Communicate Health Benefits Information More Effectively

All employers have responsibility of guiding their employees about the health benefit schemes offered by them. Even the employees on the other hand also have the right to receive information about the health benefit schemes offered to them. Therefore an employer has the right to inform the employees about certain information regarding the health benefit schemes. For this reason, organizations have created the position of Health Benefit Manager having communication as one of the responsibilities for health benefit related schemes and procedures.

Key information heads to be shared by employer

There is a plethora of information available for communication. It is the skill of the Health benefit Manager to present them in a structured manner on behalf of the employer.

– Employers need to provide a detailed list of information to the employees about what health benefit schemes are provided to them or the scheme they are entitled to.
– Providing information regarding cost sharing as well as arrangements
– To take up necessary steps to resolve problem as well as to deal with appeals.
– To provide and guide its employees about the status of accreditation, certification as well as licensure.
– Provide sufficient and necessary information about the composition of the provider network too.
– To use the emergency care services as when required by the employees of the organization.
– To obtain referrals to specialists
– Most importantly provide all the information regarding the quality, safety of the health benefit plan and the cost of the employer sponsored plan.

Regulatory directives
According to the Employer Retirement and Income Security Act of 1974, it is necessary to provide all detailed information that the employees are entitled to that includes plan rules, covered benefits, documents about the plan management and operation as well. The employees are also entitled to receive a document with the summary plan description, known as SPD. The SPD contains

– Information of the health care services that are covered in the plan.
– Description of what services are being provided by the plan and how these schemes function.
– It provides information also on how to calculate the benefits.
– Explanation on the cost that the plan covers and the cost that the beneficiary has to pay.

Tools and Methods for communicating
There are various methods by which the Health Benefit Manager, on behalf of the employers, can communicate health benefit information to the employees:

– One of the best ways is to communicate with the employees about the health coverage plan but providing too much information of it should also be avoided. The employees should be given the required time to understand the scheme and ask questions if any.

– It is best to explain the changes in simple terms to the employees to make them understand.

– Apart from the employees it is also necessary to explain the health benefit plans to the health benefit managers so that they can explain it to the employees to.

– Employers should be ready to face any questions asked by employees regarding the health benefit scheme and clear their doubts.

– It is equally important as well to be direct and honest when discussing about the coverage plan especially if employees face cost increase due to the coverage plan.

– Discussing the 5C’s too is essential with the employees. This 5C’s include cost, changes in plans, coverage of the plan, comparison of the previous year’s plan and also the current option.

– It is necessary to provide information the employees about the health care providers that are available in the revised and new plan option.

– Providing testimonials of other employees about the changes in health benefit plans can also be quite helpful for the present employees.

– Taking the help of various means like internet, face to face discussions, telephonic conversations, office intranet as well as printed materials can be helpful too. However it is also necessary to use materials that are easily understood by employees.

Using health communication campaigns

What are its advantages?

– It is important for the employers to conduct communication campaigns to educate the employees about the need of health benefit schemes and how they operate.

– The responsible manager’s aim should be to identify the objective and aim of the health care campaign.

– To develop health care message that meets the objectives and aim of the campaign.

– Setting up the criteria for evaluation of the campaign and also the degree to which it is getting conveyed among the employees.

– To implement and the campaign and make sure that the employees understand message that is being conveyed by the employer.

– It is also necessary to make sure that the employees also to address the education need of the employees with language barrier, literacy issues etc.

To conclude, an effective way to communicate about the health benefit scheme is the cornerstone of every business organization. In these schemes, employers can also guide and help its employees to select a scheme and explain every detail they should know. The authority should also explain the new health scheme option and also about the changes in the existing benefits. To improve the health plan costs the employer’s must keep in mind the factor of low health literacy. Health plans and employers should also be able to successfully communicate with employees. Lastly, employees and employers should also be able to communicate clearly about the health benefit plans.

Cherries Health Benefits – Information

Cherries health benefits are one of the most talked about themes in food health and nutrition. Not only are health enthusiasts beginning to recognize the marvelous benefits that cherries can offer with just a few servings a day, but consumers are also beginning to catch on and embrace the trend. Today, many cherry-based products line supermarket shelves from Europe to the USA and this can only be attributed to the increased awareness for cherries health benefits.

To understand and appreciate the extent of cherries health benefits, it is important to look at this from the aspect of both prevention and healing which are two of the areas in health that cherries are recognized stars.

