Benefits Solution

Professional Services

Saving money on employee benefits is imperative in today's economy. The cost of providing benefits continues to rise, and employees consistently seek more and more. Many employers struggle to balance employee needs with their own bottom lines. Helping you meet these divergent needs is GDI Insurance Agency, Inc.'s specialty.

Obtaining competitive quotes for coverage and handling claims problems is only a small part of what you should expect from your insurance and employee benefit advisors. We go much farther by providing quality services throughout the year. Providing your current carriers with a simple letter that names GDI Insurance Agency, Inc. as your "Broker of Record" will allow us to complete an in-depth market analysis and obtain quotes from more markets and leverage our relationships with carriers. Brokers typically receive commission dollars from carriers on a monthly basis which means that your plan renewals dates do not affect your ability to change brokers at any time during your plan year.

Your employees are paying for a portion of your benefit plans, and consequently are paying a portion of your broker's fees. Ensure that you are providing the best value and service for your company and its employees by working with a quality organization. Our professional employee communications will keep your employees informed, healthy, and safe.

In addition to employee communications, our professional services include the following:

• Plan Strategy
• Data Analysis
• Pharmacy Benefits
• Plan Administration and Legislative Compliance (which includes access to a client portal)
• Employer Education
• Human Resources
• Employee Communications
• Wellness Services
• Marketing/Marketing Action Plan

Plan Strategy Capabilities

GDI Insurance Agency, Inc. offers the following services to help you offer competitive and cost-effective benefit plan designs:

Eliminate guesswork from your benefits renewal process. Our goal is to turn viable solutions into real results through value-added tools that benefit your business. PlanAdvisor offers a simplified way to approach your benefits design planning by balancing both cost and value for your company and employees. With PlanAdvisor, we can help you:

• Analyze your benefits plan costs against reliable benchmark information
• Project the impact of medical and dental plan design changes
• Estimate your renewal costs
• Streamline the plan selection process for your employees
• Compare yourself with other employers by region, size and industry

Benchmark Surveys & Statistics

Our benchmarking data provides you a standard to which you can compare your benefit programs. We will make recommendations to help you enhance your plan while at the same time remaining competitive and reducing your overall plan costs.

Valuable benefit trend statistics and surveys are one of the core pieces of information that we provide to our clients to help support your benefit plan design strategy and decisions. These surveys and statistics provide benchmark data from leading consulting organizations around the country and cover the following topics:

• Ancillary Benefits
• Benefit Costs
• Benefit Management
• Healthcare Costs
• Health Plans
• Prescription Drugs
• Retirement Plans
• Wellness Benefits
• Vacation and Paid Time Off

Plan Design

We offer our clients plan design educational pieces so that they are fully informed when considering their design options.

What do you See?

At GDI Insurance Agency, Inc., we see a simplified way for you to approach the benefits plan design process. With our innovative PlanAdvisor tool, we can help you eliminate the guesswork involved in the benefits renewal process.

Imagine working with us to design a benefits plan that balances both cost and value for your company and its employees. With PlanAdvisor, we can help you to:

§ Analyze your benefits plan costs against reliable benchmark information;

§ Project the impact of medical and Rx plan design changes;

§ Estimate your renewal costs; and

§ Streamline the plan selection process for your employees.

Our goal at GDI Insurance Agency, Inc. is to turn trusted solutions into real results. Let us help you with your benefits renewal process. We think you will like what you see.

Compare Your Plan

§ Reliable benchmark data from HealthLeaders Media and Kaiser Family Foundation allows us to compare your plan utilization to other employers of similar plan type, region, and industry

§ Uncover cost or utilization concerns

§ Access to over 40 medical and Rx exhibits based on reliable benchmark data

See Your Plan Options

§ Analyze the impact of plan design changes

§ Based on proven actuarial factors

§ Applies to medical, Rx, HRA and HSA plans

Project Your Plan Costs

§ Calculate projected plan costs based on trend, midpoint, and large claim information

§ Estimate costs either mid-year and/or pre-renewal

Simplify the Enrollment Process

§ Employees can review estimated predictions and costs

§ Offers most relevant plan information to help employees make effective enrollment decisions

§ Advances consumerism via employee awareness of costs of services

Trusted Benefits Solutions

With Big Benefits

Compare Your Plan

Our comprehensive claims analysis tool allows you to examine your plans in comparison to national norms, and easily spot the critical cost or utilization areas of concern.

We provide you access to over 40 easy-to-read medical and Rx exhibits, based on reliable benchmark data from HealthLeaders Media and Kaiser Family Foundation.

Reports include:

§ Health Plan Cost

§ Employees vs. Dependents

§ Inpatient Admissions

§ Maternity Admissions

§ Emergency Room

§ Office Visits

§ Major Diagnostic Categories

§ Rxs per 1000 and average paid

§ Rx Direct vs. Mail Order

§ Rx Brand vs. Generic

See Your Plan Options

Prior to reviewing renewal quotes, our Plan Modeler allows you to see the results of various plan options. We can help you to easily evaluate the impact of plan design changes for medical, Rx, HRA, and HSA plans, based on proven actuarial factors.

Project Your Plan Costs

Wouldn't it be great to have someone help you predict your future plan costs? At GDI Insurance Agency, Inc., we can help you do just that with our Renewal Estimator.

We calculate projected costs based on trend, midpoint, and large claim information to help your management team in the budget planning process.

Simplify the Enrollment Process

We know you want your employees to be wise health care consumers, and to take a more active role in their health care choices.

To help you meet those goals, Plan Selector is a decision support tool you and your employees can't do without. Employees can review estimated costs, based on the most relevant plan information, to help them make effective enrollment decisions. This feature also helps you to advance employee awareness of the total costs of their benefits package.

Collaborate Online

One of the many value-added services available to you when you partner with GDI Insurance Agency, Inc. is access to a Client Portal that allows you to effortlessly click, connect, and communicate with us.

Benefits include:

§ Document posting capabilities that allow a seamless exchange of information from our agency to you.

§ Access to Benchmark Surveys, which allows you to participate in benefit plan program surveys, and to determine how your plans and programs compare to others across the U.S.

§ Access to a vast and knowledgeable network of colleagues from across the country via the sites interactive Community forum.

Trust the Experts

When it comes to renewal planning, let GDI Insurance Agency, Inc. turn trusted solutions into real results. We think you will like what you see.

In an effort to respond to the rising cost of health insurance, many employers have made use of tax-favored accounts such as health flexible spending accounts (health FSAs), health reimbursement arrangements (HRAs), and medical savings accounts (MSAs) to offer consumer-driven health plans. Beginning in January 2004, the Medicare Prescription Drug Improvement and Modernization Act of 2003 (the Act) created yet another tax-favored account - a health savings account (HSA).

This article will provide answers to commonly asked questions related to HSAs. It highlights guidance issued by the Treasury Department and Internal Revenue Service, as well as recent legislation, from 2003 through 2008.

 What is a Health Savings Account (HSA)?

An HSA is a tax-exempt[1] trust or custodial account established exclusively for the purpose of paying qualified medical expenses. HSAs are much like Archer Medical Savings Accounts (MSAs), but the rules applicable to HSAs are less restrictive.

 Who can establish an HSA?

An individual may contribute to an HSA in any month in which he or she is:

· Covered under a high deductible health plan on the first day of the month,

· Not also covered by another health plan that is not a high deductible health plan (with certain exceptions), [2]

· Not entitled to benefits under Medicare,[3] and

· Not eligible to be claimed as a dependent on another person's tax return.

Self-employed individuals can be eligible to establish an HSA.

What is a high deductible health plan (HDHP)?

A high deductible health plan (HDHP) is a plan that provides coverage as follows:

High Deductible Health Plan (HDHP)
Type of Coverage	Minimum Annual Deductible	Maximum Annual Out of Pocket Expenses
Individual	$1,150*	$5,800*
Family	$2,300*	$11,600*

*Calendar Year 2009

 How must an HDHP administer the deductible under a family plan?

In addition to establishing minimum annual deductibles for HDHPs, the IRS has also set forth rules governing how the deductible is to be administered.

Most existing health plans administer plans covering a family in a way that includes "stacking the deductible" or an "embedded deductible." A plan that "stacks deductibles" or has an "embedded deductible" pays claims for a specific individual if he or she has met the individual deductible, although the family as a whole has not met the family deductible.

Example :

Susan, Bob and their dependent elected family coverage under an HDHP. The plan year begins on January 1 and includes a $1,100 individual deductible and a $2,200 family deductible. Susan incurs $2,000 in medical expenses on January 15^th. Since the plan has an embedded deductible, Susan is required to pay $1,100 and the plan pays the remaining $900. Although the family deductible was not met, the plan will pay claims for Susan after she has met the individual deductible.

Under the IRS rules, this plan does not qualify as an HDHP since claims were paid before the $2,200 HSA-required family deductible was met.

Example :

Susan, Bob and their dependent elected family coverage under an HDHP. The plan year begins on January 1 and includes a $2,200 individual deductible and a $5,200 family deductible. Susan incurs $3,000 in medical expenses on January 15^th. Since the plan has an embedded deductible, Susan is required to pay $2,200 and the plan pays the remaining $800. Although the plan's family deductible was not met, the plan will pay claims for Susan after she has met the individual deductible.

In this example, the plan complies with the IRS rules and qualifies as an HDHP. The plan includes an embedded deductible, but its minimum individual deductible is equal to the minimum HSA-required family deductible.

An HDHP is not required to include an embedded or stacked deductible. If it does, however, it must comply with the minimum annual deductible requirements explained here.

What is preventive care?

On March 30, 2004, the IRS clarified that preventive care includes, but is not limited to, the following:

· Periodic health examinations, including tests and diagnostic procedures ordered in connection with routine examinations, such as annual physicals;

· Routine prenatal and well-child care;

· Child and adult immunizations;

· Obesity weight loss programs; and

· Screening services.[4]

However, preventive care does not generally include any service or benefit intended to treat an existing illness, injury, or condition.

The IRS provided temporary transitional relief for individuals in states where HDHPs were not available because state laws required fully-insured health plans to provide certain benefits at levels not permitted under an HDHP. For example, some state laws define preventive care more broadly than the IRS. IRS guidance clarified that for purposes of HSAs and corresponding HDHPs, the IRS (not the state) definition of preventive care governs. In order to provide states with time to modify their laws to accommodate HDHPs, the IRS only began enforcing its definition requirement after December 31, 2006.

According to America's Health Insurance Plan's (AHIP) Center for Policy and Research 2007 survey, "100 percent [of HSA/HDHP plans offering first-dollar coverage for preventive care outside plan deductibles] cover adult and child immunizations, well-baby and well-child care, mammography, Pap tests and annual physical exams. Nearly 90 percent of policies purchased first-dollar coverage for prostate cancer screenings and more than 80 percent offered this coverage for colonoscopies." Preventive screenings may also include newborn screenings, children's vision tests, adult blood pressure and cholesterol tests, women's bone density testing, colorectal cancer screening, prostate cancer screening for men over 50 and adult screening for depression.

Can preventive care include prescription drugs?

Yes. Prescription drugs or medication are preventive care when taken by a person who has risk factors for a disease but is asymptomatic or to prevent the reoccurrence of a disease from which a person has recovered. While HDHPs may cover some prescription drugs like any other preventive care or service, determining on a case-by-case basis whether a prescription drug is taken preventively or to treat an existing condition may be problematic for processors of claims. The IRS also does not consider drugs to be preventive if they "treat an existing illness, injury or condition." Since it is not always decipherable if medication is taken as a preventive measure, most HSA/HDHP plans do not include prescription drugs as a preventive benefit.

Must prescription drug benefits be subject to the deductible?

Yes. Except for prescription drugs that are preventive care, prescription drug benefits covered under an HDHP must be subject to the overall plan deductible. An individual that is covered by an HDHP and a separate prescription drug plan that provides prescription drug benefits after a small copayment is not eligible to contribute to an HSA.

Who can contribute to an HSA?

As clarified in IRS Notice 2004-50, any person, including but not limited to the account holder, an employer, or a family member, may make contributions to an HSA on behalf of an eligible individual.

Unlike MSAs, the employer and employee may both contribute to the HSA in the same year, subject to annual contribution limits. However, if an employer makes contributions to any employee's HSA, the employer must make comparable contributions (that is, the same dollar amount or the same percentage of the HDHP deductible) to the HSAs of all comparable participating employees. "Comparable participating employees" are eligible individuals who are in the same category of employees (current full time, current part time, or former employees) and who have the same category of HDHP coverage (self only, self plus one, self plus two, or self plus three or more). For the purposes of making a contribution to the HSA of an employee who is not a highly compensated employee (as defined by the IRS), however, highly compensated employees are not treated as comparable participating employees.

An employer may allow employees to contribute pre-tax dollars to the HSA through a Section 125 plan. IRS Notice 2004-50 clarifies that matching contributions made by an employer through a cafeteria plan are not subject to the comparability rule. However, the employer's contributions are subject to the nondiscrimination rules governing cafeteria plans (i.e., eligibility rules, contributions and benefits tests, and key employee concentration tests). An employer considering matching employee contributions should consult with its cafeteria plan administrator or legal counsel to ensure compliance with these nondiscrimination rules.

Can an individual make contributions to an HSA when they are also covered under an FSA or HRA?

Yes. IRS guidance released on May 11, 2004 clarifies how an individual's participation in an HSA can be coordinated with coverage under an FSA or HRA. The IRS sets forth four examples of acceptable plan coordination:

· Limited Purpose FSA or HRA,

· Post Deductible FSA or HRA,

· Suspended HRA, and

· Retirement HRA.

What is a Limited Purpose FSA or HRA?

A Limited Purpose FSA or HRA pays or reimburses Section 213(d) medical expenses that are "permitted coverage" (i.e., dental, vision). For example, an individual that is covered under an HDHP and a Limited Purpose FSA continues to be eligible to contribute to an HSA where the FSA only pays or reimburses expenses for dental or vision care not reimbursed by any other source.

What is a Post Deductible FSA or HRA?

A Post Deductible FSA or HRA pays or reimburses medical expenses incurred after the individual has met the minimum annual deductible within the HDHP. For example, an individual may seek reimbursement for amounts paid as copayments or coinsurance, after he or she has met the deductible. Note, however, that funds within an FSA are subject to the use-it-or-lose-it rule. Therefore, in general, an individual will forfeit contributions made to their FSA if they do not meet the deductible during the year.

What is a Suspended HRA?

A Suspended HRA, pursuant to an election made before the beginning of the HRA coverage period, does not pay or reimburse at any time, any medical expenses incurred during the suspension period, except preventive care or "permitted coverage." Once the suspension period ends, the individual is no longer eligible to contribute to an HSA because the individual is entitled to receive Section 213(d) medical expenses from the HRA.

What is a Retirement HRA?

A Retirement HRA pays or reimburses medical expenses incurred after the individual retires. After retirement, the individual is no longer eligible to contribute to an HSA.

Can an individual be eligible to contribute to an HSA if they are also covered under an Employee Assistance Plan (EAP)?

Yes. An individual will not fail to be eligible to contribute to an HSA merely because the individual is also covered under an EAP, disease management program, or wellness program if the program does not provide significant benefits in the nature of medical care or treatment. An example within IRS Notice 2004-50 clarifies that the availability of short-term counseling, including but not limited to substance abuse, alcoholism, mental health or emotional disorders, does not provide significant benefits in the nature of medical care or treatment.

Can an individual be eligible to contribute to an HSA if they also purchase a discount card?

Yes. On July 23, 2004, the IRS clarified that an individual's purchase of a discount card does not disqualify him or her from being eligible to contribute to an HSA. The individual must be required to pay for the cost of the services, less the discount, until the deductible is met. For example, an individual may purchase a discount card to purchase prescription drugs or vision care or services.

Can an individual be eligible to contribute to an HSA if he or she participates in an FSA with a grace period?

It depends. In IRS Notice 2005-86, the IRS clarified the interaction between the FSA grace period and eligibility to contribute to an HSA. Later legislation and IRS Notice 2007-22 amended this relationship further. In general, coverage by a general purpose health FSA with a grace period would disqualify an individual from contributing to an HSA during the FSA's grace period, unless the employee had a zero balance in the FSA at the end of the plan year. An FSA can also be amended to allow HSA contributions. Notices 2005-86, 2007-22 and statutory changes made at the end of 2006 provide further guidance regarding participants' HSA eligibility during the cafeteria plan grace period.

How much can an individual contribute to an HSA?

For each month an eligible individual is covered under an HDHP, he or she may contribute 1/12^th of $2,900 for individual coverage or $5,800 for family coverage for calendar year 2008 ($3,000/$5,950 for calendar year 2009). Nonetheless, an eligible individual who enrolls in an HSA after the beginning of the plan year is permitted to make a full year's contribution provided the individual remains covered by the HDHP for at least the 12-month period following that year, except for death or disability.

Further, HSA contributions do not have to be made in equal amounts each month. An eligible individual can contribute in a lump sum or in any amounts or frequency he or she wishes. However, an account trustee/custodian (bank, credit union, insurer, etc.) can impose minimum deposit and balance requirements.

The HSA contribution limit is reduced by any contributions made to an MSA in the same year. Rollover contributions from another HSA or MSA can be accepted. These rollover contributions are not subject to the annual contribution limit. Additionally, certain one-time rollover contributions from an FSA, HRA or IRA may also be made under statutorily specified conditions.

