As a means to reduce rising health care costs, innovative solutions are rising to the surface. One such solution is known as direct primary care (DPC).
What is DPC?
In this model, physicians, pediatricians and internists charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at lower prices, instead of accepting insurance for routine visits. As a result, DPC can provide substantial savings to patients. Consider the following:
Because they don’t operate under the typical fee-for-service model, many DPC providers are able to spend more time with their patients. Research shows that patients who have a good relationship with their doctor receive better care and are happier with the care they receive.
Does DPC replace the need for health insurance?
No, in fact, DPC providers recommend that their patients have some form of insurance to protect themselves in the event of an emergency. Remember, DPC is for primary care. It will not take care of catastrophic injuries, surgeries or trips to the emergency room.
How popular is DPC?
DPC is emerging as a way to combat rising health care costs and maintain a high quality of care. Those who partner with the right providers may find great success with this type of health care model. While DPC has grown steadily in the past few years, the market is still slow. Despite this, DPC providers and supporters are optimistic about its future.
As health care costs continue to climb and the prevalence of expensive chronic conditions increases, the importance of choosing the right doctor and type of care is exemplified. DPC presents a way for employees to receive more personalized health care while containing their health care costs. Moreover, DPC can be an attractive option for employees with high deductible health plans and health savings accounts, as it would provide them with the option of receiving care without paying high out-of-pocket costs.
It may be worth it for you to further investigate this model and evaluate if it’s right for your organization. For more information on DPC, please contact us today.
Fun in the sun is even better when you have a swimming pool in your backyard to stay cool on hot, summer days. Despite all the entertainment that a swimming pool offers, there are also homeowner liabilities. To help you minimize your risk, we’ve gathered some safety tips to keep you in the know as you swim.
To Minimize Drowning Risks:
As the homeowner, you are liable for the safety of all swimmers. To ensure that you can adequately protect people on your property, consider taking life-guarding, CPR and first aid courses so you know what to do in an emergency.
Chances are you are under insured and could benefit from umbrella coverage if you:
Liability comes in many forms. Here are a few of the ways you may be responsible for damages beyond what your current home and auto policies cover.
It’s no secret that distracted driving accidents, fatalities, and the resulting medical care costs are on the rise, making higher limits more important than ever. Even relatively minor accidents can incur substantial medical bills. If an accident involves disability or death, the costs can be hundreds of thousands, or even millions, of dollars. Those with teenage drivers incur greater risk as teens are more likely to have a serious crash.
Do you have children?
Those with children, teen and adult children living with them can benefit from an umbrella policy, as you could be liable for injuries to others’ children during carpooling, a playdate or babysitting. Even if your child attends a party where there is an injury or death, you can be sued, even if your child did nothing wrong.
Do you entertain at home?
If so, you could be liable for everything from trip/fall hazards, to food poisoning, to someone drinking alcohol at your house and getting in a car accident on their way home. A homeowner’s policy worth $300,000 won’t go very far if the courts award a $500,000 judgement against you.
What about pets?
While dog bites only comprise a third of all homeowner’s liability, according to the Insurance Information Institute, even friendly dogs can frighten or knock down elderly or youthful guests and cause injury.
Personal injury and personal offense liability.
Gossip can be hurtful. It can also result in painful lawsuits. People can be sued for embellishing an embarrassing story about someone, writing a bad review of a business, re-posting material subject to copyright laws, or even a rant on social media. In short, anyone can sue another person for any reason, frivolous or not. Regardless of the validity of the suit, you must respond.
Drop down protection. Do you travel overseas?
You may be at risk without realizing it. For instance, if you rent a car and have an accident, your home or auto policy probably won’t cover it. Likewise, if you rent a boat while on vacation, you are likely without protection. But an umbrella policy may provide primary liability in both situations. Further, if you are sued personally, the umbrella may cover your legal defense. A good attorney starts at $250 an hour, but with personal umbrella insurance, you could receive extended protection for less than a dollar a day.
You don’t have to be rich to be sued like it.