Disease Prevention. All the product labels would tell you that cherries have no actual therapeutic claim but that does not mean cherries are not able to contribute to fostering health and preventing illness. In studies conducted by some of the world’s leading institutions, the antioxidants in cherries are known to help lower the risk for cancers and many other diseases.

Two types of antioxidants that are known to play a role in cancer prevention are quieritrin and ellagic acid. The first is known as a very aggressive cancer fighting antioxidant which plays a direct role in combating the formation and growth of cancer cells. The second is a phenolic anti-carcinogenic compound which works by combating cellular mutations which often trigger the onset of cancer.

In general, the disease-prevention characteristics of this small fruit which pave the way for a myriad of cherries health benefits is made possible by its generous dose of substances that are essential to a fully functioning body. When antioxidants are abundant for example, the body can take on a more proactive approach in cleansing itself from toxins and other disease vectors rather than only responding to an illness that has already set in. A regular diet containing cherries, therefore, lowers the risk for many of these diseases like heart ailments, age-related degenerative conditions, as well as promoting healthier body functions like normal sleep and better digestion.

Disease Treatment. Cherries are not medicines per se but the substances contained in them can have a healing effect on many serious health conditions. The most important of cherries health benefits in this area is with regard to cherries and arthritis. Anthocyanins and bioflavonoids in this fruit help manage and treat inflammatory symptoms which are the underlying cause of arthritis. As a result, arthritis patients who regularly consume cherries report significant improvements in both pain severity and attack frequency.

Another area where cherries health benefits are evident is in the management of migraines. Again, anthocyanins and bioflavonoids are at work in these situations. The anti-inflammatory benefits of both compounds normalize blood flow in the brain soothing migraine attacks and lowering the likelihood of frequent migraine episodes.

To take advantage of these benefits, nutritionists recommend getting at least 2 servings of cherries per day. During the summer months just after the cherry season, this fresh fruit is widely abundant and available in supermarket shelves. Farther into the year when fresh cherry supplies are limited, one can always have substitutes consisting of cherry juice and concentrate and even cherry pills. This way, one always has access to valuable cherry products regardless of the time of year.

The Benefits And Risks Of Self Funding Your Employee Health Benefit Plan

What Is Self Funding?

An employer who operates a self funded health plan assumes the financial risk for providing health care benefits for its employees. Self funded plans differ from fully insured plans in that employers do not pay monthly premiums for health care that employees might be given, the employers, rather, pay only those claims that employees actually receive.

To limit their liability most employers purchase stop-loss insurance. The stop-loss insurer agrees to reimburse the employer for health care costs that reach a certain threshold (usually $25,000-$100,000) in exchange for premium payments. Generally, the lower the threshold amount the higher the premium.

For example, assume a stop-loss threshold set at $25,000. The employer will pay employee health care claims up to and exceeding $25,000. However, the employer will be reimbursed for those paid claims over and above $25,000. The stop-loss insurer does, however, put annual and lifetime limits on coverage and will adjust premium costs accordingly. The higher the annual and lifetime max the more premium will be demanded.

The employer’s money may solely be used to pay claims or, alternately, it may be a shared expense with employees making some contribution. The money is typically placed in a trust account that is then debited to pay claims as they are incurred.

What Are the Benefits of Self Funding?

Typically, employers automatically save money in the first 12 months while self-funding. This occurs because claims payments are not processed until the second or third month. In the first year, employers have 12 months worth of money set aside to pay claims but they will only be paying 10 or 11 months worth of claims because of the time lag.

Employers also experience savings on direct costs that are included in fully insured medical insurance premiums such as overhead, taxes, profits and commissions. Most self funded plans use a third party administrator (“TPA”) to process and pay medical claims. Most TPA’s administration costs are significantly lower than those included in the premium by an insurer or HMO. And the premiums paid to a stop-loss insurer are usually much lower than those paid to an insurer for a fully insured plan.

Self funded employers also save on premium taxes that they would ordinarily pay if fully insured as they merely hold money in trust to pay for health claims. Self funded plans are not required to pay to the 2-3% premium taxes applicable to fully insured plans.

Mandatory benefits imposed by state law are also not applicable to most self funded plans, as federal law governs regulations of most self funded plans. These state mandated benefits are oftentimes expensive and cutting them out removes added expense.

Self funding provides employers the flexibility to design their health benefit plans. And they have greater control of the distribution of benefits as compared to a fully insured plan. In a self funded plan, employers have access to the money in the claims fund that is being used to pay current claims. This money produces interest income that can be added to the fund that would not otherwise exist in a fully insured plan.