Individuals that are age 55 or older by the end of the tax year are permitted to make "catch-up contributions." An additional $900 may be contributed to the HSA in 2008, with an additional $1,000 in 2009 and thereafter.

What expenses are eligible for reimbursement from an HSA?

An HSA may reimburse qualified medical expenses incurred by the account beneficiary and his or her spouse and dependents. Qualified medical expenses are defined within IRC Sec. 213(d).

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;[5] and

· Any health insurance premiums paid, other than for a Medicare supplemental policy, by individuals age 65 and over.

Distributions made from an HSA to reimburse the account beneficiary for qualified medical expenses are excluded from gross income.

What expenses are not eligible for reimbursement from an HSA?

The following expenses may not be reimbursed from an HSA:

· Premiums for Medicare supplemental policies;

· Expenses covered by another insurance plan; or

· Expenses incurred prior to the date the HSA was established.

Can ineligible expenses be reimbursed from an HSA?

Yes. The trustee is not required to determine if a claim submitted for reimbursement is a qualifying medical expense. The amount withdrawn from an HSA for a non-qualifying medical expense is added to the account beneficiary's income and subject to a 10% penalty. Where funds are distributed as a result of the account beneficiary's death, disability, or after he or she is eligible for Medicare, the 10% penalty does not apply.

Who can administer an HSA?

On August 10, 2004, the IRS revised Notice 2004-50 to clarify that insurance companies, banks, or similar financial institutions that have received IRS approval to be a trustee or custodian may administer HSAs. In addition, any other person or organization already approved by the IRS to be a trustee or custodian of IRAs or MSAs is automatically approved to be an HSA trustee or custodian. Unless an employer applies for IRS approval, it may not self-administer an HSA.

Notice 2008-59 further clarifies that any administrative and maintenance fees charged by a trustee or custodian and withdrawn from the HSA are not to be reported as distributions from such HSA. The fair market value of the HSA at the end of the taxable year should also be reduced by the amount of such withdrawn fees.

What are the differences among an HSA, HRA, FSA, and MSA?

The attached chart provides a comparison among these tax-favored accounts.

Where can I find more information on HSAs?

To view the statute, technical guidance and other consumer friendly information released by the U.S. Department of the Treasury, please visit http://www.treas.gov/offices/public-affairs/hsa/.

HSAs may not be the right solution for all employers or individuals. Please contact your GDI Insurance Agency, Inc. representative for assistance in determining what tax-advantaged account will best meet your goals.

GDI Insurance Agency, Inc. welcomes the opportunity to help your organization examine its plan design(s) and make recommendations for improvement.

This copy of Plan Designs is not meant to be exhaustive nor should any discussion or opinions provided be construed as legal advice. Readers seeking legal advice should contact an attorney.

Comparison of Tax-Advantaged Accounts     HSA MSA HRA FSA Name of account Health Savings Account Medical Savings Account Health Reimbursement Arrangement Health Flexible Spending Account Who owns the account? Individual/employee Individual/employee Employer Individual/employee Who may fund the account? Employer or employee, can be both in the same year Employee can contribute pre-tax dollars through Section 125 plan Employer or employee, but not both in the same year Must be small employer or self-employed individual Employer* Employer/employee* Typically the employee contributes pre-tax dollars through a Section 125 plan What plans may be offered with the tax-advantaged account? An HDHP as follows: Min. Deductible $1,150 I $2,300 F** OPM $5,800 I $11,600 F** An HDHP as follows: Min. Deductible $2,000 I $4,000 F** Max. Deductible $3,000 I $6,050 F** OPM $4,000 I $7,350 F** Any or no health plan Any or no health plan Is there a limit on the amount that can be contributed per year? $3,000 I $5,950 F** Catch-up contributions: $1,000/year** - age 55 by end of tax year Reduced by MSA contributions in same year 65% of individual deductible 75% of family deductible No, there is no IRS prescribed limit No, there is no IRS prescribed limit Does the uniform coverage rule apply? No No No Yes *Self-employed individuals, including partners, and more than 2% shareholders in a subchapter S-corporation cannot contribute. ***For calendar year 2009.

Since June 1984, the National Association of Insurance Commissioners (NAIC) rules permit an option for plans to coordinate at less than 100 percent of allowable expenses, provided that the percent of allowable expenses for COB purposes is never less than 80 percent.­­

Comparison of Tax-Advantaged Accounts, continued   HSA MSA HRA FSA Can unused funds be rolled over from year to year? Yes Yes Yes, subject to COBRA No, but in some cases employee may elect COBRA through end of plan year What expenses are eligible for reimbursement? Section 213(d) medical expenses -COBRA premiums -QLTC premiums -Health premiums while receiving unemployment benefits -If Medicare eligible due to age, health insurance premiums except medical supplement policies Section 213(d) medical expenses -COBRA premiums -QLTC premiums -Health premiums while receiving unemployment benefits Section 213(d) medical expenses Health insurance premiums for current employees, retirees, and qualified beneficiaries, and QLTC premiums Employer can define "eligible medical expenses" Section 213(d) medical expenses Expenses for insurance premiums are not reimbursable Employer can define "eligible medical expenses" Must claims submitted for reimbursement be substantiated? No Yes Yes Yes May account reimburse non-medical expenses? Yes, but taxed as income and 10% penalty (no penalty if distributed after death, disability, or eligible for Medicare) Yes, but taxed as income and 15% penalty; no penalty if after age 65 No No Is interest earned on the tax-advantaged account? Yes, accrues tax-free Yes, accrues tax-free Yes, paid to the employer No

Data Analysis

GDI Insurance Agency, Inc. has managed medical benefit programs for hundreds of employer groups in an effort to keep costs below comparable levels experienced by other employers. Our aggressive management technique includes a number of internal medical management and preventive health initiatives.

As the healthcare industry continues to change, we have remained ahead of the game. With leading-edge technology, we will obtain meaningful information that helps us evaluate cost drivers, trends, and savings opportunities associated with our clients' medical benefits. In addition, we work to evaluate the impact of future plan changes.

We provide employer groups with tools that will provide consistent year-to-year data, reporting formats, and comparative benchmarks. This highly meaningful yet understandable information enables us to work together with your data in a continuous, interactive manner as plan management issues arise.

Decision Master Warehouse ^®

You face soaring healthcare and prescription drug costs, but lack the data you need to make money-saving decisions. Decision Master Warehouse (DMW) is a Web-based decision support system that allows you to assess your group medical and Rx plans with an easy-to-use management report. With DMW, we'll offer you clear recommendations to combat problems with utilization and plan costs based on analysis of your carrier data. You'll have the solid, high-quality information you need to formulate plan design decisions. Here's a small sample of the issues you can drill into with DMW:

• Why are office visits so high? Who is going to the doctor? Why are they going? Are they using in-network or out-of-network providers?
• Why are plan members using the emergency room so frequently? Who is using the ER most - employees, spouses, or dependents?
• What is the plan's generic substitution rate? Should your client encourage an increase in generic utilization to align more closely with benchmarks?

In addition to health and Rx reports, DMW offers sophisticated plan modeling that takes the decision-making process to the next level.

The following fact sheet explains the details of DMW.

Decision Master^® Warehouse

Data → Information = Power

You want meaningful health care claims and utilization information. You've asked, you've begged, and maybe you've just given up, thinking that good reporting is simply not an option. That may be the case with your current broker, but with GDI Insurance Agency, Inc. and Decision Master Warehouse, you can meet your data reporting and analysis needs head-on. Decision Master Warehouse (DMW) is a Web-based decision support system that analyzes claims data in ways that you never dreamed were possible by turning detailed data into meaningful information. Now you've got the power.

Illuminate Potential Problems.

The DMW Health Plan Management Report - the key to your health plan analysis - is a sophisticated guide through your claims data. Over seventy easy-to-use and understand management exhibits let you detect problems with medical utilization or plan cost by comparing your health plan information to national norms of similar employers. This will serve to drive decisions with real numbers.

 Find Underlying Causes.

DMW's powerful querying module, Drill-Down, lets you view limitless variations of your claims data. By analyzing critical components of data in multiple ways, Drill-Down can answer nearly any question you may have about claims experience. The results delivered by Drill-Down's analyses will help you formulate focused strategies for reducing utilization and costs.

 Determine Solutions.

After Drill-Down isolates problem areas, DMW's Alternative Modeling feature focuses on solutions. Modeling allows us to experiment with plan design alternatives, and most importantly, determine how plan changes can lead to savings. And, Plan Design Modeling even shows the impact of design changes on plan members.

Look at Your Plan

in a Different Light

Health Plan Management Report

The DMW Health Plan Management Report is a sophisticated claims analysis for . Each report contains over seventy easy-to-read and understand exhibits. Nearly every exhibit contains helpful charts to make the data easier to comprehend. Medstat's Marketscan database is incorporated throughout as the benchmark comparisons to illustrate crucial comparative information. Medstat's data includes over five million lives and is adjusted by age, gender, region, and industry to match your population. The exhibits also provide explanations about the data methodology and how to get more detail.

The Health Plan Management Report exhibits include:

· Total Health Plan Costs

· Claims by Age

· Claims by Relationship

· Claims by Network/PPO Affiliation

· Inpatient and Outpatient Claims

· Claims by Place of Service

· High Cost Claimants

· Claimant Distribution

· Top Hospitals

· Top Doctors and Clinics

· Inpatient Hospital Usage and Cost

· Inpatient Days/1000 and Payment/Day

· Maternity Usage and Cost

· Top Inpatient Surgery Procedures

· Top Outpatient Surgery Procedures

· Emergency Room Utilization and Cost

· Office Visit Utilization and Cost

· Chiropractic Utilization and Cost

· Inpatient Mental Health Utilization and Cost

· Outpatient Mental Health Utilization and Cost

· Claims by Major Diagnostic Categories

· Lifestyle-Related Claims

· Disease Management and Intervention Opportunities

· And many more!

View Your Claims from a New Angle

Drill-Down

DMW uses state-of-the-art online analytical processing known as OLAP. This powerful querying engine formulates your data into robust "cubes" that allow it to be viewed in limitless variations. DMW's Drill-Down can answer nearly any question you have about your claims experience, and help you determine accurate strategies for reducing utilization.

Just some of the questions you can answer include:

· Why are office visits so high? Who is going to the doctor? Why are they going? Are they using in-network or out-of-network providers?

· Why are plan members using the emergency room so frequently? Who is using the ER most - employees, spouses, or dependents? Are they using the ER appropriately?

· What does our experience tell us about disease management and intervention opportunities to select?

· What types of wellness or educational materials should our employee communication campaigns focus on?

Not only can we help you answer these questions and many more, but Drill-Down is also easy to use! This viewing tool in DMW makes use of intuitive, drag-and-drop technology which allows you and your GDI Insurance representative to just point and click your way to the roots of problems.

Drill-Down can be used to analyze the following categories:

• Claims History
• High Cost Claimants
• Inpatient and OutpatientHospital

· Inpatient and Outpatient Surgery

· Inpatient and Outpatient Mental Health

• Chiropractic Care
• Emergency Room
• Lifestyle Claims

· Major Diagnostic Categories

• Place of Service
• Disease Management
• Preventive Services
• And more!

Take Your Claims

Into the Future

Alternative Modeling

Once we isolate problem areas using Drill-Down, Alternative Modeling lets GDI Insurance help you focus on solutions.

DMW's modeling feature lets us experiment with plan design alternatives and see if plan changes can save you money. The advanced modeling capabilities even show how many plan members would be affected by a particular plan change.

DMW allows us to model your plan based on a variety of plan elements, including the following for both in-network and out-of-network claims:

· Calendar year deductibles, coinsurance, and out-of-pocket maximums

· Office visit copay and coinsurance

· Inpatient hospital copay and coinsurance

· Outpatient hospital copay and coinsurance

· Inpatient surgery copay and coinsurance

 Outpatient surgery copay and coinsurance

· Emergency room copay and coinsurance

· Chiropractic copay, coinsurance, maximum days, maximum amount, and maximum amount per visit

· Inpatient mental health copay, coinsurance, and maximum

· Outpatient mental health copay, coinsurance, maximum days, maximum amount, and maximum amount per visit

· And more!

Let GDI Insurance and the power of information assist you in creating a long-term strategy for your health plan using Decision Master Warehouse.

Pharmacy Benefits Services

Our Understanding of Your Needs

Pharmacy benefits have become one of the most high-profile areas of employee health plans, from both an economic and a member desirability and satisfaction standpoint. What's more, the pharmacy arena is highly complex, and many brokers do not have the time or special expertise needed to give their clients' pharmacy benefits or pharmacy benefits managers (PBMs) the attention they need. GDI Insurance Agency, Inc. is a rare exception.

Our Approach to Meeting Your Needs: ZywaveRx™

ZywaveRx was formed by leveraging the buying power of a nationwide network of employee benefits brokers, including GDI Insurance Agency, Inc. that collectively represents over 1.3 million self-funded lives.

ZywaveRx lets you compare your current pharmacy benefits manager to two leading national PBMs - Express Scripts and Systemed. With ZywaveRx, can provide you with access to exclusive, extremely favorable terms for your pharmacy benefits.

The highlights of the ZywaveRx program include zero dollar administrative fees, low dispensing fees, deep pharmacy discounts, and aggressive rebates. Using ZywaveRx's exclusive online savings calculators, can compare your current PBM, Express Scripts, and Systemed to determine the most cost-effective program for you.

See the fact sheet that follows for a full description of what we are able to offer you

A cure for the common PBM

You know that health care costs are rising, fast. You know there's no slowdown in sight. But, do you know that pharmacy benefits are one of the biggest contributors to those rising health care costs?

In fact, drug benefit costs are rising 15 - 20% per year, and account for 10 - 15% of total health care expenditures. Clearly, keeping drug benefits costs in line can go a long way toward improving your overall health benefits costs. But, drug benefits are popular, highly utilized benefits; simply slashing or eliminating them isn't the right answer.

Accountability. Express Scripts and Systemed know that we are presenting more than one option to our clients. We expect nothing but the highest level of service from them both in order to win your trust.

Support. Express Scripts and Systemed are dedicated to helping GDI Insurance Agency, Inc. and our clients understand their organizations, their products.

Favorable terms. Express Scripts and Systemed can provide extremely favorable terms for our clients. You will be able to retain a cost-effective pharmacy benefits program for your employees for years to come.

FDA Approves Nonprescription Zyrtec-D for Allergies

The Food and Drug Administration (FDA) has approved Zyrtec-D (cetirizine HCl 5 mg and pseudoephedrine HCl 120 mg), an allergy drug, for nonprescription use in adults and children 12 years of age and older. This drug combines an antihistamine with a nasal decongestant.

Available as a prescription drug since 2001, Zyrtec-D is now approved as a nonprescription drug for the relief of symptoms due to hay fever or other upper respiratory allergies such as runny nose, sneezing, itchy, watery eyes, itching of the nose or throat, and nasal congestion. Zyrtec-D is also for reducing swelling of the nasal passages, for relief of sinus congestion and pressure, and restores freer breathing through the nose.

Hay fever and other allergies are the sixth leading cause of chronic disease, with about 50 million sufferers each year in the United States, according to the National Institute of Allergy and Infectious Diseases. This approval reflects FDA's commitment to bringing prescription drugs to the over-the-counter market when they can be safely used without a prescription.

Source: FDA.gov

Drug Costs Eat Away at Retirement Savings

Medical and drug costs are threatening to eat away at retirement nest eggs, as many Americans underestimate their health care spending, according to a new survey from pharmacy benefits manager Medco Health Solutions Inc.

The survey revealed an overall lack of awareness and planning for drug expenses by retirees, which is putting their savings at risk. The survey of 1,000 Americans over the age of 65 found that 33 percent of retirees say medical and drug costs far outpaced expectations. Results also showed that one in four retirees spend 10 percent or more of their monthly retirement income on medications alone.

In addition, the company said three out of four retirees indicated they were aware of the cost savings benefits of getting their drugs from a mail order pharmacy, but only 40 percent actually use the tool to save money on their medications.

Employers should consider education efforts to raise retirees' awareness of generic alternatives and the ability to take fewer higher-dose pills each day in order to reduce the number of pills purchased.

Younger Adults Increasingly Treated for Heart Disease-Related Conditions

According to new research by Medco Health Solutions, Inc., heart disease, high blood pressure and hardening of the arteries - conditions that are usually associated with the senior population - are creeping into young adulthood. The research revealed that prescription drug use by younger adults for heart disease-related conditions is increasing at a rapid rate, far outpacing older adults and offering a glimpse into the forthcoming clinical and financial challenges facing the nation's health care system.

The study found that between 2001 and 2006, the number of 20-44 year olds taking prescription medications to treat high cholesterol increased 68 percent, and use of antihypertensives jumped 21 percent.

The good news is that younger patients are taking medications that control conditions which, if left untreated, could lead to heart attacks and strokes. The bad news is that these conditions are showing up in patients at younger ages, which could be the result of the growing obesity epidemic and various lifestyle factors.

For some people with high cholesterol and hypertension, lifestyle changes such as weight loss, dietary changes and exercise can control the conditions. For others, medications may be needed. The most common medications used to treat high cholesterol are statins. To treat hypertension, diuretics, beta-blockers and ACE inhibitors are often prescribed.