Some people assume that since they aren’t rich, they can’t get sued since they don’t have the money to pay. However, the courts disagree. If a person is held responsible, or even partially responsible, for an accident, their wages can be garnished, their savings taken, and in some states their home and other assets seized. While financial responsibility rules vary from state to state, not having umbrella insurance exposes you to a lot of risk.
A personal umbrella policy is an inexpensive hedge against such risks. Many times, umbrella insurance is available for around a dollar a day. In short, bad things happen to good people. The key is to do a thorough interview with your agent about your family, your lifestyle, and hobbies. He or she can use that information to determine if your risk is tangible so you can make a more informed decision about liability and umbrella insurance.
Article from 2/26/18 Insurance Journal - insider-tips-for-increasing-umbrella-sales
Written by Brook McGuire is the Strategy Lead for Specialty Products at Safeco Insurance.
Workers on a shift schedule tend to have poor eating habits and lack regular exercise, which can contribute to sleep problems, fatigue and stress. Read this article to learn how shift workers can fight fatigue.
Minding Your Mental Health
For some, work can be a major source of stress due to heavy workloads, pressure to perform at a high level, job insecurity, long work hours, excessive travel and conflicts with co-workers. Read on to learn when you should consider speaking to your manager about your mental health.
For shift workers, unconventional schedules can take a toll on health and safety. In fact, research shows that people who sleep during the day often struggle with getting an adequate amount of rest.
What’s more, workers on a shift schedule tend to have poor eating habits and lack regular exercise, which can contribute to fatigue and stress. To combat these adverse health factors, shift workers should consider doing the following:
It’s important to be mindful about your scheduling, and avoid permanent or consecutive night shifts whenever possible. In addition, employees should be allowed to gradually change from night shifts to normal shifts, as this gives the body time to recover and adapt to a new schedule.
Fatigue due to poor quality or lack of sleep can affect every aspect of an individual’s life, and can severely hamper one’s ability to perform at work. Speak to a doctor if you are concerned about the quality of your sleep or want more general health tips.
For some, work can be a major source of stress due to heavy workloads, pressure to perform at a high level, job insecurity, long work hours, excessive travel and conflicts with co-workers.
Over time, this level of stress can lead to insomnia, anxiety, depression, low morale and drastic mood swings. Overcoming these symptoms isn’t always easy, but knowing when to step back and evaluate your mental health can help.
Evaluating your mental health is incredibly useful when it comes to decompressing and alleviating stress caused by workplace factors.
While mental health and workplace stress can vary on an individual basis, the following are some examples of when speaking with a manager can help reduce workplace stress:
TWFG Insurance Spring / The Woodlands | Our Policy is Caring! | (281) 466-1310
Employers with group health plans must generally extend coverage to the children of an employee when a state court or agency issues a qualified medical child support order. A National Medical Support Notice (NMSN) is the standardized document that state agencies use for the medical child support order.
The Department of Health and Human Services (HHS) recently issued frequently asked questions (FAQs) for employers about NMSNs. These FAQs address a variety of topics related to NMSNs, including how to administer the notice and coverage requirements.
Employers with group health plans may sometimes receive medical child support orders, requiring them to extend coverage to an employee’s children. These FAQs are helpful because they answer common questions about NMSNs.
Employers should also be aware that there are additional requirements that apply under ERISA when an employer receives a medical child support order, such as a requirement to notify the employee about the order.
HHS has provided the following FAQs for employers on the NMSN:
When is the NMSN sent to the employer?
Child support agencies send the NMSN to employers when appropriate. Specifically, when:
• A new child support order is issued requiring a parent to provide medical coverage;
• An existing order is modified;
• The parent(s) ordered to provide health care coverage has a change in employment; or
• It is not clear that the parent is complying with an existing order to provide coverage.
The NMSN is divided into two parts, Part A and Part B. Part A is a Notice to Withhold for Health Care Coverage and includes the employer response and instructions. Part B is a Medical Support Notice to the Plan Administrator and includes the plan administrator response and instructions.
Does the release of private medical information in response to the NMSN violate the Health Insurance Portability and Accountability Act (HIPAA)?
