Get All Your Docs In A Row

Whether it’s for a parent, a spouse, or even ourselves, chances are all of us will face the complicated issues of elder care at some point in the near future. In the first article of this series, we talked about the importance of planning in advance. In this installment, we look at all the paperwork that can turn a minor complication into a major crisis if it’s needed and can’t be found.

written by William Markin, Editor of The Masonic Bulletin

Let’s Start at the Very Beginning  (A Very Good Place to Start)  I’m going to start making a very big assumption. I’m going to assume that you were born. Of course you were, you’re probably thinking. But can you prove when? And where?

To do that, you need a birth certificate. And if you don’t have one…or it can’t be located when it’s needed…it can be a major problem. A whole host of services and programs can require one, and there may be times when you or a relative will be required to submit copies to multiple places at the same time. And not just plain old photocopies. Oh, no! They want genuine certified copies.

Fortunately, if you were born in Ohio, you can probably get certified copies (with colorful pin-hole seals) at the Vital Records bureau in the basement of the Lucas County Health Department. They aren’t cheap, though. Currently, they’ll set you back $25 each, but it’s not a bad idea to have at least a couple copies on hand.

You may also need official copies of your marriage license or any divorce decrees. For these, you’ll have to make a trip down the street to the County Courthouse.  If you were born out-of-state, on the other hand, tracking down these documents can range from a few hours on the computer to days or weeks of correspondence and hunting.

Similarly, if you need a copy of your military discharge papers, they can be ordered on-line in a fairly simple process, but it can take from six to nine weeks to get them. There are services (the VA has a list of authorized ones) that can get you a copy of a DD-214 in a matter of days, but at a cost of a hundred dollars or more.

Your Very Own Paper Trail
The point is, the easiest and least costly time to get these documents together is long before you need them. And your birth certificate is just the beginning. There are a host of important documents that can be critical in case of a major medical event. The Area Office on Aging suggests a whole checklist full.

Pretty overwhelming, isn’t it? But believe me (from experience), if you or a loved one doesn’t know where these documents are, it can  be a real headache when you or someone you care about needs special care or assistance or, ultimately, goes to that Great Celestial Lodge in the Sky where we all know we’re headed but are never totally prepared for.

Ideally, all of these documents would be in single safe place, known to your family. A small, fire-resistance safe in a closet can be a great location…as long as someone else knows the combination. Similarly, a safe-deposit box at a bank works well, unless you lose or misplace the key.

One way to handle this is to get a simple notebook or journal, and write down exactly what papers you have and where they can be found. List your bank accounts and credit cards and numbers. And while you’re at it, write down the phone numbers from the back of your credit cards….the ones you’re supposed to call if they’re lost or stolen.

If possible, include copies of things like insurance policies, deeds, and stock certificates, as well as copies of your social security, Medicare and health insurance cards. If you don’t have a copier (and these days, you can get a combination copier-printer-fax for as little as $40), there are plenty of copy services around, including FedEx and UPS stores, Kinko’s and CopyMax (part of OfficeMax).

The Fabulous Five
All of these documents are important, but there are five that deserve special mention because you might not have misplaced them, but might never have had them. And you need them.

1) A Will. When I think of a will, I usually think of the scene in the movies where the family gathers together in a posh attorney’s office to hear the reading of Uncle Charlie’s will, and who will get his millions and who will get stuck with his beloved but incontinent cat.

If you have millions, you probably already have a will, or can afford an attorney or estate planner to help you get one. For most of us, though, our possessions, estates and bequests are fairly simple, so all we need is a simple will. Most attorneys will draw up a simple will for a few hundred dollars, although there are alternatives even to that, including computer programs that ask you questions, then compose them for you and web sites that do the same thing on-line.  There are even workbooks that will guide you through the process.

Then, just sign it and date it and presto, you have a valid will. Even if it’s just written on the back of an envelope, in case you have a Lincoln complex and are planning on attending the theatre tonight. Of course, your signature should be witnessed, and it wouldn’t even hurt to take it down to your local bank branch and have it notarized (assuming you wrote it on a large–enough envelope for the notary seal).

Even though a will is a legal document, it doesn’t have to be fancy. But unless you have a document that clearly specifies what you want to leave to whom, a judge may end up deciding that, and your beloved but incontinent cat end up with someone who really doesn’t fully appreciate her.

(Lest you think I’m joking – and alright, maybe I am a little -- if you have a pet, one of the most important things you need to think of in advance is what’s going to happen to that  pet if you are no longer able to keep and care for it.)

2) A Living Will. This somewhat misleadingly-named document, also sometimes called an “Advance Directive”, is simply a statement to a doctor about how far you want them to go to keep you alive if you develop a terminal or irreversible condition. I’m not going to try to advise you on what decision to make on this, because it’s really a very personal matter. If it’s for yourself, you may want to talk it over with your family first.  In the case of an elderly parent or grandparent, you definitely should discuss it with them in advance, and clearly understand their wishes.

It’s not an easy or very comfortable subject to broach with someone. “Oh, by the way, Grandpa, just the other day I was thinking about what happens if you’re laying in the hospital dying of an incurable disease…”, but it really should be discussed. If nothing else, use this article to start the conversation. Let them blame me. I can take it.

Again, standard forms are readily available for this purpose. Check on-line or call the Area Office on Aging and ask them for a copy.

3) Health Care Power of Attorney. Another misleadingly-named document, sometimes called a Durable Power of Attorney for Health Care, this simply gives someone else the power to make health care decisions for you if you are unable to make them for yourself, and really is a good idea. In fact, it’s best to name an alternate as well, in case the first-named person is unavailable, and discuss your wishes with both. And it goes without saying it’s probably best to name people who like you. At least a little.

4) Power of Attorney. This gives another person – not necessarily an attorney, but anyone -- the legal ability to make financial transactions for you if you are ill or unavailable. Depending on how it’s written, it can be a very sweeping document that grants broad powers to another person to do as they wish with your assets (although there are legal ramifications for misusing this power), so be careful who you pick for this one. Still, someone should have the ability to take care of your financial affairs if you can’t.

5) Consent for Release of Information. This is a fairly new addition to this list, so it may be – but shouldn’t be -- overlooked. You know those privacy statements you’re always being asked to sign every time you visit the doctor or hospital (unless you’re just visiting a friend, and even that wouldn’t surprise me)?

That’s because of something called HIPAA, which stands for the Health Insurance Portability and Accountability Act. It makes it illegal for doctors and hospitals to divulge any information about any patient to anyone without the patient’s permission. So in that classic movie scene where the doctor comes out of surgery into the waiting room, and a teary-eyed relative, “Doctor, are they okay?” his legally and politically correct answer would be, “Can I see your HIPAA Authorization for the Release of Confidential Medical Information, please?”

Again, it’s a simple thing, but one that is important for your loved ones to have, and for you to have in case it’s them in the hospital.

Make The Computer Your BFF
Before you non-techno-geeks let your imaginations run wild, BFF stands for Best Friend Forever, and if you’re comfortable with a computer and have internet access, it can be an enormous help in gathering the paperwork I’ve talked about. If you’ve never learned to use one, this could be a good time to start. Check at a nearby Senior Center. Chances are, they have whole classes full of people that are just as wary/confused/frightened/apprehensive/antagonistic about these little boxes as you are.

But even if you’ve lived ninety-seven years without touching a computer and don’t intend to now, I still have good news for you. Most true computer nerds just love to show off their abilities to others, and that includes doing a whole lot of on-line research and document retrieval for you. So all you have to do is find someone who has a computer for their BFF, or even OFE (Only Friend Ever), and make them your BFF!

The Long and Short of It
In short, pulling all these documents together, whether it’s for yourself or someone else, can be a long process. That’s why it makes so much sense to do it in advance, when you can take your time and work at your own leisure.

Doing it this way can save you – or someone you care about – a lot of grief and even money. It makes sense to get your docs in a row. Now.

Important Document Checklist (Courtesy of Area Office on Aging)

INSURANCE

• Medicare Card
• Secondary Health
• Life
• Special Care
• Long Term Care
• Catastrophic Illness
• Auto
• Home
• Other

LEGAL
• Auto Title
• Deeds
• Living Will
• Living Trust
• Power of Attorney
• Power of Attorney for Health Care
• Trust Papers
• Will

LIFE EVENTS
• Birth Certificate
• Burial Plot
• Funeral Arrangements
• Immigration/Naturalization Papers
• Marriage/Divorce Papers
• Military Papers
• Social Security Card

FINANCIAL
• Bank Notes
• Bank Savings Accounts
• Bonds
• Broker Name/Phone
• Certificates of Deposit
• Checking Account
• Credit Card List
• IRAs
• Mortgage Papers
• Mutual Funds
• Safety Deposit Keys/Combination
• Stock Certificates
• Tax Records

William Markin, Editor

The Masonic Bulletin, Copywrite 2011

Facts About the Flu

Though influenza can appear at any time, the typical flu season in the United States is during winter, with peak flu activity between November and March. Each season is unique, but each year, anywhere from 5 to 20 percent of the U.S. population gets the flu. Around 200,000 people are hospitalized due to its complications, and another 36,000 die from it. Yet, some myths still remain about its origination and transmission. It is important to be correctly informed about the disease in order to remain healthy during the flu season.