Source: Medco

 

FDA Approves Products that Reduce Spread of Dangerous Bacteria

The spread of the deadly strain of staphylococcus bacterium known as MRSA away from hospitals and

into schools and the general population has prompted the U.S. government to speed up the approval process of products designed to combat the antibiotic-resistant germ. The FDA recently approved an IV connection tube coated with an antimicrobial substance to prevent bacteria from entering the blood stream, and has established more streamlined procedures in the approval process to address the spread of MRSA.

Source: FDA.gov

Generic Initiative for Value and Efficiency (GIVE)

On October 4, 2007, the FDA launched the Generic Initiative for Value and Efficiency, or GIVE. The initiative will use existing resources to help the FDA modernize and streamline the generic drug approval process.

GIVE aims to increase the number and variety of generic drug products available. Having more generic-drug options means more cost savings to consumers, as generic drugs cost about 30-80 percent less than brand-name drugs.

Generic drugs are identical to their brand-name counterparts in dosage form, safety, strength, route of administration, quality, performance, and intended use. Generics also go through a rigorous scientific review to ensure both safety and effectiveness.

Source: FDA.gov

Plan Administration and Legislative Compliance

There are countless rules and regulations governing employee benefit plans. Our expert team will help ensure that you are meeting your compliance obligations. We stay up to date, and will inform you of any laws or regulations that may affect your employee benefit program. Our compliance consulting services include:

• Easy-to-read Legislative Briefs that summarize recent federal legislative developments in insurance and employee benefits.
• Answers to common COBRA, FMLA, HIPAA, HIPAA Privacy, Medicare Part D, and Section 125 questions.
• Commonly used forms in COBRA, FMLA, HIPAA, HIPAA Privacy, Medicare Part D and Section 125 administration.
• A community of knowledgeable colleagues from all over the country to share resources and information via the Community's interactive forum.
• A variety of insurance, employee benefits, and human resources Web sites and articles, all in one convenient location.

Legislative Briefs

is happy to provide our clients with the exclusive Legislative Briefs publication that summarizes recent federal legislative developments in insurance and employee benefits. These informative documents are researched and written in an easy-to-read manner by experienced benefits attorneys.

All clients receive access to a personalized Web Client Portal, which is designed to offer time-saving tools and resources that build convenience into managing your everyday work tasks.

Plan Administration and Legislative Compliance

Community

The Client Portal Community section lets clients network with a vast, knowledgeable group of colleagues from all over the country, and share resources and information via the Community's interactive forum; this allows you to post questions to peers, and provide insight to others' questions. Topics include Compensation, Employee Relations, HR Development, HR Management Topics, Recruitment, Risk Management, and Other.

Collaboration Center

The Client Portal's CollaborationCenter allows a seamless exchange of information sharing from our agency to you.

Accessible 24/7, postings from our agency are timely, relevant, and easy to locate in one convenient place online.

Surveys

The Client Portal allows all clients to participate in benefit plan surveys, allowing them to determine how their plans and programs compare to other employers across the U.S.

The Client Portal also features several value-added services and resources for 's human resources and benefits personnel. It facilitates efficient and easy communication with and our clients, and provides a vast array of material regarding HR data, such as Legislative information, employee communications, industry-related Web sites, and consumer-related information.

Resources

The Client Portal Resources supplies clients with a variety of insurance, employee benefits, and human resources Web sites and articles, all in one convenient location.

Compliance

The Legislative Guides give our clients an exclusive set of comprehensive guides to federal legislation. Complete guides include COBRA, HIPAA, HIPAA Privacy, Section 125, and FMLA. Within each guide, sections include Related Articles, Q&A, Forms, and Quick Reference.

Documents on Command

Communication materials provide clients with instant access to a library of downloadable articles including categories such as Wellness Program Tools, Human Resources, Employer Education, Benefit Announcements, Employee Communication & Education and Benchmark Surveys & Statistics.

HealthShop

provides our clients with HealthShop - comprehensive consumer information in a ready-to-print newsletter format. Topics include At the Doctor's Office, At the Pharmacy, Home Care, and Your Health Plan.

 The following are examples of the legislative briefs and state-specific compliance information we offer our clients along with a fact sheet that describes the client portal in detail.

On December 20, 2006, President Bush signed the Tax Relief and Health Care Act of 2006 (Act). The Act included some substantial changes to the rules governing Health Savings Accounts (HSAs) and the requirements applicable to high deductible health plans (HDHPs). These changes were expected to make participation in an HSA plan more attractive. The Act applies to taxable years which began on or after December 31, 2006. The IRS issued related guidance in February 2007 regarding certain rollovers to HSAs, and has indicated that additional guidance will be published at later dates.

This issue of the GDI Insurance Agency, Inc. Legislative Brief provides an overview of the Act's modifications to the rules surrounding HDHPs and HSAs, as well as the related IRS guidance. The Act includes changes in the following areas:

• Termination of Flexible Spending Arrangement (FSA) or Health Reimbursement Arrangement (HRA) to fund an HSA,

• Treatment of prior coverage under an FSA,

• Limitations on contributions to an HSA,

• Cost of living adjustments,

• Contribution limits applicable to employees covered part of the year,

• Comparable contribution requirements, and

• Distributions from individual retirement plans to fund an HSA.

Termination of FSA or HRA to Fund an HSA

The Act allows a one-time contribution to an HSA from an FSA or HRA. However, this contribution must take place prior to January 1, 2012. The amount contributed to the HSA may not exceed the lesser of the FSA or HRA account balance as of: a) September 21, 2006 or b) the account balance at the time of distribution. Because this contribution is a "qualifying transfer," it does not impact the annual contribution limit.

 Treatment of Prior Coverage Under an FSA

As allowed by the IRS rules, some FSA plans allow participants to submit and incur claims for 2½ months after the plan year has ended. This FSA plan design causes an individual to be disqualified from participating in an HSA plan the following year because the 2½ month grace period overlaps with the HSA contribution period. An individual is not eligible to make contributions to an HSA account in the same month he or she also has established an FSA account that reimburses expenses related to medical services that are covered under the individual's HDHP.

Beginning in tax years on or after December 31, 2006, the Act allows individuals covered under an FSA plan which includes a 2½ month grace period to be eligible to establish an HSA the following year if:

• The balance of the FSA is zero at the end of the plan year, or

• The individual transfers his or her unused balance into the HSA at the end of the FSA plan year.

 IRS Guidance on Rollovers

The IRS issued a 14-page guidance, Notice 2007-22 (Notice), which among other things provides guidance on rollovers from FSAs and HRAs to HSAs. According to the Notice, the FSA or HRA plan with a grace period must be amended, and a rollover must be elected by an employee before plan year end. The year-end balance must be frozen and transferred to the HSA by March 15 of the following year.

Limitations on Contributions to an HSA

Prior to passing the Act, the HSA annual contribution limits allowed an eligible individual to contribute 100% of the lesser of:

• The actual deductible, or

• $3,000 for individual coverage and $5,950 for family coverage for the 2009 calendar year.

The Act allows eligible individuals to contribute $3,000 for individual coverage and $5,950 for family coverage, regardless of the actual deductible contained within their HDHP. Therefore, it is possible that an individual could make contributions to their HSA account in an amount that exceeds their deductible.

Cost of Living Adjustments

Currently, the IRS adjusts the deductible requirements and contribution requirements each year to reflect an increase in the cost of living. These adjustments are often made in November and are effective the following January - leaving employers little time to modify their plans to comply. The Act requires that the IRS release any cost of living adjustments to a) the deductible amounts required under a HDHP or b) annual HSA contribution limits no later than June 1 of the prior year.

Contribution Limits Applicable to Employees Covered Part of the Year

The Act allows individuals that are eligible to contribute to an HSA in the last month of the taxable year to contribute an amount equal to the annual HSA contribution amount. For example, an individual that first becomes eligible to contribute to an HSA on December 1, 2008 and who enrolls in an individual HDHP could contribute up to $2,900 in that taxable year. However, an eligible individual who enrolls in an HSA after the beginning of the plan year is permitted to make a full year's contribution provided the individual remains covered by the HDHP for at least the 12-month period following that year, except for death or disability.

Comparable Contribution Requirements

An employer is not required to contribute to the HSAs of its employees. However, if an employer makes contributions to any employee's HSA, it must make comparable contributions (that is, the same dollar amount or the same percentage of the HDHP deductible) to the HSAs of all comparable participating employees. Comparable participating employees are eligible individuals who are in the same category of employees (current full time, current part time, or former employees) and who have the same category of HDHP coverage (self only, self plus one, self plus two, or self plus three or more). If an employer fails to make comparable contributions to the HSAs of its employees during a calendar year, an excise tax equal to 35% of the aggregate amount contributed by the employer to the HSAs of its employees during that calendar year is imposed on the employer.

The Act allows employers to exclude highly-compensated employees (as defined by the IRS) when determining whether its contributions to non-highly compensated employees are comparable. This change makes it possible for an employer to make greater HSA contributions to employees that are not considered highly compensated without failing to meet the comparable contribution requirement.

Distributions From Individual Retirement Plans to Fund an HSA

The Act allows individuals to make a once in a lifetime trustee-to-trustee transfer from some individual retirement plans to an HSA. Unlike transfers from an FSA or HRA, the amount transferred does apply toward the annual HSA contribution limit.

Effective Date of Changes in Law

The Act applies to taxable years which began on or after December 31, 2006. Please contact your GDI Insurance Agency, Inc. representative with any questions.

This GDI Insurance Agency, Inc. 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. Content copyright © 2006-2008 Zywave, Inc. Images copyright © 2006-2007 Getty Images, Inc. All rights reserved.

 

Comparison of Federal and California Continuation Laws

	FEDERAL (COBRA)	CALIFORNIA
Covered Employers and Plan Coverage	Group health plans maintained by private-sector employers with 20 or more employees, employee organizations, or state or local governments; coverage must be identical to that available to similarly situated beneficiaries who are not receiving COBRA coverage under the plan (generally, the same coverage that the qualified beneficiary had immediately before qualifying for continuation coverage)	Employers with 2 to 19 employees not covered by federal COBRA. Only indemnity policies, PPOs, HMOs, and church plans are eligible. Employers with more than 20 employees, once employee has exhausted federal COBRA, but employee had less than 36 months of federal COBRA coverage.
Qualified Beneficiaries (Employee / Dependents)	Individual covered by a group health plan on the day before a qualifying event - either an employee, the employee's spouse, or an employee's dependent child. In certain cases, a retired employee, the retired employee's spouse, and the retired employee's dependent children may be qualified beneficiaries. In addition, any child born to or placed for adoption with a covered employee during the period of COBRA coverage is considered a qualified beneficiary. Agents, independent contractors, and directors who participate in the group health plan may also be qualified beneficiaries.	Any individual who, on the day before the qualifying event, is covered under a group benefit plan offered by a disability insurer, and has a qualifying event (without evidence of insurability).
Continuation Period	18 months - COBRA beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work. 29 months - Disability can extend the 18 month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours. If certain requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage. Plans can charge 150% of the premium cost for the extended period of coverage. 36 months - Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. 36 months - Under COBRA, participants, covered spouses and dependent children may continue their plan coverage when they would otherwise lose coverage due to divorce (or legal separation) for a maximum of 36 months.	Up to 36 months - regardless of the qualifying event Plans can charge not more than 110 percent of the applicable rate charged for covered employee or dependent. In the case of a qualified beneficiary determined to be disabled under the United States Social Security Act, plans can charge no greater than 150% of the group rate after the first 18 months of continuation coverage.
Qualifying Events	Qualifying Events for Employees: Voluntary or involuntary termination of employment for reasons other than gross misconduct - 18 months Reduction in the number of hours of employment - 18 months Qualifying Events for Spouses: Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct - 18 months Reduction in the hours worked by the covered employee - 18 months Covered employee's becoming entitled to Medicare - 36 months Divorce or legal separation of the covered employee - 36 months Death of the covered employee - 36 months Qualifying Events for Dependent Children: Loss of dependent child status under the plan rules - 36 months Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct - 18 months Reduction in the hours worked by the covered employee - 18 months Covered employee's becoming entitled to Medicare - 36 months Divorce or legal separation of the covered employee - 36 months Death of the covered employee - 36 months	Any of the following events that would result in a loss of coverage under the group benefit plan: Death of the covered employee Termination of employment or reduction in hours of the covered employee's employment (except for gross misconduct) Divorce or legal separation of covered employee from spouse Loss of dependent status by dependent With respect to covered dependent only, the covered employee's entitlement to benefits under Medicare
Eligibility	To be eligible for COBRA coverage, must have been enrolled in employer's health plan when employed and health plan must continue to be in effect for active employees. COBRA continuation coverage is available upon the occurrence of a qualifying event that would, except for the COBRA continuation coverage, cause an individual to lose his or her health care coverage.	"Continuation coverage" means extended coverage under the group benefit plan under which an eligible employee or eligible dependent is currently covered, or, in the case of a termination of the group benefit plan or an employer open enrollment period, extended coverage under the group benefit plan currently offered by the employer.

Notice Requirements	Employers or health plan administrators must provide an initial general notice when employee is hired if entitled to COBRA benefits. When no longer eligible for health coverage, employer has to provide a specific notice regarding rights to COBRA continuation benefits. Employers must notify their plan administrators within 30 days after an employee's termination or after a reduction in hours that causes an employee to lose health benefits. The plan administrator must provide notice to individual employees of their right to elect COBRA coverage within 14 days after the administrator has received notice from the employer. Employee must respond to this notice and elect COBRA coverage by the 60th day after the written notice is sent or the day health care coverage ceased, whichever is later. Otherwise, employee will lose all rights to COBRA benefits. Spouses and dependent children covered under such health plan have independent right to elect COBRA coverage upon employee's termination or reduction in hours.	A plan's evidence of coverage must disclose the rules of continuation coverage and miscellaneous notice requirements, including a statement that individuals should examine their options carefully before declining continuation coverage. Employers are required to notify the insurer in writing of any employee who has had a qualifying event within 30 days of the qualifying event. Insurer/employer shall provide election information to qualified beneficiary within 14 days of receiving notice of qualifying event. Employers are required to notify qualified beneficiaries currently receiving continuation coverage whose coverage will terminate under a group plan prior to the beneficiary's full coverage period of the ability to continue coverage under a new group benefit plan for the balance of the full coverage period. This notice must be provided the later of 30 days prior to termination or when all enrolled employees are notified. Qualified beneficiaries must notify insurer/employer in writing of qualifying events within 60 days, or be disqualified from continuation coverage.
Termination of Coverage                     (Termination of Coverage)	Coverage begins on the date that coverage would otherwise have been lost by reason of a qualifying event and will end at the end of the maximum period. It may end earlier if: Premiums are not paid on a timely basis. The employer ceases to maintain any group health plan. After the COBRA election, coverage is obtained with another employer group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition of such beneficiary. However, if other group health coverage is obtained prior to the COBRA election, COBRA coverage may not be discontinued, even if the other coverage continues after the COBRA election. After the COBRA election, a beneficiary becomes entitled to Medicare benefits. However, if Medicare is obtained prior to COBRA election, COBRA coverage may not be discontinued, even if the other coverage continues after the COBRA election.	Continuation coverage requirements do not apply to the following individuals: Individuals who are entitled to Medicare benefits or become entitled to Medicare benefits (entitlement to Part A only constitutes entitlement to benefits) Individuals who have other hospital, medical or surgical coverage, or who are covered or become covered under another group benefit plan that provides coverage and does not impose any pre-existing condition exclusion or limitation Individuals who are covered, become covered, or are eligible for federal COBRA coverage or coverage under Ch. 6A of the PHSA Qualified Beneficiaries who fail to timely meet notification requirements Qualified beneficiaries who fail to timely submit correct premium amount, or fail to satisfy other terms/conditions of policy/contract
Conversion Rights	Some plans allow participants and beneficiaries to convert group health coverage to an individual policy. If this option is generally available from the plan, a qualified beneficiary who pays for COBRA coverage must be given the option of converting to an individual policy at the end of the COBRA continuation coverage period. The option must be given to enroll in a conversion health plan within 180 days before COBRA coverage ends. The premium for a conversion policy may be more expensive than the premium of a group plan, and the conversion policy may provide a lower level of coverage. The conversion option, however, is not available if the beneficiary ends COBRA coverage before reaching the end of the maximum period of COBRA coverage.	Employee is eligible upon termination of group coverage; spouse is eligible upon change in marital status. No evidence of insurability is required. Employers must notify employees of their conversion coverage rights within 15 days of termination of group coverage. Individuals have 63 days after group coverage ends to apply and make a first premium payment for conversion coverage.
Other		Labor Dispute - during a labor dispute, coverage may continue for up to six months after the cessation of work if employees covered by the policy timely pay both the individual and employer contribution of the premium.
Applicable Statutes	IRC § 4980B, ERISA §601 et seq.	CA Insurance Code § 10128.50-.59, CA Health and Safety Code § 1366.20-.29, 1373.621
Government Agency Contact	Depts. of Labor and Treasury (private sector plans); Dept. of Health and Human Services (public sector plans)	CA Department of Insurance (Indemnity Policies) and Department of Managed Health Care (HMO/Managed Care Plans)

 

This Chart is provided to you for general informational purposes only. It broadly summarizes state and federal statutes, but does not include references to other legal resources (e.g., supporting regulations, or formal or informal opinions of state offices of commissioners of insurance) unless specifically noted. Please seek qualified and appropriate counsel for further information and/or advice regarding the application of the topics discussed herein to your employee benefits plans.