No. The Privacy Rule at 45 CFR 164.512(f) permits a health plan to respond to a request for information by a child support agency that issued a NMSN. The Privacy Rule allows a medical plan administrator to disclose protected health information in response to the NMSN.
Do I enforce the NMSN to cover the child(ren) of a recently terminated employee if the employee elected self-only COBRA coverage?
Yes. A child covered by a group health plan is a beneficiary under the plan. The covered child is a qualified beneficiary with the right to elect continued coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) if the plan is subject to COBRA and if the child loses coverage because of a qualifying event.
Can the plan administrator change the employee’s coverage to a different option even if it affects the employee’s premiums?
Yes. The plan administrator may take whatever steps necessary to enroll the children named in the NMSN if coverage is available and the premiums can be deducted within the Consumer Credit Protection Act (CCPA) limits.
What should I do if the employee is no longer eligible for employer-sponsored medical insurance coverage?
You should notify the child support agency that sent the NMSN.
What should I do if the medical insurance provider changes?
You should notify the child support agency that sent the NMSN.
What should I do if the employee no longer makes enough money to continue employer-sponsored medical insurance coverage?
You should stop withholding premiums if your employee cannot make the payments within the CCPA limits and notify the child support agency.
What should the employee do if he or she does not make enough money to cover the medical insurance premiums?
Your employee should look at other options to provide medical insurance coverage, such as:
• Enroll in the Health Insurance Marketplace;
• Obtain private coverage; or
• Enroll his or her child in a state Children’s Health Insurance Program.
The employee should also notify the child support agency to modify the medical support order.
Are withholdings for medical support subject to the CCPA limits?
Yes. In most states, payments deducted from an employee’s pay for medical support are subject to CCPA limits. However, some states require that medical support premiums be withheld before computing the maximum to withhold under the CCPA. See HHS’ Income Withholding Requirements Matrix for information on state withholding priorities and other withholding information.
Does withholding for medical support have a higher priority than child support?
Not usually. Most states give priority to current child support. However, state law governs the priority given to ongoing child support and medical support, so please refer to the Income Withholding Requirements Matrix for information on priorities and withholding information.
Who can I contact with questions about the NMSN?
You should contact the state child support agency that issued the NMSN. The contact information is in the top box on Page 1. You can also find each state’s point of contact on HHS’ State Medical Support Contacts and Program Information Matrix.
Who completes Part A of the NMSN?
The employer completes Part A if the employee:
• Is not eligible for health insurance;
• Has been terminated; or
• Does not have enough disposable income to cover the health care premiums.
If any of the above applies, the employer must complete Part A and return it to the child support agency and discard Part B. If the employer determines that the employee is eligible to provide coverage, the employer forwards Part B to the plan administrator.
Who completes Part B of the NMSN?
The plan administrator completes Part B and returns it to the child support agency. The plan administrator may enroll the child in existing coverage or notify the child support agency about other coverage options available to the parent(s). Once the child is enrolled in a plan, the plan administrator will let the employer know how much to deduct for the insurance premium. The employer may determine whether the premium and ongoing child support exceed the CCPA limits under the state priority for withholding. If so, the employer will notify the child support agency using Part A of the NMSN – the Employer Response.
Must I determine if the cost of medical support coverage is reasonable?
No. The child support agency generally determines if the cost to cover the children is reasonable.
Must I determine which parent meets the Affordable Care Act (ACA) affordability test before enrolling the children?
No. If a child support agency sends the NMSN, the employer has to use the child support definition of reasonable cost, not the ACA’s affordability test.
TWFG Insurance - Spring / The Woodlands
Uh oh, you just got into a fender bender on your way to run a quick errand. What should you do now? Stay calm and read on to learn how to react to make sure
Get The Facts
Sounds easy, but many people forget to do this after an accident for one reason or another. It is important to get the names, address and phone numbers of everyone involved. Also, gather a description of the car(s) and license plate number(s), and make sure to get the insurance company and the vehicle identification number of everyone involved when you’re at the scene of the accident.
TWFG Insurance Spring / The Woodlands
Our Policy is Caring!