The flu is an infection of the respiratory tract caused by the influenza virus. It can cause mild to severe illness, and at times can cause complications leading to death. People who have the flu often feel some or all of these symptoms:

• Fever or chills
• Headache
• Fatigue
• Cough and/ or sore throat
• Runny or stuffy nose
• Muscle or body aches
• Stomach ailments such as nausea, vomiting and diarrhea (this is more common in children than adults)

How the Flu is Spread
The flu is spread primarily through germs when coughing, sneezing or talking close to others. It also can be spread if an individual touches a surface that was touched by an infected person, and then touches his or her own mouth, eyes or nose. People are typically contagious beginning one day before symptoms start and up to five to seven days after symptoms appear.

If Bitten by the Flu Bug
If you contract the flu, it is important to take good care of yourself. The Centers for Disease Control and Prevention (CDC) recommends:

• Stay home from work! It’s your best chance for recovery, and you will avoid   spreading the disease to others.
• Get lots of sleep.
• Drink plenty of fluids.
• Take over-the-counter (OTC) medications appropriate for your symptoms.
• Most people do not need medical care, but consult your doctor if you are concerned. Also, seek immediate medical attention if you have any of the warning signs discussed on the next page.

Prevention
It is possible for serious complications to arise from the flu, including bacterial pneumonia, ear infections, sinus infections, dehydration and worsening of chronic medical conditions. This is why it is crucial to do all you can to prevent the virus from attacking you in the first place.

These simple steps should be taken in order to avoid the flu:

1. Get a yearly flu vaccine. It is the most important step in protecting against the disease.
2. Take preventive actions. Cover your mouth when you sneeze or cough. Try to avoid close contact with sick people and avoid touching your eyes, nose and mouth. Wash your hands often or use alcohol-based hand sanitizer.
3. Take antiviral drugs if your doctor recommends them. These are prescription drugs that fight the flu by keeping the viruses from reproducing in your body.
4. Maintain a healthy immune system by not smoking, eating healthy food, exercising, taking a daily multivitamin, getting adequate sleep and controlling your stress level.

Flu Vaccination
In 2010, the CDC changed their recommendation regarding flu vaccination – previously they had suggested that children and high-risk individuals get vaccinated. Now the official CDC recommendation is that everyone 6 months of age and older get a yearly flu vaccine. Vaccination is especially important if you are at high risk for serious flu complications, such as young children, pregnant women, people with chronic medical conditions, and people 65 years and older.

The 2011-2012 seasonal flu vaccine will vaccinate against multiple strains of influenza, including H1N1. Thus, only one flu shot is needed to protect against both seasonal and H1N1 flu this year. The vaccine is available in a shot or a nasal spray.

Contrary to popular belief, you cannot get the flu from the flu vaccine – but sometimes side effects mimic those of the flu, such as a headache, low fever and/or runny nose. These will only persist for a day or less, however.

Certain people should NOT get a flu vaccine without first consulting their physician, including:

• Those with a severe allergy to chicken eggs
• Those who have had a severe reaction or have developed Guillain-Barre syndrome within six weeks of getting an influenza vaccination
• Children less than 6 months of age

Emergency Situations
Occasionally, the flu can cause serious medical complications. It is important to seek immediate medical treatment if someone with the flu displays any of these signs.

In children, emergency warning signs include:

• Fast breathing (or trouble breathing)
• Bluish skin color
• Not drinking enough fluids
• Not waking up or interacting
• Being so irritable the child does not want to be touched
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In adults, emergency warning signs are:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms that improve but then return with fever and worse cough

This newsletter is for informational purposes only, and is not intended as professional advice. © 2008-2011 Zywave, Inc. All rights reserved

Ten Ways to Save on Prescription Drugs

TEN WAYS TO SAVE ON PRESCRIPTION DRUGS

1. Tell your doctor you can't afford the drugs he's prescribing.

According to a Consumer Reports survey, only 4% of those polled said they'd had a conversation with their doctors about the cost of a drug. You shouldn't hesitate to talk to your doctor about prices; these days, many people can't afford the skyrocketing prices of prescription drugs.

2. Ask your doctor whether there's a generic that would work just as well.

It's amazing how much money you can save with this one little question. For example, if your doctor prescribes lunesta, a sleeping pill, you could end up paying about $93 for 15 doses. Switch to zolpidem, which is the generic form of ambien, and you'll pay $33 for the same number of doses, according to Consumer Reports Best Buy Drugs.

To make it really easy, bring in a list of the low cost generics sold at your local pharmacy and hand it to your doctor. If there isn't a generic that will work for your particular problem, ask whether there might be a less-expensive brand name available.

3. Ask the pharmacist for less-expensive alternatives.

You can also ask your pharmacist whether there's a less-expensive drug in the same class as the one your doctor prescribed.

4. Consider using mail order delivery.

Mail order is a key way to save on medications when needing to take medicines long-term. Mail order makes it more convenient and affordable:

• To fill prescriptions for people who take medicine regularly for arthritis, asthma, diabetes, high cholesterol, high blood pressure and other chronic conditions.
• To get specialty medications to people with complex conditions like multiple sclerosis, rheumatoid arthritis, anemia or cancer.

5. Find a Prescription Assistance Program.

Prescription assistance programs (PAPs) are an excellent resource, particularly for those families with limited income. There are several out there to help people who can't afford their prescription drugs.

6. Be suspicious of free samples.

Samples are indeed enticing. But what a lot of people don't know is that samples are often for the most expensive drugs on the market. Although the samples will help you out for a month or two, after that, you'll have to start forking over the big bucks by yourself.

7. Buy a three-month supply.

Usually, it is less expensive to get a 90 day supply instead of buying one month at a time. For instance, a 30-day supply of 5 milligram tablets of simvastatin, a cholesterol medicine, costs $18 at drugstore.com, while a 90-day supply costs $43, saving you about 20% over the long term.

8. Split medications with caution.

Sometimes you really can save money by asking your doctor to prescribe a double dosage of a medication and then splitting the pills in half. There are safe and unsafe ways to split medications and some should never be split at all, such as time-delivery drugs. Always ask your doctor or pharmacist if the medicine is suitable for splitting. Invest in a pill cutter to ensure an accurate dosage.

9. If you don't have insurance, shop around.

Pricing your drugs may take you some time, but you'll be surprised at the differences in costs. Phone your local pharmacies and ask them what they charge for your drug, and ask what the costs are for a 30, 60 and 90-day supply. Pharmacies sometimes charge very different prices for the same drugs. In fact, Consumer Reports found that prices for the same bottle of pills can vary by more than $100. Additionally, many of the local pharmacies have websites to help make your research easier. A website called Pharmacy Checker helps you compare prices too.

10. Ask for a medication review.

You may be taking medicines you don't need, especially if you see a variety of doctors who don't talk to one another about what they're prescribing. If you take more than a couple of drugs on regular basis, schedule periodic review visits with your doctor to reevaluate each medication. You can also check with your pharmacist if your drugstore offers medication therapy management which will reappraise your entire medication list, make sure you need all of them, and recommend less expensive options.

Resources: March 19, 2009|by Elizabeth Cohen, CNN Senior Medical Correspondent; Five Tips to Help Patients Reduce Drug Costs by Trisha Torrey, About.com Guide, April 2010

Leadership

If your actions inspire others to dream more, learn more, do more and become more,
you are a leader. 

John Quincy Adams, 6th U.S. President

Savings Fitness- Seven Easy Ways to Save

A Guide to Your Money and Your Financial Future –

1.  Negotiate a lower credit card interest rate. Simply call up your credit card company and ask for a better rate. If you have an excellent credit score of 720 or higher, you may be able to get a rate of 10 percent or less. If the company refuses to lower your rate, threaten to cancel the card.

2.  Fill up your car with regular gas instead of premium (unless required by your car’s manufacturer.) Premium gas is about 8 percent more expensive, and most cars run just as efficiently using regular.

3.  Use coupons.  Sure, it might be tedious to go through the Sunday paper, but that 50 cents here and there can really add up. Combine that with the fact that some grocers pair with products to have them on sale that same week, and that minor annoyance just saved you double digits!