The information contained in this newsletter is not intended as legal or medical advice. Please consult a professional for more information.

Click+Connect+Communicate

Welcome to a whole new way of working - MyWave^® is your personalized Web site that allows you to effortlessly click, connect, and communicate with GDI Insurance Agency, Inc..

It's designed to offer you time-saving tools and resources that build convenience into managing your everyday work tasks. Whether you want to view documents online, participate in plan/program surveys, or connect with over 200,000 peers in your industry, this is the place to be. It's easily accessible, hardworking, and just one of the many value-added services available to you when you partner with us.

• Our document posting capabilities allow a seamless exchange of information sharing from our agency to you

• Accessible 24/7, postings from our agency are timely, relevant, and easy to locate in one convenient place online

Survey Benchmarking

• Participate in benefit plan and/or P&C program surveys

• Allows you to determine how your plans and programs compare to other employers across the U.S.

Community

• You have access to a vast and knowledgeable network of colleagues from across the country

• Share information and resources via the Community's interactive forum that allows you to post questions to your peers, provide insight into other users' questions, and allows you to track responses based on topics or individual questions

• Community topics include Compensation, Employee Relations, HR Development, HR Management Topics, Recruitment, Risk Management, and Other

A helping hand for all your Human Resource needs. Whether you are looking for legislative information, employee communications, industry-related Web sites, or consumer-related healthcare information,Compliance

Looking for quick answers to tough legislative questions? MyWaveHR's Compliance section has the answers you're searching for. You will be directly linked to an exclusive set of comprehensive guides full of federal legislation. Complete guides include COBRA, HIPAA, HIPAA Privacy, Section 125, and FMLA. Within each guide, sections include Related Articles, Q&A, Forms, and Quick Reference. A search function is also available to help you easily source information by allowing you to browse all or only particular sections within each guide.

Documents on Command

When you need to resource information fast, provides instant access to a library of downloadable articles covering a variety of topics - exactly when you need them! Articles are conveniently grouped by general category and include: Benchmark Surveys & Statistics, Compliance & Plan Designs, and Employee Communication & Education - to help you easily locate all the resources available to you. Or, use its keyword search function to find related documents.

Resources

Resources provides useful links and articles to industry-related Web sites -all through the convenience of your homepage. In addition, use the helpful search function so you can promptly find all the information you are looking for, as well as any related documents from the Documents on Command section. And if you still cannot find exactly what you need, use the convenient "Contact your broker representative" help link. So many helpful resources - all at your fingertips.

Your Client Portal:

Click+Connect+Communicate

Welcome to a whole new way of working! Your client portal is a personalized Web site that allows you to effortlessly click, connect, and communicate with GDI Insurance Agency, Inc..

It's designed to offer you time-saving tools and resources that build convenience into managing your everyday work tasks. Whether you want to collaborate with our agency online, quickly access timely news, information, and resources, or connect with over 200,000 peers in your industry, this is the place to be. It's easily accessible, hardworking, and just one of the many value-added services available to you when you partner with us.

 Document Posting

• Our document posting capabilities allow a seamless exchange of information sharing from our agency to you

• Accessible 24/7, postings from our agency are timely, relevant, and easy to locate in one convenient place

Survey Benchmarking

• Participate in benefit plan and/or P&C program surveys

• Allows you to determine how your plans and programs compare to other employers across the U.S.

Discussion Forum

• Through your client portal's interactive discussion forum, you have access to a vast and knowledgeable network of colleagues from across the country

Compliance

• Looking for quick answers to tough COBRA, HIPAA, FMLA and Section 125 questions? Your client portal has all the answers you're searching for.

Documents on Command

• When you need to resource information fast, you have instant access to a library of downloadable health, wellness, HR and compliance articles - exactly when you need them!

Resource Links

• Useful links to industry-related Web sites are all available from the convenience of your client portal.

Health Newsletters

• Want consumer-based health articles packaged in a professional-looking format... in a flash? No problem! Your client portal supplies you with newsletters to help your employees make smart and informed health care decisions.

Human Resources Tools

GDI Insurance Agency, Inc. is dedicated to helping you create and maintain a positive work environment by offering solutions for your organization's human resource challenges. Our services include:

• Clarification and advice on compliance with laws governing employment such as FMLA, ADA, EEO
• Employee Handbooks and Policies
• Employee Communications
• HR Communications and HR Tools
• Benefit Statements
• A community of professionals to discuss your day-to-day human resource challenges

Often it can be more difficult to deliver the message than it is to create it. We recognize that many employers are seeking a more effective and efficient means of communicating important information to their employees. Fortunately, newer, more efficient ways of communicating human resources and benefits information are becoming more prevalent every day. Technology-based systems are forging the way toward improved communications, increased productivity, streamlined processes, and saved money for many human resources and benefits departments. GDI Insurance Agency, Inc. is pleased to be able to offer you such a system.

HRconnection^® is a complete online employee communication tool that lets employers manage and communicate important company information in one secure and convenient location. Through it, employees can access your company history and mission statement, employee handbook, human resources and benefits forms, an explanation of their benefit plans, rates and options along with their personal information, vacation tracking and online benefit election.

Educate - Empower - Connect

GDI gives it clients the most powerful HR communication system available, features more ways to educate and empower your employees than any other site of its kind. GDI Insurance Agency, Inc. is pleased to bring you the solution to your HR and benefits communication challenges.

It is an easy-to-use employee Web site that serves as a custom company information and employee benefits expert. For employees, it provides 24-hour access to company and benefits information from any computer with Internet access. For employers and human resources personnel, HRconnection increases productivity and costs savings by providing employee self-service and improving employee communication efforts.

GDI helps employers manage company information in one secure and convenient location that is easily viewed by employees. It is an easy-to-build Web site that is customizable to the agents and employer's preference. HRconnection allows human resources personnel to function more efficiently and devote more time to strategic issues.

GDI Helps Employers…

• Communicate with employees and solve human resources challenges

• Improve employee satisfaction

• Save money!

GDI  Helps Employees…

• Instantly access up-to-date company and benefits information and useful forms

• Connect to comprehensive human resources information 24 hours a day, 7 days a week

• Learn about career growth opportunities, job postings, and training programs

• Obtain real time answers to frequently asked questions

• Enroll online

GDI  Helps Human Resources…

• Efficiently showcase benefit programs to employees and their families

• Communicate important company information to all employees in a consistent, timely, and useful manner

• Attract and retain valued employees by portraying a high-quality image

Company Homepage Companies that use HRconnection receive their own homepage. On this homepage, your clients can:

• Display a customized greeting

• Provide a list of links to employer-recommended Web sites

• Activate a Message Board with current company announcements.

• Schedule and display targeted Communication Campaigns.

 Company Information GDI's Company Information section contains basic facts and data about the employer, allowing new and long-term employees alike to have all the company facts they need ¾ right at their fingertips.

The Company Information area can include:

• An employee directory

• Departmental contacts

• Birthday and Anniversary lists

• A list of recognized holidays

• Mission statement and vision

• Company history

 HR Information

The HR Information area of GDI's client websites eliminates the need for distributing bulky and costly company handbooks, forms, policy and procedure information, and more. The HR Information area also allows employees to view detailed, client-specific answers to their frequently asked questions.

 Benefit Plans

The Benefit Plans section of GDI's client websites provides access to everything employees want to know about their benefit plans, taking Human Resources personnel out of the middle. Benefits are listed by type (Medical, Dental, Vision, Life), and within each plan type, employees can obtain general plan information and benefit summary information.

Employees can:

• View plan design information including rates and eligibility

• Access Summary Plan Descriptions

• Compare plan details

• Obtain plan forms

• View carrier contact information

 Career Growth

You can prove your commitment to your employees' growth and development by showcasing job postings and training programs on HRconnection.

 Administrative Functions Summary

With HRconnection, you will find unsurpassed sorting, grouping, and categorization capabilities and a customizable menu system. Some additional administrative capabilities of HRconnection include the ability to:

• Choose from forty-eight different color schemes and over twenty images for a customized homepage

• Create an unlimited number of company divisions and display different information for each division.

• And much more!

HRconnection is the easiest employee Web site to set up and update, with the fastest and most flexible administrative functions available.

HRconnection…

Employee Data Module

In addition to all of the functionality of the Base Module, the Employee Data module of HRconnection allows you to maintain a database of employee information against which you can run reports.

Employee Information

The Employee Information section allows you to track employee specific data. Employees will have access to their personal information and can update it at any time. You can also run reports on that information for your use, to compare changes to employees' records.

Dependent Information

The Dependent Information section allows you to track dependent data. Employees will have access to their dependent information and can update it at any time. You can also run reports on that information for your use.

Vacation Tracking

The Vacation Tracking function allows employees to see their own vacation summary by type of time off (e.g. vacation, personal days, sick days, etc.).

Employees can submit vacation requests online, and supervisors and managers can likewise approve or deny those requests online.

The Employee Attendance, Pending Vacation, and Out-of-Office functions allow them to view and process the vacation requests of their employees.

Orientation Wizard

The Orientation Wizard can be activated to walk a new employee through important company information, provide them with the forms they need to complete, as well as allow them to update or add personal and dependent information to the database.

The Orientation Wizard exposes the employee to important company information as well as helps drive home the point that the employees really should be accessing HRconnection to obtain information.

Administrative Functions Summary

• Upload employee data, including dependent information, addresses, phone numbers, emergency contacts, job title, plus custom fields from an Excel spreadsheet.

• Report against employee information stored in the site

• Customize a new employee orientation wizard

• Track employee time off

• Walk through a wizard to move employees from one division to another

 Reports Available

• Employee Changes - monitor changes to information

• Employee Information - extract information

• Employee Username - use this to distribute login information

• Employee Vacation Requests - extract request detail

• Employee Vacation Totals - use this to create a new upload for a subsequent time period

The Employee Data Module of HRconnection provides employees access to the important company information, as well as information specific to them.

Election Module

The Election Module of HRconnection allows you to take the Employee Data Module one step further by allowing employees to make their benefit elections within the site.

Benefit Plans

Employees can:

• Make benefit elections during open enrollment

• Select covered dependents or beneficiaries for each plan

• Update benefit selections if they experience a life event

• View personal elections throughout the year

Administrative Functions Summary

• Create an open enrollment period for the entire company or for an individual that has experienced a life event

• Run reports against the employee election information stored in the site

• Administer life events and open up enrollment periods for life event changes or for new hires

Available Reports

In addition to the reports available with the Data Module, Administrators will also have access to the following reports:

• Benefit Comparison Report - Use this report to compare employee elections at two points in time

• Carrier Extract Report - extract election information that can be supplied to carriers

• Census Report - create an employee census for any line of coverage

• Elections Summary - create an election summary for an individual or all employees (which is available to the employees in the benefit plans section of the site)

• Enrollment Report - monitor employees' enrollment status

• Flexible Spending Report - extract annual and per pay period FSA contributions by employee

• Payroll Extract Report - pull payroll information

• Personal Instruction Sheet - generate a personal instruction sheet for employees' to use during open enrollment and for employees who do not have access to the Internet to make their elections

• Plan Design Report - provides detailed information, including rates and benefits, on any of the plan offerings

• Premium Report - reconcile a carrier's monthly billing

• Projected 401(k) Premium Report - show projected employee 401(k) contributions

The Election Module of HRconnection allows the employee to view not only their personal information, but also their election information at any point in time during the year.

Federal and state laws require that questions on the job application, during the interview, and during the testing process be job-related. Employers should not ask about race, gender, religion, marital status, disabilities, ethnic background, country of origin, or age. Illegal interview questions are those that single an individual out for reasons that are contrary to equal employment opportunity and anti-discrimination laws. Some employers ask these questions to intentionally discriminate, and others do innocently because they are unaware of the laws. Technically it is not illegal to ask these questions, but if a question has discriminatory implications, and employment is denied based on the applicant's answer, the employer may have broken the law. The following are examples of "illegal" questions and their "legal" alternatives.

1. Subject: Relatives/Marital Status

Illegal: What is your marital status? What is the name of your relative/spouse/children? With whom do you reside? Do you live with your parents? How old are your children? Do you plan to have a family? How many kids do you have? What are your child care arrangements?

 Legal: What are the names of relatives already employed by the company or a competitor? Are you willing to relocate if necessary? Are you willing to travel as needed by the job? (Must be asked of all applicants) Are you willing and able to work overtime as necessary? (Must be asked of all applicants)

 2. Subject: Residence

Illegal: With whom do you reside? Do you rent or own? Do you live in town?

 Legal: Inquiries about address to the extent needed to facilitate contacting the applicant are O.K. Will you have problems getting to work by 9 a.m.?

3. Subject: Pregnancy

Illegal: Questions relating to pregnancy and medical history concerning pregnancy are illegal. Do you plan on having more children?

Legal: Inquiries to duration of stay on a job or anticipated absences which are made to males and females alike are legal. Do you foresee any long term absences in the future?

4. Subject: Physical Health

Illegal: Over general questions which would tend to divulge handicaps or health conditions which do not relate reasonably to fitness to perform the job are illegal. Do you have any handicaps or disabilities? What caused your handicap? What is the prognosis of your handicap? Have you ever had any serious illness? Please complete the following medical history. Have you had any recent or past illnesses or operations? What was the date of your last physical exam? How's your family's health? Have you ever been treated for a mental condition? Are you taking prescribed drugs? Have you ever been treated for drug or alcohol addiction? Have you ever filed a worker's compensation claim?

Legal: Can you lift 40 lbs? Do you need any special accommodations to perform the job you've applied for? How many days did you miss from work (or school) in the past year? The questions have to relate to the job. Are you able to perform the essential functions of this job with or without reasonable accommodations?

5. Subject: Family

Illegal: Questions concerning spouse, or spouse's employment, salary, child care, arrangements, or dependents are illegal. How will your husband feel about the amount of time you will be traveling if you get this job? What kind of child care arrangements have you made?

Legal: You may ask whether an applicant can meet specified work schedules or has activities or commitments that may prevent him or her from meeting attendance requirements. Is there any reason why you can't be on the job at 7:30 am? This job requires that you work overtime on occasion. Would you be able and willing to work overtime as necessary?

6. Subject: Name

Illegal: Any inquiries about an individual's name which would divulge marital status, lineage, ancestry, national origin or descent are illegal. If your name has been legally changed, what was your former name?

Legal: Whether an applicant has worked for the company or a competitor under any other name and if so, what name was used is legal. Name under which applicant is known to references if different from present name. i.e. By what name do your references know you? Have you ever been convicted of a crime under another name?

7. Subject: Sex

Illegal: Any inquiry that relates to sex is illegal. Do you wish to be addressed as Mr., Mrs., Miss, or Ms.? Do you have the capacity to reproduce? What are your plans to have children in the future?

Legal: None

8. Subject: Photographs

Illegal: Requests that an applicant submit a photo at any time prior to hiring is illegal.

Legal: Photos may be requested after hiring for identification purposes.

9. Subject: Age

Illegal: Any question that tends to identify applicants age 40 or older are illegal. How old are you? When did you graduate from college? What is your birthday? Requests for birth certificate or record.

Legal: Are you 18 years of age? If hired, can you furnish proof of age?

10. Subject: Education

Illegal: Any question asking specifically the nationality, racial or religious affiliation of a school is illegal.

Legal: All questions related to academic, vocational or professional education of an applicant, including the names of the schools attended, degrees/diplomas received, and dates of graduation and courses of study are legal. What is the highest grade you have completed?

11. Subject: Citizenship

Illegal: Asking whether an applicant is a citizen or requiring a birth certificate, naturalization or baptismal certificate are illegal. Any inquiry into citizenship that would tend to divulge an applicant's lineage, descent, etc. are illegal. Are you a citizen of the US? Are your parents or spouse citizens of the US? On what dates did you, your parents or your spouse acquire US Citizenship? Are you, your parents or your spouse naturalized or native-born US citizens? What is your native tongue?

Legal: Questioning whether applicant is prevented from lawfully being employed in this country because of visa or immigration requirements is illegal. It is legal to ask an applicant to provide proof of citizenship (passport), visa, and alien registration number after hiring. If you are not a US citizen, do you have the legal right to remain permanently in the US? What is your visa status (if no to the previous question.)? Are you able to provide proof of employment eligibility upon hire? Are you authorized to work in the United States? What languages do you read, speak or write fluently? (Ability must be relevant to performance of the job).

12. Subject: National Origin/Ancestry

Illegal: What is your nationality? How did you acquire the ability to speak, read or write a foreign language? How did you acquire familiarity with a foreign country? What language is spoken in your home? What is your mother tongue?

Legal: What languages do you speak, read or write fluently. This is only legal when the inquiry is based on a job requirement.

13. Subject: Race or Color

Illegal: Any question that directly or indirectly relates to a race or color is illegal. What is your race? What is your complexion?

Legal: None

14. Subject: Religion

Illegal: Any question that directly or indirectly relates to a religion is illegal. What religious holidays do you observe? What is your religious affiliation?

Legal: Can you work on Saturdays? (Only if it relevant to the job.)

15. Subject: Organizations

Illegal: To what organizations, clubs, societies and lodges do you belong?

Legal: To what professional organizations do you belong which you consider relevant to your ability to perform this work? (Exclude those names that indicate the race, religious creed, color, national origin or ancestry of its members. These inquiries must only relate to the applicant's professional qualifications.)

