of amalgam fillings, you should talk with your qualified health care practitioner," the agency states. "Dental amalgam fillings are very strong and durable, they last longer than most other types of fillings, and they are relatively inexpensive. You may want to weigh these advantages against the possibility that dental amalgam could pose a health risk, until further information is conveyed through the rulemaking or otherwise." Some unscrupulous dentists may try to take advantage of the latest publicity on mercury amalgams and attempt to scare patients into exchanging them for other fillings. "For those dentists inclined to pray upon public, this might be [an opportunity]," agrees Jacobson. "But they would be abusing the FDA's cautionary note. Dentists who remove amalgams unnecessarily would invite the careful review of third-party carriers and the attention of the ADA."

Environmental concerns

In fact, the dental industry has been moving away from using amalgams, "not because of safety concerns, but because of environmental issues," Jacobson notes. The Clean Water Act of 1972 set a new standard for wastewater, including the amount of mercury allowed in it. To meet the CWA requirements, municipalities passed regulations restricting the amount of mercury that dental offices may add to the local wastewater system, he explains.

"Dental offices are being compelled to buy equipment to collect excess mercury-containing amalgam. Consequently, many dentists are saying we won't use mercury amalgams anymore. Fifty percent to 60% of posterior, or back, fillings, where amalgams were most often used, now are being done with composite or 'white material.'"

At Delta Dental, which covers 50 million plan members in 50 states, there has been no increase in inquiries about the safety of mercury amalgams as a result of the recent publicity on the court settlement, Dr. Jacobson reports.

"We've been dealing with this for over 10 years. We get at least one call a day from a plan subscriber or dentist wanting to know where we stand on amalgams and whether we'll pay for them. "We cover amalgams and composites and leave the decision on which to use in the dental office between dentist and patient. Both [fillings] work; mercury amalgams last a little longer. Until one proven is proven to be safer, we consider them equally effective."

Source: Employee Benefit News, September 1, 2009

Neck Push

Many people suffer from neck stiffness arid soreness, and its no wonder your neck has the difficult burden of carrying your bead around, and it never gets a break except when you lay down. This neck push can be done sitting or standing and helps strengthen your neck muscles, which in turn will help alleviate some of the discomfort.

Keeping your head upright, hold the palm of one hand against your forehead, and press your head forward, resisting with your palm. Hold for 10 to 15 seconds. Now clasp your hands behind your head, and press your head backward, resisting with your hands. Hold for 10 to 15 seconds. Now hold your right hand against the side of your head, and press your head to the right, resisting with your hand. Again, hold for 10 to 15 seconds. Then repeat on left side

Relax and Roll

Stress and anxiety often lead to an aching neck. Poor posture also plays a role. This stretch relieves tension in your neck and surrounding muscles.

Relax your shoulders and let your head roll forward, chin to chest. Slowly rotate your head in a circle without straining your neck. Repeat five times. Relax. Then rotate in the opposite direction and repeat five times. Try not to raise your shoulders as you do this exercise.

Source: http://uclivingwell.ucop.edu/deskercise/neck.html

Packing a healthy kid lunch your children will enjoy day in and day out certainly isn’t an easy task

It’s hard to keep coming up with fresh ideas for packed lunches for the 20 or so school days there are in a month. No wonder we often rely on the same old lunch recipe favourites.

Here are a few of my favorite kid lunch box ideas. I’m sure you’ve heard some of them before but I’m hoping you’ll find a few new ideas to inspire you.

Change The Bread
For a change from everyday sandwich use soft tortillas for wraps, bagels, English muffins, pita pockets or fresh baked rolls.

Create Your Own Snack Mix
Use a selection of small flavorful crackers, cereal, dried fruit or pretzels. Just about anything goes. For an occasional kid lunch box treat toss in a few M & Ms or yogurt or chocolate covered raisins. Experiment with different mixes and pre-package in individual zip lock bags.

Try Different Sandwich Fillings
Alter the sandwich fillings. Consider combinations like diced chicken and corn, ham and avocado, grated carrot and cheddar cheese, or jam and cream cheese.

Quesadillas
Place on soft tortilla in a hot frying pan. Spread with tomato sauce or pizza sauce. Sprinkle grated cheese on top and other fillings like ham, bacon, peppers, onions and tomatoes. Place another tortilla on top and heat until cheese melts. Cut into pizza triangles.

Don't Forget The Veggies
To ensure your child gets her daily requirement of vegetables cut up a selection of carrot sticks and celery sticks. Consider also other veggies like cucumber, ears of baby corn, cherry tomatoes, and zucchini. Pack a small container of dip.

Fruit Cubes
Cut up different pieces of fruit and package in a plastic container. Use fruit or vanilla yogurt as a tasty dip.

Fruit & Cheese Bites
Cheese cubes and grapes make a nice snack or lunch dessert. Pineapple and apple slices dipped in lemon juice also go nice with cheese.

Mini Muffins
Kids love things that come in small packages. So think ‘mini’ – small muffins and bagels. Vary flavors to avoid boredom.

Sandwich Shapes
Remove crusts from bread and cut out different shaped sandwiches using cookie cutters.

Pack A Note
Occasionally pack something extra special in your child’s kid lunch box like a note saying I love you or even a simple smiley face. Be creative and come up with something like a funny cartoon or saying that you know will put a smile on your child’s face.

Beyond Sandwiches
If your child is tired of bread in any form consider crackers. What about packing a few crackers in your child’s kid lunch box along with a side of cheese and ham slices? Kind of like a homemade lunchable only healthier. You can even cut the ham and cheese slices into fun shapes using cookie cutters. Be sure to package the crackers, cheese and meat separately.

Source: http://www.school-lunch-ideas.com