What Are The Risks of Self Funding?

Despite these important benefits there are several risks that must be considered before the decision to self fund is made. The biggest issue in self-funding is the potential financial exposure.

Catastrophic events and high utilization by employees can lead to exorbitant claims costs. This can mitigated, as discussed above, by purchasing stop-loss insurance. But proper analysis of your company’s potential risk is essential when trying to determine the attachment points for stop-loss coverage.

Your company also must be aware of potential legal exposure. As a self funded plan you remain ultimately liable for claims decisions errors. In addition, labor relations problems could arise with employees in event that employee medical claims are paid late and this could lead to unrest, job dissatisfaction or a decrease in productivity. Both of these risks make choosing a qualified, competent TPA absolutely essential.

Finally, there are many legal complexities that impact self funded plans. Most self funded plans are regulated by the Department of Labor and are subject to federal law, specifically the Employee Retirement Income Security Act (“ERISA”). And there are several important tax law considerations that must be accounted for as well. Developing a relationship with an ERISA attorney well versed in self funding can save you time, money, and the headache of employee lawsuits.

Is Self Funding Right For Your Company?

In general, the decision whether to self fund is much easier for those employers with more than 200 employees. In fact, self funding is not widespread among small employers, only 12% of those with just 3 to 199 employees self fund their health plans, according to the 2007 Kaiser Family Foundation Survey of Employer Health Plans. The more employees you have the easier it is spread the risk. Medical claims tend to be quite volatile and smaller employers oftentimes cannot maintain the cash-flow necessary to fund those months where costs are excessive.

To determine whether self funding is the right option for your company, you should perform a risk analysis and cash-flow analysis, then examine employee demographics and covered dependents. You should also review the claims history of your company. You must know the age and distribution of the claims submitted by your employers in order to determine the risk that you will be accepting by self funding.

With this information you will have an idea about the general age of your employees and be able to identify what their aggregate health claims reveal. For example, if your employee population is older the data may reveal expensive conditions of age such as heart disease or cancer. Or perhaps your employees are disproportionately overweight, then you may see more diabetes claims or at least be put on notice that these types of claims are likely. On the other hand, if your employees are young they may have very little utilization but may be susceptible to sport injuries. At this point, you must review utilization rates for the last 3 to 5 years.

With this data in hand you should be able to determine whether you can reasonably afford self funding. Be realistic, however, about your company’s cash-flow. Claims do not arrive in an orderly fashion over a 12 month calendar period. Some months are more expensive than others. You cannot postpone claims payments you must have adequate cash-flow and enough reserves to immediately pay claims. The assistance of a qualified TPA, insurance broker, and/or ERISA attorney is essential at this point and a competent professional will be able to assist you to determine whether self funding is a viable option.

What Impact Will ERISA & Other Laws Have On Your Self Funded Plan?

Most self funded plans are subject to ERISA and the comprehensive bundle of regulations associated with this statutory scheme. ERISA, however, preempts state insurance laws including reserve requirements, mandated benefits, premium taxes, and consumer protection regulations. Self funding provides more freedom to create plans free from state mandates, which can result in substantial savings versus fully insured plans.

However, in addition to ERISA there are other federal laws that definitely impact your self funded plan including:

1. Health Insurance Portability and Accountability Act (“HIPAA”);
2. Consolidated Omnibus Budget Reconciliation Act (“COBRA”);
3. Americans with Disabilities Act (“ADA”);
4. Pregnancy Discrimination Act;
5. Age Discrimination in Employment Act;
6. Civil Rights Act;
7. Internal Revenue Code (“IRC”);
8. Tax Equity & Fiscal Responsibility Act;
9. Deficit Reduction Act; and
10. Economic Recovery Tax Act.

While this is no inconsequential list, a good TPA will be able to handle the administration and compliance with the most onerous of the statutes listed above including ERISA, HIPAA, and COBRA. However, be aware that while TPAs will provide compliance service they may not accept liability for violations of these laws (other than for gross negligence), which will rest squarely on the shoulders of you the employer.

Who Will Administer Your Self Funded Plan?

As you can see, choosing the right TPA is one of the most important if not the most important decision when deciding to self fund. A TPA can help with the cash-flow analysis and risk analysis and can administer much of the compliance requirements of a self funded plan.

Here are 10 steps to take when seeking a qualified TPA:

1. Look for a TPA that is capable of providing a customized health plan specific to your company’s needs;

a. Your chosen TPA should be flexible enough to create a plan that fits your demographics. Working with your TPA to customize coverage will cut costs and improve employees’ satisfaction with the benefits provided.