16. Subject: Military

Illegal: It is illegal to ask the type or condition of military discharge or an applicant's experience in other than US armed forces. A request for discharge papers is illegal. Were you honorably discharged? In what branch of the Armed Forces did you serve?

Legal: Inquiries concerning education, training or work experience in the armed forces of the United States are legal. What type of training or education did you receive in the military?

17. Subject: Height & Weight

Illegal: Any inquiries not based on actual job requirements are illegal. How tall are you? How much do you weigh? What color are your eyes/hair?

Legal: Inquiries about the ability to perform a certain job are legal. Being of a certain weight or height will not be considered a job requirement unless the employer can show that no employee with the ineligible height and weight could do the work. Are you able to lift a 50 pound weight which is an essential function required by the job?

18. Subject: Arrests & Convictions

Illegal: All inquiries relating to arrests are illegal. Have you ever been arrested? (Arrests are not the same as convictions. An innocent person can be arrested.)

Legal: Legal inquiries about convictions are: Have you ever been convicted of any crime? If so, when, where and what was the disposition of the case. Have you ever been convicted under criminal law within the past five years (excluding minor traffic violations)? It is permissible to inquire about convictions for acts of dishonesty or breach of trust. These relate to fitness to perform the particular job being applied for.

Employee Benefits Survey

strives to provide useful, valuable, comprehensive, and affordable benefit programs for our employees. Each year, we review our current programs - particularly our health and dental plans - to ensure they live up to these goals and are meeting our employees' needs.

Please take a few moments to complete this survey and help us with our annual benefits review process. Your input is important to us regardless of whether or not you currently participate in any of the programs.

Please return the completed survey to by . Thank you.

1. Are you currently enrolled in the employee health care plan?

Yes o

No o

2. If you answered no to question one, are you:

Covered under spouse's plan? o

Covered under another plan? o

Uninsured? o

3. If you do not have health insurance, are you uninsured because of:

Cost o

Other o - please explain:________________________________________________________

4. Are you currently enrolled in the employee dental care plan?

Yes o

No o

5. If you answered no to question four, are you:

Covered under spouse's plan? o

Covered under another plan? o

Uninsured? o

6. If you do not have dental insurance, are you uninsured because of:

Cost o

Other o - please explain:________________________________________________________

7. How would you rate the information you receive from about your benefit plans?

Excellent o

Above average o

Average o

Below average o

Poor o

8. What do you consider the most effective resource for learning about your benefit plans?

Written material o

Easy to access Web site o

Slide or video presentations o

Employee meetings o

Other o - please explain _____________________________________________________

9. Which benefits are most important to you? Rank the following benefit plans in order of importance, with number 1 being most important, and number 6 being least important.

____ Health/Medical Plan

____ Dental Plan

____ Prescription Plan

____ Employee Assistance Program

____ Short-term Disability Plan

____ Long-term Disability Plan

Questions 10 and 11 are for health plan participants only.

 

10. How would you rate the benefits provided by ?

Excellent o

Above average o

Average o

Below average o

Poor o

Explain: ___________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

11. How would you rate the service provided by ?

Excellent o

Above average o

Average o

Below average o

Poor o

Explain: ___________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Questions 12 and 13 are for dental plan participants only.

 

12. How would you rate the benefits provided by ?

Excellent o

Above average o

Average o

Below average o

Poor o

Explain: ___________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

13. How would you rate the service provided by ?

Excellent o

Above average o

Average o

Below average o

Poor o

Explain: ___________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

14. Is your spouse eligible for medical insurance and/or other benefits from his or her own employer?

Yes o

No o

Not applicable o

15. If your spouse is eligible for benefits from his or her own employer, does he or she participate in those benefit plans?

Yes o

No o

Not applicable o

16. If coverage were available for your spouse from his or her own employer, would you be willing to have your spouse use his or her employer's plan (rather than the dependent coverage offered by the plan) if you were paid a fee to do so?

Yes o

No o

Not applicable o

17. Please mark the answer that best describes your overall feeling about the indicated benefit plans or plan elements.

Medical Plan

Excellent o

Above average o

Average o

Below average o

Poor o

Medical Plan Provider Network

Excellent o

Above average o

Average o

Below average o

Poor o

Dental Plan

Excellent o

Above average o

Average o

Below average o

Poor o

Dental Plan Provider Network

Excellent o

Above average o

Average o

Below average o

Poor o

Accidental Death & Dismemberment Plan

Excellent o

Above average o

Average o

Below average o

Poor o

Short-term Disability Plan

Excellent o

Above average o

Average o

Below average o

Poor o

Long-term Disability Plan

Excellent o

Above average o

Average o

Below average o

Poor o

Prescription Drug Plan

Excellent o

Above average o

Average o

Below average o

Poor o

Life Insurance Plan

Excellent o

Above average o

Average o

Below average o

Poor o

 

18. What do you think is the annual cost per employee for providing medical and dental benefits?

$1,000 - $2,500 o

$2,500 - $5,000 o

$5,000 - $7,500 o

$7,500 + o

19. Would you prefer to pay more money from your paycheck for medical insurance or more money when you actually go to the doctor or hospital (for example, pay higher deductibles and higher co-payments)?

More money from my paycheck (premium contribution) o

More money only when I go to doctor or hospital (higher deductibles or co-payments) o

Do not understand o

20. What is your impression of 's benefit plans compared to other local employers?

Excellent o

Above average o

Average o

Below average o

Poor o

21. Rate your benefits in terms of importance. On the next page, please circle the number that best corresponds to the degree of importance you place on the following benefits.

	Very Important	Important	Undecided	Not too Important	Not at all Important
Health (Medical) Plan	1	2	3	4	5
Prescription Drug Plan	1	2	3	4	5
Vision Plan	1	2	3	4	5
Dental Plan	1	2	3	4	5
Employee Assistance Program	1	2	3	4	5
Supplemental Life Insurance	1	2	3	4	5
Dependent Life Insurance	1	2	3	4	5
Accidental Death & Dismemberment	1	2	3	4	5
Short-term Disability	1	2	3	4	5
Long-term Disability	1	2	3	4	5
401(k) Plan	1	2	3	4	5
Tuition Reimbursement Plan	1	2	3	4	5
Holidays	1	2	3	4	5
Vacation	1	2	3	4	5
Sick Pay	1	2	3	4	5
Dependent Care Spending Account	1	2	3	4	5
Medical Care Spending Account	1	2	3	4	5

22. Please answer the following questions related to possible plan alternatives.

Would you like to have different medical plans to choose from? One may cost more and provide higher benefits, while another may cost less and provide lesser benefits.

Yes o

No o

Would you like the opportunity to trade some of your current benefits for others of more importance to you?

Yes o

No o

Would you consider trading (or giving up) some of your benefits in order to receive more money in your paycheck?

Yes o

No o

The IRS allows employees to establish an employee owned health savings account (HSA) that secures pre-tax dollars in a fund for future medical needs. HSAs are established with high deductible health plans that come with much lower premiums than traditional plans. If you had the option of participating in a high deductible health plan in conjunction with owning a HSA , would you choose to do so?

Yes o

No o

 The IRS allows employers to establish a Health Care Reimbursement Account to help employees pay for certain health care costs with pre-tax income that they must otherwise pay for with after-tax income (for example, deductibles and non-covered medical expenses). If you could allocate a portion of your income to that account, would you choose to do so?

Yes o

No o

 23. Please provide any additional comments on how we can improve upon our employee benefit plans, or how we can better meet your needs.

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Thank you.

Application for Employment

 4/23/2010

 Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, color, national origin, religion, age, sex, disability, veteran status, or any other characteristic protected under local, state or federal law. WE ARE AN EQUAL OPPORTUNITY EMPLOYER.

Name __________________________________________________________________________

Last First M.I.

Street Address____________________________________________________________________

City___________________________________ State_______________________ Zip__________

Telephone__________________________________ Social Security #_______________________

Type of work for which you wish to be considered ________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

What source led you to make application with us? ________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Employment History

Please list your complete employment history. List present or most recent employer first. Use an additional page, if necessary.

Employer	Employed (mo./Yr.) From: To:	Type of work performed	Present or last salary	Reason for leaving
Address/City
Name of Supervisor
Employer	Employed (mo./Yr.) From: To:	Type of work performed	Present or last salary	Reason for leaving
Address/City
Name of Supervisor
Employer	Employed (mo./Yr.) From: To:	Type of work performed	Present or last salary	Reason for leaving
Address/City
Name of Supervisor

Education

Schools	Name/Location	Circle Last Yr. Completed	Major Courses	Diploma/Degree
High School		7 8 9 10 11 12
College		1 2 3 4 more
Business or Trade		Months Attended

If you served in the United States Armed Forces, briefly describe the skills you acquired:____________

__________________________________________________________________________________

__________________________________________________________________________________

Personal Information

Are you legally authorized to work in the U.S.? Yes ¨ No ¨

Note: you will be required to furnish documents to verify your eligibility for employment in accordance with the Immigration Reform and Control Act and your employment is contingent upon furnishing such documents.

 

Are you at least 18 years of age? Yes ¨ No ¨

Have you ever been convicted of a crime or are there any pending charges against you?

(A conviction does not automatically bar you from employment)

Yes ¨ No ¨ If yes, include details ___________________________________________________

__________________________________________________________________________________

If you are an experience operator of any office machines or equipment, please list:

__________________________________________________________________________________

__________________________________________________________________________________

Typing speed	wpm
Short hand	wpm

Do you have any other skills you wish to mention?__________________________________________

__________________________________________________________________________________

Are you presently employed? Yes ¨ No ¨ If so, may we contact your present employer? Yes¨ No¨

If hired, when would you be available?___________________________________________________

What are your salary requirements?______________________________________________________

References

Name_____________________________________________________________________________

Occupation_________________________________________________________________________

Address____________________________________________________________________________

City, State, Zip_______________________________________________________________________

Telephone Number___________________________________________________________________

 

*For additional references, please attach a separate sheet.

 

 

I certify that the answers given by me to the foregoing questions and statements are true and correct to the best of my knowledge without consequential omissions of any kind. I agree that the Company shall not be held liable in any respect if my employment is rejected or subsequently terminated because of false statements, answers or omissions made by me in this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may lead to employment termination. I understand that a medical examination based on the requirements of the position for which I am being considered may be required, and drug testing may be included as part of the regular pre-employment physical. I also voluntarily and knowingly authorize the companies, schools or persons named above to give any information requested regarding my former employment, character and qualifications. I hereby voluntarily and knowingly fully release and discharge, absolve, indemnify, and hold harmless said companies, schools or persons from any and all liability for any damages for issuing this information, except for the malicious and willful disclosure of derogatory facts concerning my employment made for the express purpose of preventing me from obtaining employment, which the party disclosing such facts knows to be untrue. In consideration of my employment, I agree to conform to the rules and regulations of this organization. My employment and compensation can be terminated with or without cause and with or without notice, at any time, at the option of either my employer or myself.

Signature______________________________________________________ Date_____________

 

 This is not legal advice. Employer should review this Application for Employment with local counsel prior to use, as each state has its own set of laws which relate to discrimination and hiring practices.

Custom Employer/Employee Communications

Understanding the complexity of employee benefits plans is a challenge even for experienced benefits managers. Employers need to keep abreast of constantly changing trends, laws, and other regulations. Employees need to be able to understand their benefits well in order to be wise consumers and understand the value of their "hidden paycheck." Unfortunately, most employers have limited resources in this area.

The team helps you tackle your mounting employee communication challenges. With strategic planning and thorough understanding of your communication objectives, we provide custom communication materials that will help both you and your employees understand your plans and the issues influencing your benefits decisions.

Benefits Announcements & Educational Material

Contains memos, flyers, payroll stuffers, and articles used to announce benefit changes, introduce new benefits or plans, or to help employees understand and use certain benefits.

Benefit Statements

This category provides you with benefit statement items such as a summary of an employee's benefits package showing overall compensation including salary and benefits.

Consumer-Directed Healthcare (CDHC)

We provide everything you need, including letters, flyers, articles, payroll stuffers, posters and e-mails to help support your CDHC campaigns.

Employer Education Articles and Newsletters

This category contains educational articles covering hot benefit topics from CDHC and benefit costs to trends. Includes a quarterly Benefits Bulletin newsletter and a quarterly pharmacy newsletter, along with a monthly one-page newsletter covering highlights of current HR and benefit news.

Handbooks & Policies

Contains a full employee handbook, as well individual policies, that you can give to your employees to communicate company policies or procedures.

Health Awareness Newsletter

A monthly, customized, two-page newsletter for your employees that covers various health and wellness topics.

Health Awareness Payroll Stuffers

These payroll stuffers focus on a single health or wellness topic.

Know Your Employee Benefits

The Know Your Employee Benefits brochure series provides your employees insight and information about insurance and employee benefits topics. These brochures help your employees become more knowledgeable about their benefits, and can serve as a foundation for your ongoing employee communication campaigns.

Custom Employer/Employee Communications

Live Well, Work Well

's series Live Well, Work Well centers on health and wellness issues. The flyers teach employees how to live healthy lives and focus on preventive care.

National Health Observances Calendar

The calendar allows you to educate and inform your employees on wellness issues throughout the year by supplying you with national health observances and listings of Live Well, Work Well flyers to complement those observances.

Prevention Newsletter

This quarterly employee newsletter focuses on prevention topics such as obesity, fad diets, and drug and alcohol prevention for kids.

Retirement

The documents included in our Savings Fitness and Know Your Retirement Benefits series will help your employees prepare for their retirement.

expenses; 3) repairs to employee's primary home after a fire or other damage; 4) prevention of eviction or mortgage foreclosure; 5) tuition expenses; or 6) the purchase of employee's primary home.

Plans may limit the circumstances under which employees can get a hardship withdrawal and usually have specific procedures to obtain a hardship withdrawal.

Wellness on a Shoestring Budget

Wellness programs are proven to improve employee health, productivity and morale, and reduce healthcare costs. Despite these benefits, many companies simply do not have the resources to create a large, complex wellness program. If you fit into this category, there are some low- or even no-cost things you can do to improve the health and wellness of your employees. Try some of these suggestions on for size:

ü Contact your healthcare insurer, a local hospital, or non-profit organization to come and provide presentations on living healthy lifestyles.

ü Ask your health insurer what wellness resources they have available. They may offer Health Risk Appraisals (HRAs) at little or no cost.

ü Create a wellness committee consisting of various employees. Have them create activities that can be done at the worksite to improve employee health, such as healthy eating days.

ü Make your workplace smoke-free.

ü Ask a local healthcare provider to give free immunizations.

ü Provide healthy vending machine choices.

ü Provide physical activity breaks during the day for your employees and encourage them to go outside for a quick run or walk.

ü Encourage the use of the stairs.

ü Provide a health-related newsletter or articles to your employees. Your GDI Insurance Agency, Inc. representative can provide you with a newsletter.

ü Your GDI Insurance Agency, Inc. representative has many, many wellness resources available for your use. Call today!

FMLA Regulations are Final

On November 17, 2008, the Department of Labor (DOL) published its final rule to implement the first-ever amendments to the Family and Medical Leave Act (FMLA). The regulations provide new military family leave entitlements and generally update the regulations under the 15-year-old FMLA. The final regulations become effective January 16, 2009.

HIGHLIGHTS OF THE REGULATORY CHANGES IN THE FINAL RULE

Provisions in the final rule call for increased notice obligations for employers so that employees will better understand their FMLA rights, while revising the employee notice rules to minimize workplace disruptions due to unscheduled FMLA absences. The final regulations also implement two important new military family leave entitlements for eligible specified family members:

1) Up to 12 weeks of leave for certain qualifying exigencies arising out of a covered military member's active duty status, in support of a contingency operation; and

2) Up to 26 weeks of leave in a single 12-month period to care for a covered servicemember recovering from a serious injury or illness incurred in the line of duty on active duty. Eligible employees are entitled to a combined total of up to 26 weeks of all types of FMLA leave during the single 12-month period.

Other changes include the following:

Waivers. FMLA claims can be waived by employees without court or DOL approval.

Light Duty. Time spent performing light duty work does not count against an employee's FMLA leave entitlement.

Definition of Serious Health Condition. The new rules change the various definitions to impose time requirements on when the initial and second medical visits must take place, and defines periodic visits for chronic conditions.

Who May Contact the Employee's Doctor. HR professionals, health care providers, management officials - but never an employee's direct supervisor.

Recertification. Employer may request recertification of an ongoing condition every six months in conjunction with an absence.

Employer Notice. The time period for employers to provide the various notices is extended from 2 to 5 days.

Employee Notice. Employee notification must comply with the employer's usual procedures for reporting an absence, absent unusual circumstances.

The DOL predicts that the final rule will improve communication between employees, employers, and health care providers to make the law operate more smoothly, and provide needed clarity for both workers and employers about their responsibilities and rights under FMLA leave.

Diabetics Spend Thousands More on Medical Care

According to a new study by RTI International, people with diabetes spend thousands of dollars more on medical costs each year after the initial diagnosis. The study found that a 50-year-old newly diagnosed with diabetes spends over $4,000 a year more on medical care than a 50-year-old without diabetes. Medical costs increase $158 a year every year after an individual is diagnosed, and this does not include increased costs due to aging.