4.  Trust your instincts – not your impulses.  It may be tempting to buy that clearance-priced video or ultra-discounted vacuum cleaner, but before throwing it in your shopping cart, take another walk around the store and ask yourself if you really need it. The same goes with Internet shopping, where whims can be satisfied with the simple click of a button. Save your online basket, get off the computer, and come back online a little while later, after you have had time to think about if you really need it.

5.  Check your tires.  It is vital to your car’s health to regularly check the tire air pressure – the recommended amount is once a month (or before any long trip.) Tires that are properly inflated may improve fuel economy by as much as 3.3 percent.

6.  Use your tap.  Believe it or not, there was a time when bottled water was not available. At nearly $2 each, this convenience can really put a dent in your wallet. If you are extremely particular about your water, purchase a water filter. You can attach it to your faucet or buy a specially designed pitcher for filtered water.

7.  Comparison shop.  When buying anything – but especially something expensive – do your homework. Look online; there are many sites which will do the comparison shopping for you. Remember, too, that depending on the product, you can almost always find a used version that is just as good as new – for significantly cheaper.

This article is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.

Content © 2008, 2011 Zywave, Inc. All rights reserved.

Voluntary Benefits for Employees

Benefits and insurance issues important to you - brought to you by the insurance specialists at The Ashley Group.

Offering voluntary benefits is a great way to enhance your benefits package, differentiate from competitors and increase employee satisfaction – all without expanding your budget. Employers may choose to offer voluntary dental, vision, long-term care, property and casualty, and other types of benefits, all of which can deliver convenience and great value for employees. However, many employees do not understand the advantages of these voluntary benefit options or are unclear how these insurance benefits work. To make sure that employees are taking advantage of your voluntary benefit opportunities, educate your workers about those benefits.

Demonstrate the Value
When compared to employer-sponsored benefits, many employees may fail to see the value of voluntary benefits that they must finance themselves. For example, one perk to voluntary benefits is that purchasing insurance through an employer group is often cheaper than buying individually, yet research shows that few employees are aware of this. Also, when promoting your voluntary benefit options, discuss the benefits of having coverage (and the risks of going without) and emphasize the convenience of purchasing through the company and paying through payroll deductions.

Coverage Education
The second hurdle regarding voluntary benefits is that employees often do not understand their policy, which can lead to resentment toward the employer if they find themselves unprepared due to a misunderstanding. For instance, many consumers do not understand the nuances of property-casualty coverage such as auto or home insurance, which can lead to unpleasant surprises in the event of a major loss.

When offering any benefit option, employer-paid or voluntary, you should be sure your employees understand exactly how the coverage works. For many employees, this may mean starting with basic education about deductibles, premiums, limits and other general insurance knowledge. Communication materials are helpful for this, but employees may benefit more from an individual meeting with an HR representative, or having a broker or insurance specialist come give a presentation.

What’s In It For The Employer?
Helping employees understand their benefits completely can be very advantageous for the company. In addition to boosting participation in your voluntary benefits programs, providing this meaningful education can position the company as a valuable source of knowledge and strengthen employee satisfaction and loyalty. Talk to your Ashley Group representative to learn more about employee benefit communication resources available to you.

This article is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.

© 2011 Zywave, Inc. All rights reserved.

Keep Your Heart Healthy

Do you know your blood pressure?  In the United States, someone has a heart attack every 34 seconds according to the Centers for Disease Control and Prevention. What better time than February, American Heart Month, to take control of your heart health? Determine if you're at risk for heart disease.

Answer the following questions and tally your points in this heart disease risk quiz:

• Below 120/80 (+0)
• Between 120/80 and 14/90 (+1)
• Above 140/90 (+3)
• Don't know (+1)

What is your cholesterol?

• HDL above 50, LDL below 130, triglycerides less than 150 (+0)
• Any of the following: HDL below 50, LDL above 130, triglycerides above 150 (+2)
• Don't know (+1)

How often do you eat fried foods?

• Once a month (+1)
• Several times a month (+2)
• Never (+0)

Does anyone in your family have heart disease?

• Yes, my mother did before age 65 or my father before age 55 (+2)
• No (+0)
• Don't know (+1)

On a typical weekend night, you:

• Have one glass of alcohol (+1)
• Have more than one glass of alcohol (+2)
• Don't drink alcohol (+0)

How many cigarettes have you smoked this week?

• None (+0)
• A few (+3)
• Half a pack or more a day (+8)

How many colors were in your last meal?

• 1 - ex: chicken and rice (+2)
• 2-4 - ex: some vegetables (+1)
• 4 or more - ex: salad and assorted vegetables (+0)

How do you feel after climbing three flights of stairs?

• Fine or even energized (+0)
• Winded (+1)
• I hardly ever climb stairs (+2)

What is your body mass index (BMI)?

• 18.5 - 24.9 (+0)
• 25 - 29.9 (+1)
• 30 ore above (+2)

Results:

0-2: You are on the right track to preventing heart disease. Exercise, eating right and not smoking can prevent about 80 percent of heart disease.

3-7: Even a few harmful habits can increase your risk of developing heart disease. Simply knowing your risk factors is important, especially if you need to reduce your cholesterol or blood pressure.

8 or higher: Get to the doctor. Make the commitment to one healthy behavior change, such as quitting smoking or exercising.

Content © 2010 Zywave, Inc. All rights reserved.

Time Management...

The following are a few ideas to keep in mind. 

Negative Effects

Poor time management results in:

• Procrastination
• Lack of sleep
• Irritability
• Difficulty concentrating
• Rushing through tasks
• Feeling overwhelmed

In order to combat the above, it is necessary to construct and stick to a schedule. Use the following suggestions for assistance.  

Tips for Work 

• Use a personal digital assistant (PDA), calendar, or day planner to keep track of upcoming meetings, deadlines, and appointments.
• At the start of your day, take time to write down what you need to accomplish, and work in order of priority.
• If possible, delegate minor jobs to others - or, simply ask for assistance.
• Never skip lunch. Not only does your body need nourishment to help you focus, your mind needs the mental break.

Tips for Home

• Sort mail into "Now" and "Later" categories.
• Read it at the same time each day; this will prevent you from spending too much time reading a particular piece.
• Lists are your friend!
• Always carry a shopping list to stay on task
• Plan your weekly meals while writing out your grocery list
• Every day, create a "to-do" list; rank each item in order of priority.

Tips for Parents

• Keep a calendar or chart posted with the family's daily activities so you can keep track of important upcoming events.
• Use a different colored marker or pen for each family member for easier readability.
• Find tiny windows of opportunity to get small chores done. For example, balance your checkbook while your kids watch TV, or answer e-mails while they do their homework.
• Buy in bulk. This will reduce the amount of trips to the store.
• Teach your children to do chores. Not only will they learn responsibility, it will free up time for you to get other things done! 

General Advice 

• It's okay to say "no"! Only obligate yourself to activities you know you have time for.
• Divide large projects into smaller parts and tackle each separately. This will make the venture feel more manageable.
• Constantly ask yourself "What is the best use of my time right now?" and do that job.
• Try combining errands; for example, if you will be heading out for lunch anyway during a break from work, why not take part of that time to drop off dry cleaning or buy pet food?
• Wake up earlier! Wouldn't it be nice to get a few more things done instead of sleeping a mere 15 minutes later?
• Don't forget to pencil in some time for yourself to unwind as well! Taking a break from the stressors of life is just as important as completing your duties.

Did you know there is a mathematical formula called "Pareto's Principle," or the "80/20 Rule," which has been applied to other life concepts?  Its basic idea is that in anything, a few (20%) are essential, and the rest (80%) are trivial.  You can attribute this to your list of daily or weekly tasks and prioritize accordingly.

Content © 2010 Zywave, Inc. All rights reserved.

Frequently Asked Questions How To Manage Your Health Savings Account

How do I manage my HSA?

Your Health Savings Account (HSA) is your account; the HSA dollars are your dollars. Since you are the account holder or HSA beneficiary, you manage your HSA account. You may choose when to use your HSA dollars or when not to use your HSA dollars. HSA dollars pay for any eligible expense. Most commonly, the HSA account holder will use HSA dollars to pay the out-of-pocket expenses (i.e., deductible and coinsurance) associated with their high deductible health plan.   

What expenses are eligible for reimbursement from my HSA?

HSA dollars may be used for qualified medical expenses incurred by the account holder and his or her spouse and dependents. Qualified medical expenses are outlined within IRS Section 213(d). In summary the IRS Section 213(d) states that “the expense has to be primarily for the prevention or alleviation of a physical or mental defect or illness.” 
In addition to qualified medical expenses, the following insurance premiums may be reimbursed from an HSA:
- COBRA premiums
- Health insurance premiums while receiving unemployment benefits
- Qualified long-term care premiums*
- Any health insurance premiums paid, other than for a Medicare supplemental policy, by individuals ages 65 and over

Are dental and vision care qualified medical expenses under an HSA?