2. Check references from some of the TPA’s larger clients.

a. Ask for a list of the TPA’s larger clients then contact the clients to independently verify the client’s satisfaction with the TPA.

3. Make sure that the TPA uses and provides accurate legal information.

a. Look for a TPA that is communicative and up to date on changing regulations. It is essential that your TPA maintains a close relationship or employs an ERISA attorney due to the complexity and interplay of federal ERISA and state insurance regulation.

4. Understand how a provider (physician/hospital) network (PPO) figures into the equation.

a. TPA’s oftentimes have relationships with provider networks and can negotiate on your behalf.

5. Investigate how the TPA manages your funds.

a. ERISA requires self funded plans to prudently safeguard their assets. While not required by law, TPAs generally recommend that employers set up a trust account for their plans. This step fulfills the prudence requirement of ERISA. Many TPAs also offer client audit reports to verify that their financial practices prevent fraud and abuse.

6. Ask whether the TPA processes COBRA and HIPAA documentation.

a. COBRA and HIPAA, two federal laws, have several notification and compliance aspects that most TPAs will happily administer for you. Just ensure that your contract states that the TPA will be liable for COBRA and HIPAA administration errors and that the TPAs errors and omissions policy covers COBRA and HIPAA errors.

7. Learn all you can about the TPA’s cost-containment programs.

a. Ask how the TPA handles pre-authorizations, large case management, utilization review, and provider network evaluations.

b. Also determine how the TPA manages catastrophic claims. A good TPA is usually proactive: Detecting catastrophic claims early allows the TPA to reduce your costs without diminishing quality of care.

8. Find out how the TPA trains its claims analysts.

a. In addition to finding out how analysts are trained, inquiring about turnover rate is good idea as well.

9. Make sure that the TPA practices good management reporting.

a. Your chosen TPA should make available periodic reports explaining plan status. Reports should detail finances, number of employees served, medical costs, use of medical services, and savings realized from network providers.

b. These reports are invaluable and will provide you with the information you need to decide which services to add and whether you need to increase or decrease contributions from employees and put you on notice regarding other necessary changes or alterations.

10. Review bids from stop-loss insurance providers.

a. After you have chosen your TPA, it can contract for stop-loss insurance on your behalf. Be cognizant, however, that self funded plans are required by ERISA to obtain several bids.
b. Ensure that you are able to easily review the bids and make sure that you do some due diligence checking on the stop-loss carrier. You may not want to deal with a new company that is unfamiliar with the business and is inexperienced.

c. Lastly, ask your TPA their procedure when renewing or changing stop-loss carriers. A good TPA is aware and will put you on notice that the renewal procedures and claims definitions are often complex. These complexities are purposefully drafted by the stop-loss carrier to avoid claims liability.

d. A quality TPA will ensure that you are made aware of these complexities and will make sure that you are not left holding the bag with thousands of dollars of unpaid claims.


For those employers who have the size and available cash-flow, a self funded health plan can result in substantial medical claims savings. A self funded plan offers the flexibility to design customized benefit plans and provides much more control over plan benefits than the typical fully insured medical plan.

However, there are numerous risks and potential pitfalls including legal and compliance hazards, human resource and employee relation headaches, and potential liability for mishandling claims. Most large companies find that these risks can successfully mitigated with the help of a qualified, competent TPA.

Implementing a self funded health plan is not to be undertaken lightly, but failing to do so may mean wasting thousands of dollars every year on fully insured premiums. Performing the cash-flow analysis and risk analysis detailed above will give you a good idea whether your company is ready to self fund. At that point if you believe self funding is a viable option, contact a qualified TPA or ERISA attorney and with the assistance of a competent professional you can design a self funded plan that not only meets the needs of your employees but also bolsters your bottom line.

Helpful Information on the Medical Health Benefits of Meditation

Information on the medical health benefits of meditation shows that meditation is a safe and simple way to balance your physical, mental and emotional states. It has been in practice for thousands of years. It has been shown to work particularly well for those experiencing stress. In fact, more and more doctors are prescribing meditation to cure many stress related illnesses including anxiety, trauma and insomnia.

Most people experience stress everyday. Be it at work or at home, there are situations that put us in fear or anxiety which triggers stress. It could be at the workplace where you are faced with something that you have never done before, or it could be at home if a emergency were to happen.