Many of these increased costs can be contained through proper diabetes management. Employers can help employees manage their conditions, and in return their healthcare costs, in the following ways:

• Create a supportive work environment so that employees feel at ease managing their conditions (example: provide a private room for taking insulin shots or monitoring blood sugar.)

• Provide opportunities for all employees to live healthier lifestyles (i.e., lose weight, increase physical activity) to reduce the risk of developing chronic conditions, such as diabetes.

• Provide healthy food options at employee functions.

• Educate employees on prevention and early detection methods.

• Increase awareness of blood sugar control.

• Provide high quality medical care for people with diabetes. Then, educate your employees on the care that they have at their disposal by outlining their covered benefits, services and supplies needed to control the disease.

• Promote blood sugar management techniques for diabetic employees to keep glycemic levels near normal. This will improve their quality of life and will reduce healthcare costs.

Diabetes management programs are proven to be effective in the workplace. A 12-week study by the Wisconsin Diabetes Prevention & Control Program of 569 male employees who had type 2 diabetes revealed the following results after receiving diabetes management assistance from their employer:

• Employees were more productive on the job (99 percent versus 87 percent) and able to remain employed longer (97 percent versus 85 percent) than those who did not manage their blood sugar levels.

• The lost earnings from absenteeism were estimated at $24 per employee per month for employees who had assistance managing their blood sugar levels, versus $115 per employee per month for those who had uncontrolled blood sugar levels.

• Employees had fewer instances of needing bed rest and restricted activities than those who did not have diabetes management assistance.

Please contact your GDI Insurance broker for more information on any of these important issues.

 

The information contained in this newsletter is not intended as legal or medical advice.

Please consult a professional for more information.

Providing Insight into Today's Employee Benefits Issues

PerspectiveS

Consumer-Driven Health Care in Practice: Lessons from Early Adopters

FOR more than a decade, employers of all sizes have been finding it increasingly difficult to continue to provide employees with the health care benefits they need and expect, due to double-digit cost increases that have outpaced the rate of inflation. Five years ago, experts began examining the idea that by injecting "consumerism" into the way individuals use their health care benefits and purchase medical goods and services, the American health care system might just be able to save itself. By engaging patients in purchasing health care services - the way consumers make less vital purchases - consumer-driven health care (CDHC) plans will cut costs, improve the quality of healthcare services, and help consumers make informed decisions through financial incentives for choosing wisely.

Early on, CDHC focused simply on attempting to bring more consumer-oriented elements into existing benefits plans (promoting the use of generic rather than brand name prescriptions, 24-hour nurse lines, etc.). Today, we've seen these "tip of the iceberg" approaches evolve into fully-developed benefits plans that combine an account-based element, either a health reimbursement arrangement (HRA) or a health savings account (HSA), with a high-deductible health plan. HRAs and HSAs differ slightly, however both work to engage the consumer in using information to compare quality and prices for medical services, and allow the consumer to make the best use of their available health care dollars.¹

 

While adoption has seemed slow, health benefits models that encourage employee consumerism are now starting to become mainstream business practices. In 2001, only about 7,000 individuals were enrolled in these types of programs. The number was expected to exceed six million by 2006. According to a 2006 survey, 50% of employers planned to add an account-based consumer-driven plan to their benefits program at some time in the future, and these numbers are expected to continue to expand rapidly. The same survey indicated that 22% of respondents had a CDHC plan in place already, and 12% would be offering one for the following year. Of the respondents with plans already in place, 66% offered a HRA program while 15% offered a high-deductible PPO-type plan with a health savings account feature.²

It is without question that there are many valuable lessons we can learn from CDHC's early adopters. Can CDHC, when implemented appropriately, really make an impact on health care costs? Are benefits advisors, carriers, and employers truly embracing the concept? What successes are the early adopters having, and why?

Early Results: Medical Trend

The goal of CDHC in practice is to make consumers more aware of the true costs of health care, encourage them to make better use of their health care dollars, and ultimately lower medical cost trends. Published results regarding CDHC's success (or failure) in this regard have been minimal, but we are starting to see some promising trends being reported by the various health care companies that provide CDHC plans to employers. Highlights of these results are presented below.

Aetna

Aetna, a vendor with significant penetration into the CDHC market, reported results from 49,000 of its Aetna HealthFund^® HRA members for the 2004 plan year. The study focused on member behavior change that could be attributed to participation in a consumer-driven health plan. Their study, as well as the others referenced below, provides support to the assumption that overall

medical trend rates are lower for CDHC plans than for traditional health benefits plans (PPOs, HMOs). In fact, six of the seven plan sponsors who participated in Aetna's study experienced changes in

medical costs that lead to lower increases ― and in some cases, even cost decreases ― as compared to PPO trends for the same period. The report also indicated that Aetna's CDHC participants were generally more aware of the actual costs associated with their medical care. ³

CIGNA

In November 2006, CIGNA HealthCare released findings from a comprehensive study of its CIGNA Choice Fund enrollees. The Choice Fund packages an HRA or HSA with an underlying PPO or medical plan that has a deductible, coinsurance, and out-of-pocket maximums. The report analyzed results from a survey of 38,211 continuously enrolled pre-CIGNA Choice Fund and post-CIGNA Choice Fund enrollees, and compared them to 231,680 HMO and PPO enrollees from the same employer populations. The study found that while overall medical costs decreased, the use of preventive care services increased and consumers reported increased awareness and engagement in managing their health care.

u CIGNA Choice Fund medical costs decreased and were 16% lower than costs for traditional plan members. The change was driven primarily by decreases in inpatient and outpatient costs. Medical costs for CIGNA's traditional plan population increased during the same time period.

u Savings were observed across all spending categories indicating that members with higher claims costs changed how they used medical care, even when their plan no longer contained cost-sharing provisions.

u CIGNA Choice Fund members increased their use of preventive care services by 8%, and were also 12% more likely than those enrolled in traditional plans to seek preventive care services.

u Costs associated with chronic care and episodic care members declined almost 3% and over 8% respectively, while the costs associated with those members identified as healthy increased almost 2%. CIGNA reports that the reduction in chronic care costs for its CIGNA Choice Fund members is driven by those members practicing more careful utilization of preference-sensitive services, rather than the avoidance of needed care in an effort to avoid expense.⁴

 

Humana

Like many large employers, Humana faced large increases in its own health benefits costs in the late 1990s. Facing a projected 19.2% increase in claims costs in 2001, Humana decided to develop and test the consumerism concept within its own population of 4,800 Louisville, Kentucky employees. Along with four other traditional plans, the company offered two account-based plans called CoverageFirst. The CoverageFirst plans included first-dollar funding of $500 per member, followed by deductibles of $1,000 or $2,000.

Humana realized significant savings in just the first year, with an almost 5% claims trend versus the expected 19.2% trend. This claims trend reduction equated to $2.1 million in savings. Humana's claims trend was also down significantly as compared to the marketplace (Louisville). For example, Humana's inpatient admissions were 14.4% lower than the previous year, while the marketplace saw a 2% increase.

In 2002, Humana rolled out the program to all of its employees in locations except for Louisville and then conducted the same type of study. Here, the actual claims trend was over one percent versus the expected trend of 17.1%. This equated to a savings of $5.5 million in year two of the pilot program.⁵

 Early Results: Funding and Plan Design

CIGNA

CIGNA reported the following findings regarding the funding of account-based CDHC plans.

u The majority of plan sponsors established individual HRA funds of $500 or more.

u For 78% of the CIGNA Choice Fund population, the gap between the HRA fund and deductible amount was $500 or $750, demonstrating that to be successful, plan sponsors do not need to cost-shift.

u 91% of plan designs had in-network coinsurance of 20% or less.⁶

 

UnitedHealth Group

UnitedHealth Group's (UHC) Definity Health business conducted a study of 25,000 individuals enrolled in its health savings account plans for the full year of 2005, the first full 12-month period for which data was available. The purpose of the study was to better understand how plan structure and consumer characteristics affect HSA adoption and use.

The UHC study revealed a variety of meaningful information that can help brokers and employers determine the best way to achieve a successful HSA program.

 Who opens an HSA?

§ Eighty-four percent of eligible high-deductible health plan (HDHP) enrollees in the UnitedHealth Group study opened a HSA; this compares to industry averages of 60% - 70%.

§ Employer size affects enrollment only slightly. 88% of eligible employees for large employers (5,000 +) enrolled, 79% of workers at mid-sized employers (100 - 4,999) enrolled, and 81% at small employers (one - 99) enrolled.

§ Families and mature couples are most likely to open an account, while young singles are least likely to open one.

§ UHC's study found that HSAs are used by individuals across all income levels. Eighty percent of eligible low-income individuals opened an account; however, whether or not the employer made a contribution did affect account adoption for lower income individuals.

 

 Who funds their HSA?

§ Sixty-eight percent of UnitedHealth's employer clients funded their employee HSAs; 67% of account holders added their own dollars - demonstrating a clear connection and understanding on the part of employees regarding planning for future health care needs.

§ Employers who adopted a full-replacement strategy with their HSA program tended to make larger contributions ($1,260 on average) than those providing an HSA program as a plan option ($780 on average).

§ Among consumers who opened an account, 67% contributed their own dollars, suggesting that the majority

of enrollees understand the plan and consider the future benefit of savings.

 Saving and Spending HSA Funds

§ Eighty-six percent of enrollees carried an HSA balance from 2005 to 2006, again indicating the benefits of saving for future health care expenses. The average year-end balance was $815, representing 30% of the average deductible and 44% of the average total contribution.

§ Individuals are typically spending more out of their accounts when they are enrolled in full-replacement programs than under option-based plans. Additionall, enrollees in full-replacement plans ended 2005 with higher balances on average than those in option-based plans.⁷

 Early Results: Consumer Engagement and Behavior Change

Research shows that with information and support, consumers are more likely to engage in behavior that drives down health care costs and leads to better health outcomes. Published data also supports the notion that total health spending is reduced when individual consumers assume more responsibility for their health care expenses.

Information tools are vital to strengthening consumers' ability to navigate the health care system. Typically available online or telephonic information tools are the key to helping CDHC plan members make all kinds of decisions about their health care, from enrolling in a benefits plan to estimating out-of-pocket costs and FSA contributions. In addition, consumers benefit by learning more about their medical conditions and how to manage them, where the best places to seek treatment are, and what they need to know about the prescription medications they take.

A recent Hewitt study found that with information and guidance, consumers are more likely to engage in behaviors that drive down costs and lead to better health outcomes. For example, employees who were aware that they had medical expense estimators available were more likely to set aside money to cover future health care expenses and were more likely to ask for a generic drug option.

Several of the large national health care companies have published findings regarding availability of information and consumer behavior change.

 Aetna

Aetna's review of its own Aetna HealthFund members ― who are supported by a variety of online information tools ― found that 83% were more conscious of health care costs and 82% claimed that the plan provided access to the information they needed to make informed decisions. 87% of Aetna's CDHC plan members said the plan gave them a high level of control over their health care spending, while 88% said the plan was easy to use. Aetna's CDHC members were more likely to review their explanation of benefits online, check their claims status, and search for providers using the Web portals provided by the carrier.

Aetna also found that general adult use of preventive care services increased by as much as 23% among its CDHC plan members, compared to 8% for similar traditional plan members.⁸

CIGNA

CIGNA's members reported that their awareness of the costs and quality of health care had increased compared to two years ago, however only about four in 10 surveyed agreed that they are usually aware of the actual costs of the health care services they get or that they have an easy way to find out how much health care services would cost.

Interestingly, the study participants indicated a strong desire for information about quality rather than information about cost to help them determine appropriate doctors or facilities. For example, about 76% of respondents indicated that they would use quality comparison information to select a hospital for an inpatient procedure, but only half indicated they would use cost comparison information to make such a choice.⁹

UnitedHealthcare

UHC cites "activation programs" as key to producing real changes in consumer behavior. They use a personalized messaging program that delivers personally relevant health messages to its members (using multiple formats). Among those who read or listen to their messages, the results are as follows:

u 240% higher rates of mammography,

u 31% increase in use of pill-splitting, and

u 100% increase in use of mail order pharmacy services.¹⁰

Humana

Humana's survey of its CoverageFirst enrollees found that the significant savings realized in their pilot program was due to behavior modification among members. The study compared utilization of certain services by individuals in their pilot program to utilization of the same services by the overall marketplace (Louisville, KY).

u Inpatient admissions for Humana's CoverageFirst members were 14.4% lower during the period, while the marketplace saw a 2% increase.

u Utilization of outpatient services remained unchanged, while the marketplace saw about an 8% increase.

u Physician office visits outpaced the marketplace with a 16.9% trend, compared to the market's 13.3% trend. Humana presents this statistic as a result of an increase in utilization of family practice doctors or other primary care physicians for services such as physical exams and well-baby visits.

u Prescription drug spending also outpaced the marketplace with an increase of 5.5% versus the market's almost 2% trend. The Humana study also addressed one of the pervasive concerns regarding CDHC plans: Are consumers foregoing necessary care because of additional cost-sharing presumed in these plans? Humana cites the increase in physician services, prescriptions, and preventive care as evidence that necessary care is being sought. The savings realized from members in the CoverageFirst plans appears to come from a shift in utilization to the appropriate level of service (inpatient to outpatient, outpatient to specialist, and specialist to PCP).¹¹

Early Results: Success Strategies

Despite the limited amount of available data, health care companies and other benefits experts have already begun to formulate a variety of solid and (somewhat) proven strategies for success when implementing an account-based CDHC plan.

One analysis, "Consumer Driven Health Care: Lessons From the First Five Years," suggests that to be successful, employers should adopt a broad, all-inclusive approach that incorporates intense research and planning in the areas of plan design, pricing, integration with wellness initiatives, communication, and vendor selection.

Plan Design

An employer about to embark on offering a CDHC plan to its employees must decide if its goal is to be "evolutionary" or "revolutionary." Introducing a HRA or HSA is more "evolutionary" if financial incentives eventually "push" employees toward the CDHC option. However, a total replacement approach will result in a more true "revolution" as the employer takes a strong stance in support of CDHC.

How should an employer structure its new CDHC plan? The best enrollments seem to occur when the HRA or HSA plan option requires of the employee similar out-of-pocket costs as any traditional plan offering, particularly in the first year. Employers may consider making the CDHC option more financially attractive than the traditional plans it offers.

Regardless of the specific tactics employers decide to employ, it is vital that they keep the end goal in mind. As a plan sponsor, what behavior are you trying to shape? For example, excessive cost-shifting to your employees can potentially result in the avoidance of necessary care by your employees. Instead, consider covering preventive services at 100% to motivate employees toward routine care and thus avoid more costly treatments in the future.

Pricing

The proper use of financial incentives can promote enrollment. Higher than average participation can be achieved when an obvious advantage exists in terms of employee contribution amounts for the CDHC plan versus other plan options. In addition, make plan comparison tools available (these are often available through the health plan/vendor). These tools can help employees compare payroll deductions and anticipated out-of-pocket costs from coinsurance and co-payments to determine which option makes the most sense for their health care needs.

Integration with Wellness Initiatives

Probably the single-most important factor in achieving success with CDHC plans is engaging consumers in the idea that they must become responsible for their own health care, with the support of their employer. CDHC participants must understand the relationship between good health and manageable health plan costs and the ultimate impact on the bottom line for both themselves and their employer.

Remember, participant lifestyle change is at the root of a successful CDHC plan. CDHC participants are 25% more likely to engage in healthy behaviors and 20% more likely to participate in company-sponsored wellness programs. Some employers even go as far as to link participation in a CDHC plan to mandatory participation in wellness programs. There are several wellness programs available for integration into a CDHC plan including health risk appraisals, preventive care guidelines and recommendations, general health education, lifestyle modification modules, and referrals to disease management programs. All of these types of programs are typically made available through the vendor's online health portals.

 Communication

Employers must realize the need for adequate communication in advance of a proposed CDHC plan implementation date. The potential move to CDHC must be presented to employees and discussed early and often. Employers must expect resistance, but remain committed to being truly supportive of the idea of consumer engagement in health care. The new concept should be presented as a mutually beneficial, solid business decision rather than a "takeaway" of health care options. Consider a "kick-off" message from a senior official, demonstrations, mandatory meetings, and Q&A sessions as possible methods for getting the information out.

 Vendor selection

Early in the CDHC movement, the selection of a CDHC vendor was limited to a few small entrepreneurial firms like Definity Health and Lumenos. Now, large national health care companies like Aetna, Humana, and UHC have seen the potential of CDHC (UHC has since acquired Definity Health, and WellPoint has purchased Lumenos), and along with their offerings, there are literally hundreds of vendors offering HRAs, HSAs, or both.

When selecting a vendor for a CDHC plan, carefully review each candidate for its degree of experience, functionality, member tools, and the success of its consumer marketing tools. Plan sponsors should review, at a minimum, a vendor's product offerings, provider networks, administrative systems, member portal content and functionality, wellness resources and incentive management programs, ability of the vendor to evolve as the market progresses, and the vendor's fit into the plan sponsor's corporate strategic objectives.¹²

Several of the large, national health care companies have also formulated success strategies based on the data they've collected regarding their own CDHC members.