Yes, as long as these are deductible under the current rules. For example, cosmetic procedures, like cosmetic dentistry, would not be considered qualified medical expenses.

What expenses are NOT eligible for reimbursement from my HSA?

The following expenses may not be reimbursed from an HSA:
- Premiums for Medicare supplemental policies
- Expenses covered by another insurance plan
- Expenses incurred prior to the date the HSA was established
- Over-the-counter drugs purchased without a prescription (except insulin)

What is a coverage gap?

This is the gap between total out-of-pocket expenses associated with your high deductible health plan and your HSA dollars. For example, assume that you have a $2,000 deductible, a $4,000 maximum out-of-pocket, and either you or your employer has contributed $2,000 to your HSA account. If your medical costs incurred exceed $4,000 for the year, then you are financially obligated to pay the difference between your total maximum out-of-pocket ($4,000) and your HSA balance ($2,000) - ($4,000 - $2,000 = $2,000).* 

What happens when my HSA funds run out?

You may be financially responsible for any eligible medical expenses that fall within the coverage gap.

Can I use my HSA dollars for non-eligible expenses?

Money withdrawn from an HSA account to reimburse non-eligible medical expenses is taxable income to the account holder and is subject to a 20 percent tax penalty - unless over age 65, disabled or upon death of the account holder. 

When can I start using my HSA dollars?

You can use your HSA dollars immediately following your HSA account activation and once contributions have been made.

When do I contribute to my HSA account, and how often can I?

You, your employer or others can contribute to your HSA account through payroll deductions or as a lump sum deposit.* You can contribute as often as you like, provided your (and your employer’s) total annual contributions do not exceed these 2010/2011 limits:
- $3,050 for individual coverage
- $6,150 for family coverage
Individuals that are age 55 or older may be eligible to make “catch-up” contributions up to $1,000.

How do I pay my physician or network facility at time of service with my HSA dollars?

You may request that the network provider submit your claim to your health plan. You should make sure that your provider has your most up-to-date insurance information. Once the medical claim has been processed, if applicable, out-of-pocket expenses will be billed.  At this time you may choose to use your HSA debit card or HSA check* to pay for any out-of-pocket expenses, or you may choose to pay with your own money and receive reimbursement at a later date. You should always ask that your medical claim be submitted to the health plan before you seek reimbursement from your HSA. This procedure will ensure that provider discounts are applied. Also, remember to keep all medical receipts and Explanation of Benefits (EOBs).

What if I have HSA dollars left in my account at year-end?

The money is yours to keep. It will continue to earn interest and will be available for you and your health care costs next year. 
How do my remaining HSA dollars rollover at year-end?
Any dollars left in your HSA account at year-end will automatically roll over into next year’s HSA account.*

What happens to my HSA dollars if I leave my employer?

The funds are yours to keep. You may elect one of the following options:
- Leave your funds in the current HSA account
- Transfer your funds to an HSA with your new employer
- Transfer your funds to another qualifying account within 60 days
Can my HSA dollars be used for retirement health care costs?
Yes, only for expenses eligible for reimbursement.

Can I use the money in my account to pay for my dependents’ medical expenses?

You can use the money in the account to pay for medical expenses of yourself, your spouse or your dependent children. You can pay for expenses of your spouse and dependent children even if they are not covered by your HDHP.

Can couples establish a “joint” account and both make contributions to the account, including “catch-up” contributions?
“Joint” HSA accounts are not permitted. Each spouse should consider establishing an account in their own name. This allows you to both make catch-up contributions when each spouse is 55 or older.

My employer offers an FSA – can I have both an FSA and an HSA?

You can have both types of accounts, but only under certain circumstances. General Flexible Spending Accounts (FSAs) will probably make you ineligible for an HSA. If your employer offers a “limited purpose” (limited to dental, vision or preventive care) or “post-deductible” (pay for medical expenses after the plan deductible is met) FSA, then you can still be eligible for an HSA.

Can I shift my IRA funds to my HSA?

Owners of individual retirement accounts that are enrolled in a high deductible health plan can shift IRA funds to an HSA without facing a tax penalty. The IRS allows a one-time transfer that does not exceed your maximum HSA contribution limit.

Can I borrow against the money in my HSA?

No. You may not borrow against it or pledge the funds in it. For more information on prohibited activities, see Section 4975 of the Internal Revenue Code.

Can the funds in an HSA be invested?

Yes, you can invest the funds in your HSA. The same types of investments permitted for IRAs are allowed for HSAs, including stocks, bonds, mutual funds, and certificates of deposit.

* May vary depending on HSA plan design and benefit plan design.  Refer to your Summary Plan Description or HR administrator for specifics pertaining to your plan. 

© 2007-2011 Zywave, Inc. All rights reserved.

HSA (Health Savings Accounts) Examples of Eligible Expenses

Your Health Savings Account may reimburse:
Qualified medical expenses incurred by the account beneficiary and his or her spouse and dependents;

· COBRA premiums;
· Health insurance premiums while receiving unemployment benefits;
· Qualified long-term care premiums*; and
· Any health insurance premiums paid, other than for a Medicare supplemental policy, by individuals age 65 or older.
Distributions made from an HSA to reimburse the account beneficiary for eligible expenses are excluded from gross income.

Qualified Medical Expenses:
The Internal Revenue Service defines qualified medical care expenses as amounts paid for the diagnosis, cure, or treatment of a disease, and for treatments affecting any part or function of the body. The expenses must be primarily to alleviate a physical or mental defect or illness.

The products and services listed below are examples of medical expenses eligible for payment under your Health Savings Account, when such services are not covered by your High Deductible Health Plan. To be an expense for medical care, the expense has to be primarily for the prevention or alleviation of a physical or mental defect or illness. This list is not all-inclusive; additional expenses may qualify, and the items listed below are subject to change in accordance with IRS regulations.

*Claims for over-the-counter medicine or drug expenses incurred during 2010 can be reimbursed without a prescription. Claims for over-the-counter medicine or drug expenses (other than insulin) that are incurred in 2011 cannot be reimbursed without a prescription. This new rule does not apply to items for medical care that are not medicines or drugs. Thus, equipment such as crutches, supplies such as bandages and diagnostic devices such as blood sugar test kits purchased after 2010 will still qualify for reimbursement without a prescription.