Stress is sometimes good because it causes one to take action to respond to the situation at hand. However, stress also happens during traffic jams, or when someone raises their voice or work is not done the way you like. If allowed to run its course, people could be in a continuous state of stress which is unhealthy.

Information on the medical health benefits of meditation shows that meditation releases stress from our bodies. Regular practice leads you to a deeper state of relaxation. Meditation is an excellent way to be relieved of stress and pressure and live a life that is peaceful, calm, relaxed and happy.

Stress is not the only problem that can be relieved through meditation. There are also sources of information on the medical health benefits of meditation, that say that it leads to reduction in pain, even in such cases like cancer and heart problems. It has been reported that people have even experienced improved eyesight as well as hearing.

Aside from the effects that meditation has on the body, it also positively effects the mind. Improvement in memory and intelligence are also reported in information on the medical health benefits of meditation. Increased concentration and awareness are a couple of other benefits.

It is the psychological effects that are quite significant. There is an increased feeling of identity and people demonstrate greater self reliance. People who meditate also have a stronger sense of self because of the positive experience that they feel.

They also show an increased empathy and therefore openness when dealing with other people. That is not all. They also better appreciate other people and the good things that they get in life. Often we see people who complain and grumble despite having a good life.

What is really nice is that your creativity improves through increased intuition and inspiration. Fear reduces.

In fact, there are also reductions in addictions and other bad habits as well as improvements in dealing with depression and hyperactivity.

Based on information on the medical health benefits of meditation, it is apparent that regular practice of meditation will help you feel much calmer and in control. You improve your ability to concentrate. Instead of being stressed, you can be more peaceful and relaxed. Just go with the flow of things and live and enjoy life.

Adding Fruit Health Benefits to Our Diet

Fruit Health Benefits

We’ve all known for a very long time that fruit is good for us, but the discussion on the exact fruit health benefits that we can expect are many times left unsaid when having discussions on subject. Think about it; we always urge our kids to eat more fruit because it’s good for them, but when they ask “why”, then we are often stumped when it comes to knowing the right answer.

Though the common understanding that fruit is good for us is something that is universally recognized, this does not mean we should not be knowledgeable about the specific benefits that we get from each serving of fruit we consume. Then when asked by someone exactly what the fruit health benefits are, we will know the answer.

So let’s take a look at this in greater detail. We’ve all known for quite a while that the most important advantage of eating more fruits is that they supply our bodies with the right kind of nutrients, including but not limited to, vitamins, minerals, antioxidants and more. This is not the total answer. The crucial bit of information that is often lacking is to know which specific fruits give which specific nutrients. If you can answer this question in detail, then you will be able to explain fruit health benefits to the younger generation so they better understand the reasons.

· Antioxidants. Some years back, antioxidants were not part of the discussion when one talked about fruit health benefits. Times have changed. Today, it is difficult to discuss health benefits from fruits without starting with the value that antioxidants bring in terms of promoting health via reduction of free radical damage. This is why it is very important to recognize some of the fruits that we often take for granted but are in fact very good sources of antioxidants and all the health benefits that they bring. The berry family of fruits dominates this category by the widest of margins. Among the fruits that are rich in antioxidants are blueberries, strawberries, cranberries, cherries, and some others include grapes, apples, and kiwi. Exotic fruits like the acai berry are also widely known to be a great source of antioxidants.

· Vitamins. Different fruits contain different types of vitamins which in turn lead to different fruit health benefits. Vitamin A is more predominant in fruits that are yellowish in color owing to its beta carotene content. This vitamin plays a big role in promoting healthy eyesight. Among the fruits with high vitamin A content are apricots and melons. Vitamin C is predominantly found in the citrus family which includes oranges, lemons, tangerines and pomelo. This vitamin is crucial for boosting immunity against common illnesses.

· Minerals. Much like vitamins, different fruits contain different types of minerals. Potassium, which is important for heart and muscle health, is commonly found in bananas. Iron, which is crucial for blood health, is abundant in tomatoes, apricots and olives.

The value of fruit health benefits remains to be an underrated component of our daily diets. For example, our current fruit consumption cannot compare to our appetite for meat. We are missing out on a lot of fruit health benefits because our diets do not take advantage of the value that fruits bring.

By being more informed about the healthy contents of fruit, we will then be able to take the next step of slowly but surely re-orienting our meals so that they truly benefit us. Fruit offers some of the best answers to many of our daily health questions. So, let’s start taking advantage of all of those wonderful fruit health benefits by adding them to our daily diet.