UnitedHealth Group

UHC's study of its own members yielded the following suggestions for adopting a successful CDHC strategy.

u A successful CDHC program will pair the HSA with a complete package that includes communication, enrollment processes, and contribution strategies.

u Full-replacement HSA programs tend to reflect higher levels of employee funding, account use, and savings. This may be because employers that use a full-replacement approach typically engage in intensive employee education and change management processes.

u Employer contributions are the single greatest driver of account adoption among participants, as well as a driver of overall levels of contribution and balance growth.¹³

Humana

Humana's study revealed that engaging employees is vital to the success of any new CDHC program. It recommends that the processes critical to engaging employees include positive enrollment, use of online tools, and using year-round communication initiatives.

u Positive enrollment refers to every employee actively enrolling in a health benefits plan every year, rather than being defaulted to the previous year's plan. This keeps employees engaged in the process and sets the stage for year-round involvement.

u Using online tools, employees should be able to view all of their health plan options, model premium and out-of-pocket costs, and view their previous year's claims costs to help make the best decisions.

u Effective, ongoing communication should be present in a variety of formats including online, mail, and group presentations. Humana found that groups who use all these techniques have an overall almost 10 percent medical trend, while groups that do not employ vigorous communication techniques experience a 21.6% medical trend.

Early adopters of the consumer-driven health plan concept have paved the way for other employers to test the waters. The first comprehensive studies seem to indicate that CDHC might just be the right medicine to cure many of the health care system's ills. With careful consideration of your objectives, examination of data from early adopters, and a clear and comprehensive implementation and communication plan, you too may be able to find a way to control your organization's costs while helping your employees become wiser, more satisfied consumers of health care.

 ¹ A Health Savings Account (HSA) is a tax-advantaged fund to which employers, employees, or both can contribute. Unused funds in an HSA can be rolled over for future use and are portable from job to job. A Health Reimbursement Arrangement (HRA) is an employer-funded account. Unused HRA funds can be rolled over at the end of the year for future use but are not portable from job to job. A HRA is usually offered in concert with high-deductible health coverage; an HSA must be combined with high-deductible health coverage.

² Aon Consulting/ICEBS Survey Shows Consumer-Driven Health Plans Becoming More Popular, March 2005, as reported in "Consumer-Driven Health Care: Lessons from the First Five Years," by C. William Sharon, CEBS, and Toni Donahue, Benefits Quarterly, Second Quarter, 2006.

³ Aetna Research Study of 2004 Health Fund Members, as reported in "Consumer-Driven Health Care: Lessons from the First Five Years," by C. William Sharon, CEBS, and Toni Donahue, Benefits Quarterly, Second Quarter 2006.

⁴ CIGNA Choice Fund Results Analysis, Summary of Key Findings, November 2006.

⁵ Health Care Consumers: Passive or Active? A Three-Year Report on Humana's Consumer Solution, June 2005.

⁶ CIGNA Choice Fund Results Analysis, Summary of Key Findings, November 2006.

⁷ UnitedHealth Group Health Savings Account Adoption, Contribution and Spending Behavior, Data Analysis Executive Summary, January 2007.

⁸ Aetna Research Study of 2004 Health Fund Members, as reported in "Consumer-Driven Health Care: Lessons from the First Five Years," by C. William Sharon, CEBS, and Toni Donahue, Benefits Quarterly, Second Quarter 2006.

⁹ CIGNA Choice Fund Results Analysis, Summary of Key Findings, November 2006.

¹⁰ UnitedHealth Group Reports Consumers are Selecting Account-Based Plans at a Rapid Pace; Membership Tops 1.75 Million, news release, June 8, 2006.

¹¹ Health Care Consumers: Passive or Active? A Three-Year Report on Humana's Consumer Solution, June 2005.

¹² Sharon, C.William, CEBS, and ToniDonahue. "Consumer-Driven Health Care: Lessons From the First Five Years." Benefits Quarterly, Second Quarter 2006.

 ¹³ UnitedHealth Group Health Savings Account Adoption, Contribution and Spending Behavior, Data Analysis Executive Summary, January 2007.

Is Your Drug Plan Hard to Swallow?

Health Care Costs Series, 2^nd Edition

Your employer offers a prescription drug plan, but do you know how to use it? Do you understand the benefits the plan provides, and how the prescription drug choices you and your doctor make can affect you, your family, and your employer?

Understanding your drug plan and your prescriptions can result in greater satisfaction from your health plan, and in your overall medical care.

Prescription Drugs and Your Employer

Employees who understand their benefit plans make more informed choices about the medical services they receive, and can reduce the amounts they are required to pay for out their own pockets by simply choosing less expensive alternatives. Making cost-effective choices also helps keep employer costs down. While there may be no immediate benefit to you for reducing the costs incurred by your employer, you will likely benefit from lower premium increases and the continued availability of these plans over the long run.

Prescription drugs are one of the most costly elements of employer sponsored health care plans. As drug costs rise and more prescriptions are dispensed each year, employees must do their part to ease the burden. Being knowledgeable about how your prescription drug benefits work, and about the medications you take, can reduce costs for you and your employer.

Generic vs. Brand Name Drugs

Your health plan probably offers you some type of incentive to choose generic drugs over brand name drugs. For instance, you may have to pay a smaller co-payment when your pharmacist dispenses generic drugs instead of brand name ones.

However, many people question whether generic drugs are as good, effective, or safe as their brand name counterparts. The perception is that since many generic items found in grocery stores tend to be of lesser quality, the same must be true for medications. These types of concerns cause people to hesitate to choose generic drugs, although generics are more cost-effective for both patients and their employers.

Fortunately, in the case of prescription and over-the-counter medications, generic substitutes are the equivalent of brand name drugs. The U.S. Food and Drug Administration (FDA) regulates the chemical equivalency of generic drugs to ensure they are just as safe and effective as the brand name drugs they mimic.

According to FDA regulations, generic drugs must:

§ Contain the same active ingredients as the brand name drug;

§ Be equal in concentration or strength to the brand name drug;

§ Require the same dosage;

§ Have the same rate of absorption into the body and provide similar blood levels;

§ Have the same labels (precautions, indications, etc.); and

§ Be made under the same FDA Good Manufacturing Practice regulations as the brand name medication.

Not all medications have generic equivalents. Most new drugs have a period of time under which they are protected by a patent, and generic drugs are therefore not permitted. After the patent expires on a brand name drug, other pharmaceutical companies can manufacture that drug under its generic, or chemical, name. Generic drugs are usually less expensive than the brand name versions, usually due to lower development and marketing costs.

This lower cost is the reason your health plan provides you with a financial incentive to choose a generic drug over a brand name drug when a generic drug is available. In the long run, consistently choosing generic drugs when your doctor approves is the best way to help your employer keep health plan costs down.

What is a Formulary?

A formulary is a list of preferred medications in a prescription drug plan. A formulary allows coverage for generic drugs as well as those on the list. These drugs are selected because they are therapeutically appropriate and cost effective.

An incentive formulary takes this idea one step further. While this option allows coverage for generic drugs and those on the preferred list, it also allows a level of coverage for non-formulary or non-preferred drugs. The participant, however, is required to pay the difference between the generic copayment and the cost of the non-formulary drug.

Some formularies allow for coverage if your doctor has requested that the prescription be Dispensed as Written, or DAW.

Formularies are dynamic. This means they change regularly with the introduction of new drugs to market. New drugs that are more effective may replace existing drugs on the list. Contact your insurance company or employee benefit administrator for the most recent list.

Follow Directions Completely

Nearly half of all dispensed prescriptions are taken inappropriately. These "non-compliant" patients are doing one or more of the following:

§ Taking medications at the wrong time of day;

§ Under-dosing or stopping too soon;

§ Sharing prescriptions with others;

§ Mixing medicines with alcohol, tobacco, certain foods, and other drugs; and

§ Failing to fill or re-fill prescriptions altogether.

Not taking your prescription in accordance with your doctor's orders can result in a serious health condition. Taking the incorrect dosage, or not completing a full course of antibiotics, for example, can worsen your condition. Poor patient compliance has historically cost billions of dollars in medical bills, resulted in lower quality patient health, and even caused unnecessary deaths.

Talk to Your Doctor

The best way to ensure that you know all you can about a drug you have been prescribed, and its generic equivalents, is to talk openly with your doctor. Below are some suggested questions that you may want to ask.

§ Is the drug you are prescribing on my health plan's formulary?

§ Is there a generic substitute available?

§ Are there any drug interactions that I should be aware of?

§ Does this medication cause any side effects?

§ If I forget to take a dose, what should I do?

Also, make sure your doctor knows about any previous reactions you have had to medications. In addition, be sure to call your doctor immediately if you have any problems or adverse side effects from a new prescription.

For more information on how to become a wise health care consumer, and help you and your employer save money, look for the next edition of the Know Your Employee Benefits, Health Care Costs brochure series.

This brochure is for informational purposes only and is not intended to replace the advice of insurance professional.

Know Your Employee Benefits is written and produced for GDI Insurance Agency, Inc.. © Zywave, Inc.

 Understanding a Health Savings Account

 What is a Health Savings Account?

A Health Savings Account (HSA) is an account that can be funded with your tax-exempt dollars, by your employer, or both, to help pay for eligible medical expenses not covered by an insurance plan, including the deductible, coinsurance, and even in some cases, health insurance premiums.

Who is eligible for an HSA?

Anyone who is:

· Covered by a High Deductible Health Plan (HDHP);

· Not covered under another medical plan that is not a HDHP;

· Not entitled to Medicare benefits; or

· Not eligible to be claimed on another person's tax return.

What is a High Deductible Health Plan (HDHP)?

A High Deductible Health Plan is a plan with a minimum annual deductible and a maximum out-of-pocket limit as listed below. These minimums and maximums are determined annually by the Internal Revenue Service (IRS) and are subject to change.

Type of Coverage	Minimum Annual Deductible	Maximum Annual Out-of-Pocket
Individual	$1,150	$5,800
Family	$2,300	$11,600

(2009 limits)

 

Part 2: Health Savings Account

When do I use my HSA?

After visiting a physician, facility, or pharmacy your medical claim will be submitted to your HDHP for payment. Your HSA dollars can be used to pay your out-of-pocket expenses (deductibles and coinsurance) billed by the physician, facility, or pharmacy or you can choose to save your HSA dollars for a future medical expense.

What is a deductible?

It is a set dollar amount, determined by your plan, that you must pay, out-of-pocket or from your HSA account, before insurance coverage for medical expenses can begin.

How much can I contribute to an HSA?

As noted by federal law for the 2009 calendar year, the annual contribution limits are:

• $3,000 for individual coverage or $5,950 for family coverage.

Individuals age 55 or older may be eligible to make a catch-up contribution of $1,000 in 2009.

What is the difference between an HSA and Flexible Savings Account (FSA)?

• An HSA can roll over unused funds from year to year.
• An FSA cannot roll over unused funds from year to year.
•  

Can I contribute to both an HSA and a FSA in the same year?

Yes, a "limited FSA" is permissible. A limited FSA only allows reimbursement of expenses that are not eligible for payment under the HDHP or HSA. For example, an employer may establish a limited FSA to allow employees to contribute pre-tax dollars to an account which only reimburses expenses for dental services. Please ask your employer if a limited FSA is available to you.

If you are covered under a FSA plan that includes a grace period, you are eligible to establish an HSA in the following year if your FSA had a zero balance at the end of the plan year or if you transfer your unused balance into the HSA at the end of the FSA plan year.

What if I enroll in an HSA in the middle of a year?

If you enroll in an HSA in the middle of a year, you are allowed to make a full year's contribution, provided that you remain covered by the HSA for at least the 12-month period following that year.

 

Why should I elect an HSA?

1. Cost Savings

• Tax Benefits
  • HSA Contributions are excluded from federal income tax
  • Interest earnings are tax-deferred
  • Withdrawals for eligible expenses are exempt from federal income tax
• Reduction in medical plan contribution
• Unused money is held in an interest-bearing savings or investment account

Note: Many states have not passed legislation to provide favorable state tax treatment for HSAs. Therefore, amounts contributed to HSAs and interest earned on HSA accounts may be included on the employee's W-2 for state income tax purposes.

2. Long-Term Financial Benefits

• Save for future medical expenses
• Funds roll over year to year
• This is your account - you take it with you

3. Choice

• You control and manage your health care expenses.
• You choose when to use your HSA dollars to pay your health care expenses.
• You choose when to save your HSA dollars and pay health care expenses out-of-pocket.

 

Celiac Disease

Celiac disease is genetic condition that damages your small intestine and interferes with the absorption of nutrients from your food. If you have celiac disease, you are unable to tolerate a protein called gluten, which is found in wheat, rye, barley and some oats.

Overview

When people with celiac disease (CD) eat foods containing gluten, their immune system responds by damaging the small intestine. Sometimes CD is triggered for the first time following a surgery, pregnancy, childbirth, viral infection or episode of severe emotional stress. CD is often considered a food allergy, but it is not.

Symptoms

Celiac disease affects people differently. Some people develop symptoms as children, others as adults. Symptoms may or may not occur in the digestive system. For example, one person might have diarrhea and abdominal pain, while another person has irritability or depression. In fact, irritability is one of the most common symptoms in children.

Symptoms of celiac disease may include one or more of the following:

• Recurring abdominal bloating and pain
• Chronic diarrhea
• Weight loss
• Pale, foul-smelling stool
• Unexplained anemia
• Bone pain
• Behavior changes
• Muscle cramps
• Fatigue
• Delayed growth
• Pain in the joints
• Seizures
• Tingling numbness in the legs
• Pale sores, or ulcers, inside the mouth
• Painful skin rash
• Tooth discoloration or loss of enamel
• Missed menstrual periods

Prognosis and Treatment

The only acceptable treatment for CD is strict adherence to a 100% gluten-free diet for life. An adherence to a gluten-free diet can prevent almost all complications caused by the disease. This diet means avoiding all products that contain wheat, rye, barley or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods.

Maintenance of a strict gluten-free diet requires considerable diligence on the part of the patient, along with support and knowledge of what constitutes a gluten-free diet on the part of the monitoring physician. The goal for the patient needs to be self-management. Therefore, patients must be educated to exercise caution in food choices, carefully reading all food labels.   

2009 Benefits Statement

January 1, 2009

Dear Joe Smith:

This personal benefits statement is a brief outline of the benefits ABC Company provides to you. It summarizes each benefit and illustrates the significance of your benefits package as part of your total compensation. Please review the information carefully and direct any questions to Jane Doe at (414) 444-4444 x232.

Personal Information:		Employment Information:
SSN:	088-88-8888	Date of Hire:	January 1, 2002
Name:	Joe Smith	Annual Base Salary:	$37,562.00
Address:	123 Main Street	Job Title:	Electrician
City, State, Zip	Whitewater, WI 53190

Benefit Name:	Benefit Description:	Annual Cost:
		Employer Cost:	Employee Cost:
Medical	UnitedHealthcare Choice	$4,684.42	$783.90
Dental	MetLife Dental Plan	$360.88	$226.20
Vision	Vision Service Plan Discount Card	$0.00	$25.00
Employer-provided Short-term Disability	Company Provided STD benefit equal to 60% of your weekly rate for maximum benefit period of 13 weeks	$125.10	$0.00
Employer-provided Long-term Disability	Company provided LTD monthly benefit begins after 90 days of total disability. Benefit equivalent to 70% of basic monthly earnings while disabled up to age 65.	$210.20	$0.00
Employer-provided Basic Life & AD&D	One times salary to maximum benefit of $100,000	$174.10	$0.00
Voluntary/Supplement Life	No coverage	$0.00	$0.00
Dependent Life	No Coverage	$0.00	$0.00
Voluntary Long-term Care	Base plan covers $1,000 per month facility for 3 years or $500 per month homecare for 6 years.	$0.00	$0.00
Health Care Spending Account	2008 Contribution	$0.00	$364.00
Dependent Care Spending Account	Paid Yearly	$0.00	$5,000.00
Commuter Expense Reimbursement Account	Paid Yearly	$0.00	$800.00
401(k) Plan	Can elect to defer up to 25% of your income pretax. Company match is 50% of withholdings up to 4%.	$1,302.48	$2,604.96
Profit sharing	Determined annually by board of directors based on profitability	$650.54	$0.00
Employee Stock Purchase Plan	Shares of company stock can be purchased 2 times annually with a 15% discount (see plan document for more details).	$0.00	$650.54
Total Benefits Cost:		$7,507.72	$10,454.60
Plus Annual Base Salary:		$37,562.00
TOTAL VALUE OF COMPENSATION PACKAGE		$45,069.72
Cost of employer-sponsored benefits as a percentage of total compensation		22.3%

Miscellaneous Benefits:	Benefit Description:
401(k) and Profit Sharing	ABC Co. is pleased to partner with you in providing for your retirement. Our tax-deferred 401(k) plan offers you many advantages over a typical savings account. With a 401 (k) plan, the money you put in the account is tax-deferred. Additionally, the interest you earn on the money in your account grows without having taxes withheld, so the total grows much quicker than it would without this tax advantage.
Bereavement Pay	We have taken into consideration the personal needs which arise from the death of an immediate family member. Up to 5 days off may be granted with pay.
Credit union membership	As an employee you are eligible for membership in the Southeastern State Credit Union. See HR for details.
Direct Deposit	Direct Deposit to your financial institution is available for our convenience. See HR for details.
Employee Assistance Program	An employee assistance program is available for all employees and their families for confidential assistance in dealing with personal concerns.
Paid Holidays	ABC Co. recognizes 10 paid holidays each year, typically: New Year's Day and the day before or after; President's Day; Memorial Day; Independence Day; Labor Day; Thanksgiving Day and the day following; and Christmas Day and the day before or after.
Jury Duty Pay	If you are chosen for jury duty you will be provided with your regular pay minus any compensation from the court for up to 10 working days.
Onsite Child Care	Contact Great Kids at (800) 555-5555 for information.
Severance Pay	Negotiated upon hire.
Paid Sick Days	Our sick leave policy is established to assist you when you are unable to work due to illness, injury, or a medical condition.
Tuition Reimbursement	100% reimbursement of tuition and course-required books for classes pertinent to present position or next logical step. Course must be from accredited school, college or university. Reimbursement not to exceed $1500 annually.
Uniform Expense	$200 annually is allowed for purchase of uniforms.
Vacation	Each employee earns 10 days of vacation in the first year of employment. One vacation day is added for each additional year of employment up to a maximum of 25 days per year.
Voting Leave	ABC Co. provides up to 2 hours to vote in both the primary and general elections held each year.
Wellness Program	Up to $100 annually for eligible wellness classes, health club membership or weight loss program. See HR for program details.