* For purposes of reimbursement of qualified long-term care premiums from an HSA, reimbursement in excess of the amount which may be deducted on an individual's personal tax return is not an eligible expense. IRS 213(d)(10) establishes the tax deduction allowed for qualified long-term care premiums on individual tax returns. If the HSA reimburses long-terms care premiums for an amount greater than set forth in IRC 213(d)(10), the amount greater than allowed is included in the account holder's taxable income and is subject to a 20% penalty in 2011.
· Abortion
· Acne treatment*
· Acupuncture
· Adoption (pre-adoption medical expenses)
· Air conditioner/purifier (if to treat medical condition)
· Alcoholism treatment
· Allergy medications*
· Alternative medicine (if to treat specific medical condition)
· Ambulance
· Analgesics*
· Antacid*
· Antibiotics
· Antihistamine*
· Anti-itch creams*
· Arthritis gloves
· Artificial limbs & teeth
· Aspirin*
· Asthma treatments
· Automobile modifications (if for physically handicapped person)
· Bactine*
· Bandages/Gauze
· Birth control pills
· Birthing classes
· Blood pressure monitoring devices
· Blood sugar test kit and test strips
· Blood storage (temporary storage for when collection is part of diagnosis, treatment or prevention of existing or imminent medical condition)
· Body scan
· Braille books/magazines
· Breast pumps (only if for medical condition)
· Breast reconstruction surgery following mastectomy
· Calamine lotion*
· Carpal tunnel wrist supports
· Capital expenses
· Cayenne pepper (only if treating specific medical condition)*
· Chelation therapy
· Christian Science practitioner fees
· Contraceptives
· Condoms
· Chiropractor
· Chondroitin/Glucosamine*
· Circumcision
· Co-insurance amounts and deductibles
· Cold medicine*
· Compression hose
· Contactlenses - also materials and equipment
· Copayments
· Cough suppressants*
· Counseling (except marriage)
· Crutches
· Decongestants*
· Deductibles
· Dental treatment (except teeth whitening)
· Dentures and denture adhesives
· Diabetic supplies
· Diagnostic items/services
· Diaper rash ointments/creams*
· Diarrhea medication*
· Disabled dependent care expenses
· Doula (only if providing medical care for mother/child)
· Drug addiction treatment
· Drug overdose, treatment of
· Ear plugs (for medical purposes)
· Ear wax removal products*
· Eczema treatments
· Egg donor fees
· Egg/Embryo storage fees (only for immediate conception)
· Exercise equipment/programs (only if required by physician)
· Expectorants*
· Eye drops
· Eye exams
· Eyeglasses, prescription
· Fertility/Infertility treatments
· Fiber supplements (only to treat medical condition)
· First aid cream
· First aid kits
· Flu shots
· Fluoridation device or services, rinses
· Food thickeners (if required by physician)
· Gambling disorder
· Genetic testing (only to diagnose medical condition)
· Glucose monitoring equipment
· Guide dog/other animal aid
· Health institute fees (only if prescribed by a physician)
· Hearing aids
· Hemorrhoid treatments*
· Home improvements to accommodate a disability
· Hormone replacement therapy (HRT)
· Hospital services
· Hot/cold packs
· Humidifier (if for specific medical condition)
· Hypnosis
· Inclinator
· Incontinence supplies
· Insect bite creams and ointments*
· Insulin
· IVF (in vitro fertilization)
· Laboratory fees
· Lactation consultant
· Language training (for dyslexia or disabled)
· Laser eye surgery/Lasik
· Laxatives*
· Lead-based paint removal
· Legal fees involving medical care
· Lodging at a hospital or similar institution
· Lodging not at a hospital or similar institution (up to $50/night; only if involving medical care)
· Lodging of a companion (if accompanying a patient for medical reasons)
· Masks, disposable (only if to treat specific medical condition)
· Massage therapy (only if recommended by a physician to treat a specific trauma or injury)
· Mastectomy-related undergarments
· Meals at a hospital
· Medical alert bracelet or necklace
· Medical conference admission, transportation, meals, etc. (if related to chronic condition suffered by you, spouse or dependent)
· Medical information plan charges
· Medical monitoring and testing devices
· Medical records charges
· Menstrual pain relievers
· "Morning after" contraceptive pills*
· Motion sickness pills*
· Nasal strips or sprays (only to treat sinus problems; not to prevent snoring)*
· Nicotine gum or patches*
· Norplant insertion or removal
· Nursing services provided by a nurse or attendant
· Nutritional supplements (only if they are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician)
· Nutritionist's professional expenses (if treatment relates to specifically diagnosed medical condition)
· Obstetrical expenses
· Occlusal guard to prevent teeth grinding
· Optometrist
· Organ donors/transplants
· Orthodontia
· Orthopedic shoes/shoe inserts (only for treating specific medical condition)
· Osteopath fees
· Over-the-counter (OTC) drugs*
· Ovulation monitor
· Oxygen
· Pain relievers*
· Personal trainer fees (if for medical condition)
· Petroleum jelly (for medical condition)*
· Physical exams
· Physical therapy
· Pregnancy test kits
· Prenatal vitamins (only if taken during pregnancy)*
· Prescription drugs
· Preventive care screenings
· Probiotics (only for treatment of specific medical condition)
· Prostheses
· Psychiatric care
· Psychoanalysis
· Psychologist
· Radial keratotomy
· Reading glasses, prescription
· Rehydration solution
· Retin-A® (only if recommended by physician for specific condition)*
· Rubbing alcohol
· Screening tests
· Shipping/handling fees for medical item
· Sinus medications
· Sleep deprivation treatment
· Smoking cessation programs and medications
· Special education
· Special food required for diet by physician
· Special home costs for mentally handicapped
· Special medical equipment installed in a home
· Special TV/telephone equipment for hearing impaired
· Speech therapy
· Sperm storage (only for immediate conception)
· Spermicidal foam
· St. John's Wort (only if for diagnosed medical condition)*
· Stem cell harvesting and/or storage of (only if there is a specific and imminent medical condition the cells are intended to treat)
· Sterilization procedures
· Student health fee (not including the cost of belonging to the program)
· Sunglasses, prescription
· Sunburn cream/ointments*
· Support braces
· Surgery/Operations
· Taxes on medical services and products
· Therapy
· Thermometers
· Throat lozenges*
· Toothache/teething pain relievers*
· Transportation expenses for person to receive medical care
· Trips related to medical service
· Tuition for special needs program
· Ultrasound (prenatal - only to determine health or development; not for snapshots)
· Umbilical cord freezing/storage (only if there is a specific medical condition it is intended to treat)
· Usual and customary charges, excess
· Vaccines/Immunizations
· Vasectomy/Vasectomy reversal
· Vericose veins treatment (only if medically necessary)
· Veterinary fees (for the care of seeing- or hearing-impaired assistance animals)
· Viagra® (if prescribed by a physician)
· Weight loss program/drugs (if prescribed by a physician)
· Walkers
· Wart remover treatments*
· Wheelchair
· Wig
· X-ray fees
· Yeast infection medications*

Rev. 4/10, 11/10
Retin-A® is a registered trademark of Ortho Dermatologics. Viagra® is a registered trademark of Pfizer, Inc.
Plans that do not allow reimbursement of all eligible medical expenses as defined by the IRS and Department of Treasury must customize this brochure prior to use.
Design © 2009-2010 Zywave, Inc. All rights reserved.

Medicare Secondary Payer: The Working Aged

Legislative Brief

General Medicare Secondary Payer Provisions

Under the Medicare law, as enacted in 1965, Medicare was the primary payer for services except those covered by workers' compensation (WC). In 1980, Congress enacted the first of a series of provisions that made Medicare the secondary payer to certain additional primary plans. The purpose was to shift costs from the Medicare program to private sources of payment. These provisions are known as the Medicare Secondary Payer (MSP) provisions and are found at section 1862(b) of the Social Security Act (the Act). These provisions prohibit Medicare from making payment if payment has been made or can reasonably be expected to be made by the following primary plans when certain conditions are satisfied: group health plans, workers’ compensation plans, liability insurance, or no-fault insurance. If payment has not been made or cannot be expected to be made promptly by a workers’ compensation plan, liability insurance, or no-fault insurance, Medicare may make a conditional payment, under some circumstances, subject to Medicare payment rules. Conditional payments are made subject to repayment when the primary plan makes payment. When Medicare is secondary payer, the order of payment is the reverse of what it is when Medicare is primary. The other payer pays first and Medicare pays second.

When Medicare is the secondary payer, the provider, physician, or other supplier, or beneficiary must first submit the claim to the primary payer. The primary payer is required to process and make primary payment on the claim in accordance with the coverage provisions of its contract. The primary payer may not decline to make primary payment on the grounds that its contract calls for Medicare to pay first. If, after the primary payer processes the claim, it does not pay in full for the services, Medicare secondary benefits may be paid for the services. Generally, the beneficiary is not disadvantaged where Medicare is the secondary payer because the combined payment by a primary payer and by Medicare as the secondary payer is the same as or greater than the combined payment when Medicare is the primary payer.

Working Aged Provisions
Medicare benefits are secondary to benefits payable under Group Health Plans (GHPs) for individuals age 65 or over who have GHP coverage as a result of:

• Their own current employment status with an employer that has 20 or more employees; or 
• The current employment status of a spouse of any age with such an employer.

Employers are required to offer to their employees age 65 or over and to the age 65 or over spouses of employees of any age the same coverage as they offer to employees and employees’ spouses under age 65, i.e., coverage that is primary to Medicare.  This equal benefit rule applies to coverage offered to all employees (full-time and part-time).

Medicare beneficiaries are free to reject employer plan coverage, in which case they retain Medicare as their primary coverage.  When Medicare is primary payer, employers cannot offer such employees or their spouses secondary coverage for items and services covered by Medicare.  Employers may not sponsor or contribute to individual Medigap or Medicare supplement policies for beneficiaries who have or whose spouse has current employment status.

Health insurance plans for retirees or the spouses of retirees do not meet this condition and are not primary to Medicare.  Medicare beneficiaries are free to reject GHP coverage in which case they retain Medicare as the primary coverage.

Only employers with 20 or more employees are required to offer the same (primary) coverage to their age 65 or over employees and the age 65 or over spouses of employees of any age that they offer to younger employees and spouses.  This requirement is met if an employer has 20 or more full-time and/or part time employees for each working day in each of 20 or more calendar weeks in the current or preceding year.  Self-employed individuals who participate in an employer plan are not counted as employees in determining if the 20 or more employees requirement is met.  Where an employer does not have 20 or more employees in the preceding year, he is required to offer his employees and spouses age 65 or over, primary coverage when he has had 20 or more employees on each working day of 20 calendar weeks of the current year.  The employer is then required to offer primary coverage for the remainder of that year and throughout the following year, even if the number of employees subsequently drops below 20.  The "20 or more employees" requirement must be met when the individual receives the services for which Medicare benefits are claimed.  If at that time, the employer has met the "20 or more employees" requirement in the current year or in the preceding calendar year, the GHP is primary payer.  An employer that meets this requirement must provide primary coverage even if less than 20 employees participate in the employer plan.

Employers are not required to provide coverage to individuals.  However, any coverage provided to such individuals age 65 or older and age 65 or older spouses of such individuals of any age, by an employer of 20 or more employees must be the same as coverage provided to younger such individuals, that is, coverage primary to Medicare.  The employer must also provide primary coverage to older such individuals even if there are no younger such individuals enrolled in the plan.

Where a GHP is primary payer, but does not pay in full for the services, secondary Medicare benefits may be paid, to supplement the amount it paid for the Medicare covered service.  If a GHP denies payment for services because they are not covered by the plan as a plan benefit bought for all covered individuals, primary Medicare benefits may be paid if the services are covered by Medicare.  Primary Medicare benefits may not be paid if the plan denies payment because the plan does not cover the service for primary payment when provided to Medicare beneficiaries.  A GHP's decision to pay or deny a claim because the services are or are not medically necessary is not binding on Medicare.

If you have questions regarding this or any other Medicare Secondary Payer issue, please contact your Ashley Group representative.

Source:  Centers for Medicare and Medicaid Services Internet-Only Manual #100-05 “Medicare Secondary Payer (MSP) Manual”

This Ashley Group Legislative Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice.  Readers should contact legal counsel for legal advice.  

6/09; 6/10

Design © 2009-2010 Zywave, Inc.  All rights reserved.       

Health Care Reform: Q & A - OTC Drugs

Health care reform changes the rules for reimbursement of over-the-counter drugs through HSAs, HRAs, MSAs and FSAs. These questions and answers from the IRS clarify the new rules.

Q. How are the rules changing for reimbursing the cost of over-the-counter medicines and drugs from health flexible spending arrangements (health FSAs) and health reimbursement arrangements (HRAs)?

A. Section 9003 of the Affordable Care Act established a new uniform standard for medical expenses. Effective Jan. 1, 2011, distributions from health FSAs and HRAs will be allowed to reimburse the cost of over-the-counter medicines or drugs only if they are purchased with a prescription. This new rule does not apply to reimbursements for the cost of insulin, which will continue to be permitted without a prescription.

Q. How are the rules changing for distributions from health savings accounts (HSAs) and Archer Medical Savings Accounts (Archer MSAs) that are used to reimburse the cost of over-the-counter medicines and drugs?

A. In accordance with Section 9003 of the Affordable Care Act, only prescribed medicines or drugs (including over-the-counter medicines and drugs that are prescribed) and insulin (even if purchased without a prescription) will be considered qualifying medical expenses and subject to preferred tax treatment.

Q. When will the changes become effective?

A. The changes are effective for purchases of over-the-counter medicines and drugs without a prescription after Dec. 31, 2010. The changes do not affect purchases of over-the-counter medicines and drugs in 2010, even if they are reimbursed after Dec. 31, 2010.

Q. How do I prove that I have purchased an over-the-counter medicine or drug with a prescription so that I can get reimbursed from my employer's health FSA or an HRA?

A. If your employer’s health FSA or HRA reimburses these expenses, you would provide the prescription (or a copy of the prescription or another item showing that a prescription for the item has been issued) and the customer receipt (or similar third-party documentation showing the date of the sale and the amount of the charge). For example, documentation could consist of a customer receipt issued by a pharmacy that reflects the date of sale and the amount of the charge, along with a copy of the prescription; or it could consist of a customer receipt that identifies the name of the purchaser (or the person for whom the prescription applies), the date and amount of the purchase, and an Rx number.

Q. How does this change affect over-the-counter medical devices and supplies?

A. The new rule does not apply to items for medical care that are not medicines or drugs. Thus, equipment such as crutches, supplies such as bandages, and diagnostic devices such as blood sugar test kits will still qualify for reimbursement by a health FSA or HRA if purchased after Dec. 31, 2010, and a distribution from an HSA or Archer MSA for the cost of such items will still be tax-free, even without a prescription.

Q. Will I need a prescription to use my health FSA, HRA, HSA or Archer MSA funds for insulin purchases after Dec. 31, 2010?

A. No. You can continue to use your health FSA, HRA, HSA or Archer MSA funds to purchase insulin without a prescription after Dec. 31, 2010.

Q. I use health FSA funds for my copays and deductibles. Will I still be able to reimburse those expenses with health FSA funds after Dec. 31, 2010?

A. Yes. Copays and deductibles continue to be reimbursable from a health FSA after Dec. 31, 2010.  Similarly, funds from an HRA can continue to be used for these expenses and a distribution from an HSA or Archer MSA for these purposes will be tax-free.

Q. My company gives me two extra months beyond the end of the year to submit claims for health FSA expenses incurred during the year. What happens if I purchase over-the-counter medicines or drugs without a prescription in 2010 but do not submit the claim for those expenses until January 2011? Will they qualify for reimbursement?

A. Yes. The new restriction on plan reimbursements for the cost of over-the-counter drugs without a prescription applies only to purchases that are made after 2010.

Q. My company’s health FSA includes a provision for a grace period, so that if I don’t spend all of the money in my health FSA by Dec. 31, I can still use the amount left at the end of the year to reimburse expenses I incur during the first 2 ½ months of the following year.  If I buy over-the-counter medicines or drugs without a prescription during the 2 ½ month grace period of 2011, can I still use the amount left in my health FSA from 2010 to reimburse those expenses?

A. No. The change applies to any purchases made on or after Jan. 1, 2011. Thus, even if your employer’s plan includes the 2 ½ month grace period provision, the cost of over-the-counter medicines and drugs purchased without a prescription during that grace period in 2011 will not be eligible to be reimbursed by a health FSA.

Q. If my health FSA or HRA issues a debit card that I use to pay for over-the-counter medicines or drugs, will I still be able to use the card to purchase over-the-counter medicines or drugs after Dec. 31, 2010?

A. Generally, yes, if you have a prescription for the medicine or drug. For expenses incurred in 2010, you may continue to use an FSA or HRA debit card to purchase over-the-counter medicines or drugs (whether or not you have a prescription) at pharmacies and from mail order and web-based vendors that sell prescription drugs. Starting after Jan. 15, 2011, you may continue to use an FSA or HRA debit card to purchase over-the-counter medicines or drugs at these vendors, so long as you obtain a prescription for the medicine or drug, the prescription is presented to the pharmacist, and the medication is dispensed by the pharmacist and given an Rx number.

For further information, including guidance on purchases of over-the-counter medicines and drugs from health care providers other than pharmacies and mail order and web-based vendors (such as physicians or hospitals), see IRS Notice 2011-5. For guidance on debit card purchases at “90 percent pharmacies,” see IRS Notice 2010-59.

Q. If I use HSA or Archer MSA funds to reimburse the cost of over-the-counter medicines or drugs purchased after Dec. 31, 2010, without a prescription, what taxes will I incur?

A. If you have an HSA or Archer MSA, the amount of the distribution for expenses that are not qualifying medical expenses will be includable in your gross income and subject to an additional tax of 20 percent.

This article is for informational purposes only.  For more information call our office to speak to your Ashley Group Benifits Specilist.

This article is written and produced for The Ashley Group. Source: www.irs.gov. This is a work of the U.S. Government and is not subject to copyright protection in the United States. Foreign copyrights may apply. 

Low-Cost Wellness Resources for Small Businesses

In an effort to motivate us all to put "wellness" in the holiday equasion, I have decided to send you the following information about wellness programs geared toward small companies.

They can be as beneficial for smaller businesses as they are for large companies. In fact, small businesses have an upper hand on bigger businesses when it comes to wellness programs because they often achieve higher rates of participation and their programs are generally easier to implement. The key to developing wellness programs is keeping them simple and manageable.

Small companies need programs that are easy to use and do not require a lot of money. Use the low-cost resources identified in this article to help develop, implement and evaluate your worksite wellness program.

Please note: If you have trouble connecting to any of the following website links, please call our Marketing Department and they will help you get to the website of your choice.

Resources for Developing a Worksite Wellness Program
1. To get your program off the ground, our Ashley Group agents can provide you with the following educational articles: "Workplace Wellness: An Employer's Guide to Promoting Wellness at the Workplace" and "Workplace Wellness: Potential Legal Issues Associated with Workplace Wellness Plans."

2. The Worksite Health section of the Partnership for Prevention website offers several valuable resources for developing a wellness program: Click Here

Assessing Your Worksite
1. We can provide you with a sample wellness program survey.

2. Healthy Workforce 2010: Essential Health Promotion Sourcebook for Employers, Large and Small (pages 62-64): click here

Health Risk Appraisals
Many local health plans and health care systems have health risk appraisal or assessment programs for worksites. Contact your health plan or health care provider to see what services they offer.