Please contact Human Resources with any questions or comments about your personal benefits summary. ABC Company is pleased to be able to offer these valuable benefits to you, and we thank you for being a partner in our success.

Every effort has been made to ensure that the information in this statement is accurate; however no warranty of complete accuracy is made. This report does not in any way constitute a contract of employment. ABC Company reserves the right to amend pay and benefits at any time without notice. If you feel an error has been made or have any questions, please contact Human Resources.

Savings Fitness:

A Guide to Your Money and Your Financial Future -

Avoid Debt and Credit Problems

High debt and misuse of credit cards make it tough to save for retirement. Money that goes to pay interest, late fees, and old bills is money that could earn money for retirement.

How much debt is too much debt? Debt isn't necessarily bad, but too much debt is. Add up what you pay monthly in car loans, student loans, credit card and charge card loans, personal loans - everything but your mortgage. Divide that total by the money you bring home each month. The result is your "debt ratio." Try to keep that ratio to 10 percent or less. Total mortgage and non-mortgage debt should be no more than 36 percent of your take-home pay.

What's the difference between "good debt" and "bad debt"? Good debt is debt that provides a financial payoff. Borrowing money to buy or remodel a home, pay for a child's education, advance your own career skills, or buy a car for getting to work can provide long-term financial benefits. Bad debt is when you borrow for things that don't provide financial benefits or that don't last as long as the loan - vacations, clothing, furniture, dining out.

Do you have debt problems? You may if you are borrowing to pay off other loans; creditors are calling for payment; you're paying only the minimum on credit cards; you're maxing out credit cards; you're borrowing to pay regular bills; or you're being turned down for credit.

What can you do? (1) Avoid high-interest rate loans. Focus on the total cost of the loan - the principal and the interest. Don't just focus on the monthly payment. (2) Handle your credit cards wisely: keep only one or two cards; don't charge big-ticket items; shop around for the best interest rates, annual fees, service fees, and grace periods; pay off the card each month or at least more than the minimum; or leave the cards at home.

If you are in severe debt, a credit counseling service can help you set up a plan to work with your creditors and reduce your debts, or you can work directly with your creditors to try and work out payment arrangements.

Wellness Services

 

Wellness benefits refer to the education and activities that a workplace may implement to promote healthy lifestyles to employees and their families. Examples of wellness programming include such things as health education classes, subsidized use of fitness facilities, internal policies that promote healthy behavior, and any other activity, policy or environmental change that affects the health of employees.

At GDI Insurance Agency, Inc., we can design a simple or complex wellness program. Many programs require a minimal investment of time and money. More substantial programs often use more resources, but the many benefits to supporting and encouraging employee health and wellness outweigh the costs.

A wellness program will impact your company's bottom line by:

• helping control rising healthcare costs,
• increasing employee productivity, and
• increasing employee morale.

 We can build and customize a wellness program specific to your employee's needs and healthcare data and will deliver the tools you need to get a successful wellness program off the ground. We will help you:

• Gather claims data, a needs and interest survey, health risk assessment aggregate results, prescription drug utilization, culture audit and other pertinent data. From this data we will make some recommendations regarding the types of programs you will want to offer.
• Build a strategic wellness plan that incorporates specific goals and objectives.
• Help support the implementation of the wellness plan with specific resources and communication vehicles.
• Evaluate and refine the plan over time.

See the attached Wise & Well sheet, wellness article, and wellness tool as examples of the types of resources we have available to you.

Wise &Well

GET IT • MEASURE IT • MANAGE IT

· Does your company's financial outlook, combined with the continual rise of healthcare costs demand a step toward consumerism with your employee population?

· Have you implemented a consumerism strategy but are experiencing poor adoption because your employees lack the tools and resources to make informed decisions?

The rising cost of healthcare forces employers to evaluate a longstanding commitment of sponsoring healthcare programs for their employees.

GDI Insurance Agency, Inc. can help employers realize cost savings, while improving the overall knowledge and health status of employees and their families.

Wise & Well is a consumerism strategy that transforms employees into proactive and educated consumers of healthcare. Wise & Well combines an assessment of employee's knowledge and behaviors, with targeted interventions to align resources and information, and make continued progress toward increased knowledge and appropriate consumer behaviors.

The success of Wise & Well is dependent on integration into your culture, which includes:

• Commitment from leadership

· Employer/employee partnership

· Access to tools & resources

• Employee communication and education

· Measurable results

Wise & Well addresses the dilemmas employers have historically faced. Using the concepts outlined, GDI Insurance Agency, Inc. can deliver a customized consumer-driven strategy with measurable results to your organization.

GDI Insurance formulates an overall health care strategy, which becomes integral in controlling costs.

Consumerism Assessment Process

Wise &Well

GET IT • MEASURE IT • MANAGE IT

 A summary report provides a complete consumer readiness score, which is derived based on four topic areas:

1. Behaviors & Readiness to Change

• Attitudes towards preventive care

• Attitudes towards wellness initiatives

• Readiness to change (become an engaged healthcare consumer)

2. Cost Awareness & Extent of Planning/ Budgeting

• Healthcare cost drivers

• Cost of services

• Employee preparedness for healthcare expenses

3. Knowledge/confidence in use of benefits and services

• Use of healthcare benefits

• Prescription drug usage

• Provider selection & provider system navigation

4. Self-care initiative and tendency to use Web-based support tools

• Accessing information for self-care purposes

• Utilization of available Web-based tools

What makes Wise & Well an essential part of your healthcare consumerism strategy?

• It addresses employee's lack of knowledge about the real impact rising health care costs have on your business

• It provides tools to quantify and measure results based on your population

• It delivers tools and resources in a variety of methods to meet the educational needs of your employees

• It creates a plan to engage employees to be better consumers by understanding cost and quality while improving their overall health

 

What should employees do to make Wise & Well a successful and integrated part of their lives?

• Access to Information

• Knowledge

• Incentives to motivate behavior change

• Employer support & commitment

Workplace Wellness: Why Promote Wellness

Wellness issues important to you - brought to you by the insurance specialists at GDI Insurance Agency, Inc..

 

What is Workplace Wellness?

Workplace wellness refers to the education and activities that a worksite may do to promote healthy lifestyles to employees and their families. Examples of wellness programming include such things as health education classes, subsidized use of fitness facilities, internal policies that promote healthy behavior, and any other activities, policies or environmental changes that affect the health of employees. Wellness programs can be simple or complex. Many programs require a minimal investment of time and money. More substantial programs often use more resources, but the many benefits to supporting and encouraging employee health and safety outweigh the costs.

Why Workplace Wellness?

 

It affects your company's bottom line in many ways. Here are three key factors:

• Decreased healthcare costs
• Increased productivity
• Better morale

Rising healthcare benefit costs are a significant concern and poor health habits and unnecessary medical care costs consume portions of our corporate resources as well as the employee paycheck. The worksite is an ideal setting for health promotion and disease prevention programs. Employees spend many of their waking hours at work, nearing 50 hours per week. That's why the workplace is an ideal setting to address health/wellness issues.

Why Start a Company Wellness Program?

 

Wellness programs help control costs

An investment in your employees' health may lower healthcare costs or slow the increase in providing that important benefit. In fact, employees with more risk factors, including being overweight, smoking and having diabetes, cost more to insure and paid more for health care than people with fewer risk factors.

An employee wellness program can raise awareness so employees with fewer risk factors remain in a lower-cost group. A program also can encourage employees with health risk factors to make lifestyle changes to improve their quality of life and lower costs. The payoff in dollars as well as in quality of life can have a big impact on your company's bottom line.

 

Increase productivity

Healthier employees are more productive. This has been demonstrated in factory settings and in office environments in which workers with workplace wellness initiatives miss less work. Presenteeism, in which employees are physically present on the job but are not at their most productive or effective, is reduced in workplaces that have wellness programs.

 

Reduce absenteeism

Healthier employees miss less work. Companies that support wellness and healthy decisions have a greater percentage of employees at work every day. Because health frequently carries over into better family choices, your employees may miss less work caring for ill family members as well. The cost savings of providing a wellness program can be measured against reduced overtime to cover absent employees and other aspects of absenteeism.

Improve morale and enhanced image for the organization

A company that cares about its employees' health is often seen as a better place to work. Those companies save money by retaining workers who appreciate the benefit of a wellness program and they can attract new employees in a competitive market.

Just like food, beverages contain calories (sometimes lots) that many people do not realize are there. They can add up quickly and will affect your waistline if you don't take them into consideration when determining how many calories to consume daily. Here is the calorie content of some of your favorite drinks, both from home and at your local eatery:

 

Type of Drink	Calories	Healthier Option	Calories
16 oz. café latte made with whole milk	265	12 oz. café latte made with fat-free milk	125
20 oz. non-diet cola	227	20 oz. diet cola	0
16 oz. sweetened lemon iced tea	180	Sparkling water with natural lemon flavor	0
12 oz. sports drink	99	12 oz. fitness water	18
12 oz. fruit punch	192	12 oz. orange juice	168
8 oz. chocolate milk made with whole milk	208	8 oz. one percent chocolate milk	158
8 oz. two percent reduced-fat milk	120	8 oz. skim milk	90

When purchasing beverages at the supermarket, look out for the following sweeteners on the label. These ingredients add empty calories to your diet:

· High-fructose corn syrup and fructose

· Fruit juice concentrates

• Honey
• Sugar

· Syrup and corn syrup

• Sucrose
• Dextrose

Though it's nice to sip a relaxing cup of coffee or smoothie while reading the paper on a Sunday afternoon, you may be consuming lots of calories. Here are some tips to remember when out getting something to wet your palate:

· Request that your coffee drink be made with low-fat or skim milk instead of whole milk.

· Order the smallest size available, even if that's child's size.

· Forgo extra flavoring such as vanilla, hazelnut and caramel. These syrups are sugar-sweetened and will add calories to your drink.

· Skip the whipped cream on the top of coffee drinks and smoothies. This ingredient adds calories and fat.

· Ask that your smoothie be prepared without added sugar since the fruit used to make it is naturally sweet on its own.

GDI Insurance Agency, Inc.

Marketing

In addition to general day-to-day services, will release a Request for Proposal to the marketplace in order to review all of your vendor options now and at renewal. Evaluating, negotiating with, and recommending insurers and providers to our clients are specialties. Our position in the marketplace allows us to enjoy preferred financial arrangements with insurance vendors and third party administrators across the United States. We actively cultivate long-standing relationships with major carriers, and those relationships allow us to negotiate aggressively and obtain cost-efficient proposals for our clients.

As we negotiate with vendors, we will also examine your loss history, establish the necessary types of coverage consistent with your risk tolerance, choose carriers that provide superior services, and adopt the optimal funding mechanisms for your specific needs.

We have established rigorous selection criteria for potential vendors, and recommend a selection based on the following considerations.

Critical Vendor Selection Criteria

• Overall service and quality
• Experience in administering network-based programs
• Commitment to continuous quality improvement processes
• Experience in administering multiple option health programs
• Quality of communication materials (e.g., booklets, EOBs, etc.)
• Effective administration procedures (e.g., coordination of benefits, subrogation, etc.)
• Responsiveness of group representative
• Cost efficiency
• Responsiveness to client feedback
• Professionalism of response to RFP
• Willingness to adapt to changing needs and circumstances
• Adequate staffing ratios
• Superior network coverage in relation to location of employees
• [Other]

Marketing

We also evaluate vendors for other performance objectives and incorporate these objectives into the service agreement.

Activity Delivery of renewal information Claim turnaround time Claim processing standards Internal audits External audits Updated eligibility information Updated network provider file

Suggested Objective Employee satisfaction 90% in 10 calendar days Financial accuracy*: 99% Payment accuracy*: 98% Coding accuracy*: 97% Quarterly reports As needed Within 5 work days of receipt Within 10 work days of receipt

Activity Availability of general service representative Delivery of management reports Personnel changes Telephone responsiveness Employee satisfaction

Suggested Objective As needed Standard reports: within 1 week of request Custom reports: within 2 weeks of initial request or as agreed upon Notification before changes Call abandonment rate: <5% Average speed to answer: 90% within 30 seconds Survey results (to be determined)

*Definitions

Financial accuracy: Total amount of claims dollars paid correctly, divided by the total claims dollars paid.

Payment accuracy: Total amount of checks issued for the correct dollar amount divided by the total number of checks issued.

Coding accuracy: Total number of claims processed without a coding error (i.e. any inaccurate entry of information that does not result in a payment error), divided by the total number of claims processed.

Additional meetings will be required to understand all of 's employee benefits objectives. Implementation of the complete marketing action plan described in the Marketing Action Plan will then commence

.

Marketing Action Plan

's employee benefits plan objectives are as follows:

• List specific client objectives.
• List specific client objectives.
• List specific client objectives.
• List specific client objectives.
• List specific client objectives.

To address and fulfill your objectives and select [an] appropriate vendor[s], we propose the action plan on the following pages.

Marketing Action Plan Steps 1 - 4

Step 1

Request claims by location from current vendors

Analyze claims data to identify utilization trends

Prepare and present utilization data report with plan design recommendations

Model plan design changes to provide cost differentials (if applicable)

Prepare summary of current employee provider usage

Prepare network evaluation based on utilization data and available networks

Step 2

While completing the activities described in Step 1, above, will perform a complete market study to determine the best possible insurance and/or administrator vendors for . The market study will entail the following activities.

Planning Phase/Meeting

Identify/introduce team members

Establish communication channels

Determine satisfaction with current service

Determine expectations for future service

Determine 's specific objectives for an insurer or administrator

Determine project scope

Discuss timeframe

Review fixed costs

Review current carrier financial information (experience and rate guarantee)

Determine stop-loss insurance to include in RFP

Identify information needed in RFP

Information Gathering

Determine missing information

Request missing information

Acquire historical claims data

Acquire and review summary plan descriptions

Acquire and review plan document(s) and amendments

Acquire and review rate, benefit, and financial histories

Develop RFP Specifications

Inventory current services provided

Review contractual obligations of current vendors

Finalize list of desired vendor services

Determine other bidding requirements

Review and prioritize bid specifications

(cont'd)

Marketing Action Plan Steps 1 - 4, cont'd .

Draft, edit, and refine RFP specifications

Meet to confirm specifications

Decide upon scoring/evaluation system

Prepare final RFP draft

Vendor solicitation

Identify suitable vendors

Copy and mail specifications and RFPs

Answer vendor questions and provide additional information

Receive proposals

Vendor Selection

Conduct preliminary review of proposals

Request clarification of missing information

Conduct reference checks

Evaluate and score proposals

Develop a report and recommendations for finalists

Conduct on-site review of finalists

Review contracts with finalists

Negotiate contractual provisions

Select successful bidders

Communicate with

Review prior communication media and current goals

Develop theme and construct plan

Decide on method and media

Draft text

Modify and approve communications with management

Involve successful vendors

Finalize text and design of communication materials

Print communication materials

Distribute communication materials

Step 3

Implementation of selected vendors, PPO networks, and HMOs

Create implementation blueprint identifying each specific task, responsible party, and target completion date

Monitor each step of blueprint throughout implementation process

Step 4

After the initial plan is complete, we propose developing a three to five year strategic plan. This plan will identify and prioritize additional long-term objectives. It will also establish specific deadlines for meeting those objectives, and will allow for ongoing modification as the need arises.

[1] Some states define income differently than the IRS. As a result, HSAs that are tax exempt at the federal level may not be tax exempt at the state level.

[2] For example, accident, dental, vision, long-term care, specific conditions (i.e., cancer only policies), and hospital indemnity plans.

[3] Mere eligibility for Medicare does not make an individual ineligible to contribute to an HSA. An employee that continues to work after attaining age 65 may continue to contribute to an HSA so long as he or she has not enrolled in Medicare. IRS Notice 2004-50

[4] IRS Rev. Ruling 2004-23 clarifies that the screening services for the following conditions are included within the definition of preventive care: cancer, heart and vascular diseases, infectious diseases, mental health conditions and substance abuse, metabolic, nutritional, and endocrine conditions, musculoskeletal disorders, obstetric and gynecologic conditions, pediatric conditions, and vision and hearing disorders.

[5] HSAs may reimburse expenses for qualified long-term care premiums, even where contributions are made by employees with pre-tax dollars through a cafeteria plan. While HSAs may pay or reimburse qualified long-term care premiums, the exclusion from gross income is limited to the adjusted amounts under IRC 213(d)(10).

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