1. Send employees to physicians as part of their annual physical.

2. Have The Ashley Group do worksite wellness appraisals on-site.

3. See the Wellness Council of America (WELCOA) for tips on picking the right health risk assessment: click here

General Health Education
1. Policies outlining the functions of a comprehensive worksite wellness program: Click Here

2. Health fair as a kick-off or celebration event, or an online health fair planning guide: Click Here

3. Designate specific areas to support employees such as diabetics and nursing mothers: Click Here & Click Here (Providing break time and accommodations for nursing mothers is now required by law.)

Resources for Recommended Physical Activity Strategies
1. Physical activity breaks during the workday: Click Here

2. Map out on-site trails or nearby walking routes: Click Here

3. Host walk-and-talk meetings: Click Here

4. We can provide you with exercise and physical fitness messages, and information directed to your employees.

5. Start employee activity clubs: Click Here

6. Offer on-site fitness opportunities, such as group classes or personal training: Click Here

7. Provide incentives for participation in physical activity and/or weight management and maintenance activities: Click Here

8. Aim for a Healthy Weight: Click Here

9. The President's Challenge: Click Here

10. Physical activity incentive campaign: Click Here

11. Stairwell use program: Click Here

Resources for Nutritional Strategies

1. Send healthy food messages to employees. Our Ashley Group agents can provide you with nutrition-related articles for your employees.

2. Offer appealing, low-cost, healthful food options, such as fruits and vegetables, juices, and low-fat dairy products in vending machines, snack bars and break rooms: Click Here

3. Make water available throughout the day: Click Here

Tobacco Cessation Strategies
1. General Resources:
· University of Wisconsin Center for Tobacco

· Research and Intervention: Click Here

· Employers Tools & Resource Index page: Click Here
· Quitnet: Click Here
· American Lung Association: Click Here

2. Policy prohibiting tobacco use anywhere on company property: Click Here

Evaluation Resources

1. Evaluating Your Wellness Program: Click Here

PKN 12/06
rev. SV 12/07, EB 4/08, SV 5/09, EB 11/09, AO 8/10

Content © 2006-2010 Zywave, Inc. All rights reserved.

An Employer’s Guide to Promoting Wellness at the Workplace

Wellness issues important to you – brought to you by the insurance specialists at The Ashley Group.

There are many different types of wellness programs. The essence of these programs is to promote healthy lifestyles wellness initiatives such as smoking cessation programs, on-site gyms, educational materials and much more. While some businesses have instituted very comprehensive health programs, others have achieved savings or increased productivity with just a few simple activities that promote healthy behaviors. What’s most important is to commit to wellness promotion in your organization and get started.

Why Promote Wellness in the Workplace?

Worksite health promotion is an investment in your most important asset, your employees.  Studies have shown that employees are more likely to be on the job and performing well when they are in optimal health. Benefits of implementing a wellness program include:

• Attracting the most talented workers
• Reducing absenteeism and lost time
• Improving on-the-job time utilization, decision making and productivity
• Improving employee morale
• Reduction in turnover
• Improved disease management and prevention, and a healthier workforce in general, both of which contribute to lower health care costs

Best Practices When Developing a Wellness Program

The Wellness Council of America (WELCOA), an organization dedicated to the promotion of worksite wellness, has identified seven best practices (“The Seven Benchmarks”) for employers to follow when building a comprehensive, effective worksite wellness program within their organization.1 

1. Capture senior-level support. A commitment from the top is critical to the success of any wellness initiative. Management must understand the benefits of the program for both the employees and the organization, and be willing to commit sufficient funding. Link health promotion to business goals, values and strategic priorities, and emphasize improved employee productivity and health care cost savings. 

2. Create a wellness team. Wellness teams should include a cross-section of people from all levels of your company, to ensure broad ownership of the program, help garner buy-in from the rest of the company, and make sure the program is responsive to the needs of all participants. These individuals will drive program development, implementation and evaluation.

3. Collect data that will drive your health initiatives. Once your team is in place and management is on board, it is time to gather baseline data to help assess employee health interests and risks, which will guide you in crafting your program. This process may involve a survey of employee interest in various health initiatives, health risk assessments, and claims analysis to determine current employee disease risk.

4. Craft an annual operating plan. An annual operating plan is important for your program’s success and should include a mission statement along with specific, measurable short- and long-term goals and objectives. Your program is also more likely to be successful if it is linked to one or more of the company’s strategic initiatives, as it will have a better chance of maintaining the support of management. A written plan also provides continuity when members of the wellness committee change and is instrumental in holding the team accountable to the goals, objectives and timeline agreed upon.

5. Choose appropriate health initiatives. The health initiatives that you choose should flow naturally from your data (survey, HRA aggregate report, claims) and be cohesive with your goals and objectives. They should address prevailing risk factors in your employee population and be in line with what both management and employees want from the wellness program.

6. Create a supportive environment. A supportive environment provides employees with encouragement, opportunity and rewards. A culture of health might have such features as healthy food choices in the vending machines, a no-smoking policy and flexible work schedules that allow workers to exercise. Also, your workplace should celebrate and reward health achievements and have a management team that models healthy behavior. Most importantly, be sure to involve employees in every aspect of the wellness program from its design and promotion to its implementation and evaluation.

7. Consistently evaluate your outcomes. Evaluation involves taking a close look at your goals and objectives to determine whether you achieved your desired result. Evaluation allows you to celebrate goals that have been achieved and to discontinue or change ineffective initiatives. 

Developing an Operating Plan
   
One feature that all successful worksite wellness programs share is an outcome-oriented operating plan. An operating plan is important because it:

• Links wellness initiatives to company needs and strategic priorities
• “Legitimizes” the program, which increases the likelihood of continued resources and support
• Provides continuity for the program when personnel changes occur
• Serves as a means to evaluate the effectiveness of the programs

Your operating plan should contain the following elements:

1. Vision Statement. All successful and long-lasting wellness programs, and organizations for that matter, have clear vision or mission statements. A vision statement should include the values that drive the program along with the ultimate goals or accomplishments the program is trying to achieve. It should support the company’s overall mission statement. The following is a sample wellness program vision statement:

• To improve the health and well-being of ABC Co. employees through health education and activities that support healthy lifestyles, thereby resulting in improved employee productivity, morale and health care cost savings for ABC Co.

2. Goals. Goals are the long-term accomplishments hoped to be achieved from the program. To be attainable they should be realistically set, reflect the needs of both management and employees, and flow naturally from the data collected. Goals should include clear time limits, so it is easy to determine whether or not the goal has been accomplished. The following is an example of a wellness program goal:

• ABC Co. will reduce the prevalence of employee smoking from 35 percent to 25 percent by the end of the next fiscal year.

3. Objectives. Objectives are the tactics you will implement to achieve the stated goals. Like goals, they should be written so that it is clear whether or not they have been accomplished and include specific action steps and timelines. The following are examples of objectives that support the sample goal above:

• By x date, ABC Co. will implement a smoke-free workplace policy.
• By x date, ABC Co. will offer all employees a health risk appraisal and will follow up with smokers by x date.
• By x date, ABC Co. will offer employees and their spouses smoking cessation classes to help them to quit smoking.
• In November, ABC Co. will participate in the American Cancer Society’s Great American Smoke Out.

4. Timeline. Develop a realistic timeline to both implement and evaluate the program. The timeline will incorporate key dates contained in the objectives and goals. Health promotion programs generally begin at the start of the New Year when people are making resolutions and then are remarketed at least twice throughout the year. Wellness activities should be scheduled at times that are convenient for all participants, so it may be necessary to offer multiple sessions, including evening sessions.

5. Budget. It takes resources to implement a wellness program. Your budget may include such items as salaries, program materials, administrative needs, outside vendors, evaluation and the costs associated with incentives. A comprehensive budget is essential during the evaluation process as program costs are compared to outcomes.

6. Communication Plan.  You must communicate your program to increase employee awareness of the program and drive participation. Your operating plan should address the types of marketing efforts that will be used to inform your employees about your wellness plan. Specific communication techniques will vary depending on the size of your company and your budget. Some effective but low-cost methods are:

• Involve employees in the planning and implementation process
• Involve the company president to encourage participation
• Use e-mail, bulletin boards and company newsletters
• Make the program fun by starting with a creative name
• Provide incentives
• Keep it simple and easy by making activities easy to sign up for and participate in

7. Implementation Plan. This section of the operating plan will provide detailed information about implementing the various health promotion programs and will assign individual responsibilities associated with the offerings.

Evaluation Plan.

The final section will address how you will measure the success of your program. Ideally, evaluation will include both measuring how well the program is working and whether or not it is achieving its expected results. Participation rate, participant evaluations and surveys are good evaluation tools. Also measure your results by reviewing each program goal and determining if it has been achieved. Using the example from above: Did the prevalence of smoking decrease by 10 percent by the end of the fiscal year? If not, why not? Was the goal realistic? Does the timeline need to be adjusted and objectives revised?

Implementing a wellness program requires careful planning to ensure your company can reap the benefits of workplace health promotion: healthier employees, reduced absenteeism, increased productivity, a boost in morale and reduced health care costs. All of these benefits will contribute to keeping the company’s bottom line fit and healthy.

₁ For more information on the Wellness Council of America, please see WELCOA’s Web site at www.welcoa.org

This article is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice.  Readers should contact legal counsel for legal advice.

Smart Decision Making In Uncertain Times

Business leaders and managers are experiencing the most unpredictable business conditions most leaders have ever seen.  It’s difficult enough to plan three months out let alone three years.  Despite the emotional chaos that can stem from uncertainty, there are well-established tools that can be used to navigate the turbulent waters we find ourselves in.

The following are 5 simple steps we all can take to make sure we are making the right decision the first time.  However, to effectively implement the 5 simple steps you will need to have:

• Flexible thinking: Be ready for the unexpected.  Learn (study) a proactive mix of quantitative and qualitative management techniques.  To grow your skills read, read, read…

• Off the chart communication skills: Effective communication is essential in moving an organization forward through the white water rapids of today’s fast-changing economic environment.

• Humility: Learn from other industries even your competition.  What do they do better than you do?

Step #1 - Evaluate your business environment from 30,000 feet.  After getting the big picture, focus down to the smaller components.

• Track data in real time:  Instead of focusing on annual budgets, focus on monthly, even weekly, targets (P & L, sales activities, and customer service activities).  To stay ahead of change, managers should also be meeting daily instead of monthly or weekly.  Communication is vital in times of trouble.

• Identify trends:  What are your competitors selling?  Whose sales are up?  What’s not selling at your company? 

• Know what you don’t know:  Nothing can be taken for granted in times like these.  Old assumptions are just that, “old and out-dated.”  Pull together friends and colleagues who are successful in their own businesses or management careers.  Form an advisory team to brain storm the strengths, weaknesses, opportunities, and threats.  The more brain power you can access to assist you, the more successful you’ll become.

Step #2 – Create a flexible strategy for the short-term.  Make your plan, work your plan, adjust your plan and soon your plan will work for you.

• Review responses to possible or impossible scenarios with your team.  Put you ego on the shelf.  If what you are doing is not working, change what you do.  Don’t be too rigid.  Be open to new ideas from your team.

• Hang on to your cash.  Cut your costs where you can, but only where it makes sense.  Have your team meet with your employees one by one and ask them each to name three things they can do immediately to save money and conserve cash.  You may be surprised how much you can save in the process.

Step #3 – Lead with Passion. Take time to talk to your workers.  Show them you are supportive, decisive, and sincere.

• Be honest.  Share your own concerns about the economy, job losses, and the future in general.

• Share the vision.  Providing a pro-active plan for navigating the short-term is essential.  Share what your next step is.

• Communicate wisely.  Manage by wandering around.  Get out of the office on to the floor where your workers are. 

Step #4 – Strengthen your team.  The stronger your team, the stronger your business will become.

• Cross-train when possible.  This is good for the managers and the company. It is also good for the employee because it will develop new skills. It will also prevent the employee from getting bored or feeling underappreciated. 

• Focus on specific challenges.  Wars are won, one battle at a time.  Choose only top-priority projects that can add revenue to your bottom line. 

• Identify your top performers and recruit new ones.  Provide new opportunities to high capacity people.  Push them out of their comfort zones.  If you have the money, a down economy is a great time to hire new high capacity talent.

• Encourage assertiveness.  Workers need to feel comfortable about bringing problems to light.  Create a reward system to motivate creative problem solving.

Step #5 – Keep your ear to the ground.  Reach out to understand the changing needs of customers, suppliers, and business partners.

• Be proactive.  Don’t wait for your phone to ring.  Call your customers, suppliers, and business partners before they call you.

• Be resourceful.  Negotiate discounts from suppliers.  But a better idea is to figure out how your company can become less expensive to serve.  That could be a win-win for you and your suppliers.

Resources:
Managing Uncertainty, Harvard Business Review
Managing in the Fog, The Economist
Managing in a Downturn, Financial Times

What Everyone Should Know About Heart Attacks.

Dr. Virend Somers, a cardiologist from the Mayo Clinic, is the lead author of a report in the July 29, 2008 issue of the Journal of the American College of Cardiology. According to the report, "most heart attacks occur in the day, generally between 6 a .m. and noon," Dr. Somers said. "Having one during the night, when the heart should be most at rest, means that something unusual happened," he said.

Dr. Somers and his colleagues have been working for over ten years to show that sleep apnea is to blame. The following are things we all need to remember according to Dr. Somers:

1. If you take an aspirin or a baby aspirin once a day, take it at night. The reason: aspirin has a 24-hour "half-life." Therefore, if most heart attacks happen in the wee hours of the morning, the aspirin would be strongest in your system.
2. Aspirin lasts a really long time. It can last in your medicine chest for years. When it gets old, it smells like vinegar and that's when to throw it out.
3. It is important to always have ASPIRIN in the home.
4. There are other symptoms of heart attack besides the pain on the left arm.
5. One must also be aware of an intense pain on the chin, as well as nausea and lots of sweating, however these symptoms may occur less frequently.
6. There may also be NO pain in the chest during a heart attack.
7. The majority of people (about 60%) who had a heart attack during their sleep, did not wake up. However, if it occurs, the chest pain may wake you up from your deep sleep.
8. If that happens, IMMEDIATELY DISSOLVE TWO ASPIRINS IN YOUR MOUTH and swallow them with a bit of water. Then phone 911, a neighbor, or a family member who lives very close by, and state HEART ATTACK and that you have taken 2 ASPIRINS.
9. Take a seat on a chair or sofa and wait for their arrival.

According to a recent article by Dick Morris, a well known medical commentator, a Cardiologist has estimated that, if each person, after receiving this e-mail, sends it to 10 people, it is likely a life will be saved!

Sources:
Journal of the American College of Cardiology
DICK MORRIS Published on TheHill.com

Extraordinary Customer Service

Remember when you were young (at least those of us who are old enough) visiting your neighborhood store to get a cold drink and some chips after school, and the clerk knew you by name? Today you’re lucky if you can find someone who knows where anything is. Customer service (with most companies) just is not good enough anymore.

This brings us to the opportunity. Let’s call it "Extraordinary Customer Service." Here are seven ideas and tips I hope will help your business establish and maintain an ongoing climate of Extraordinary Customer Service.

1. Define what extraordinary really means - Knowing what exceptional service entails is essential to establishing the procedures and the corporate DNA with which to achieve it. So, delineate what extraordinary means in your business. Is it keeping appointments on time or making certain that telephone service reps always say "please" and "thank you"? Your goal is to know exactly what will move your service beyond merely "good enough."

2. Ask if you're not sure - If you find it difficult to pinpoint what extraordinary service really is in your field, call some of your customers. They will certainly let you know. See what’s important to them. Connect with the person that handles most of your customer complaints or merchandise returns. Ask this person to identify topics that are frequent issues of dissatisfaction.

3. Allow your people to be extraordinary - Talking about it is one thing, but actually carrying out extraordinary customer service is impossible without the necessary personal empowerment and procedural flexibility. One policy or solution does not fit all people nor does it fit all problems. Positive communication and purpose to serve the customer - not to simply serve the policy - is what is important. Policies should be designed to serve and enhance customer relationships so that those relationships bring your company profits. If a policy or procedure doesn’t accomplish this, your people need the freedom to do what is needed without fear of negative repercussions. The more you explore the possibilities up-front the more solutions you can develop for the various possible scenarios ahead of time.

4. Share information - Share valuable information about clients and customers with your entire organization. Customer buying habits, particular needs, interests and other data can be stored in your customer management system stored in a central location and easily shared. Don't keep it a secret. Sharing the information with your employees lets them know your organization is running on all cylinders. It also helps them promote these products or services to customers. In other words, don't keep critical customer information close to the vest.

5. Share the commitment - Treat your staff like customers. Adopt a servant leadership attitude. Servant leadership is an approach to leadership development, coined and defined by Robert Greenleaf and advanced by several authors such as Stephen Covey, Peter Block, Margaret Wheatley, Ken Blanchard, and others. Servant-leadership emphasizes the leader's role as steward of the resources (human, financial and otherwise) provided by the organization. It encourages leaders to serve others while staying focused on achieving results in line with the organization's values and integrity. As your staff sees you serving them and others in your organization, that kind of DNA, in time, will transfer to your entire organization.

6. Don't expect magic overnight - Exceptional service takes time to take hold in an organization, particularly one with lots of people and departments. Review your progress monthly.

7. Mistakes are going to happen - Don't pretend mistakes are not there. Don’t play the blame game. People need to have the freedom to make mistakes and learn from them without negative consequences.