Corrections or additions?
These articles were was prepared for the July 11, 2001
edition of U.S.
1 Newspaper. All rights reserved.
Hard Knocks of Healthcare
For some reason, we allow healthcare to defeat us. With
retirement benefits, we know that thorough study may mean the
between celebrating our golden years in a cliff-perched bungalow on
Aruba or a three-story walk-up in Queens. But when we hear the terms
HIPAA, ERISA, and of course, the Consolidated Omnibus Budget
Act of l985 – COBRA, employers and employees alike glaze over. It’s
all too much, and many give up even trying to keep abreast of the
Recent changes in COBRA and several related laws, however, have made
continual healthcare a friendlier system. On Tuesday, July 17, at
Philadelphia law firm of Morgan Lewis & Bockius, speaks on "COBRA
Clarifications" at a seminar sponsored by the Central Jersey
of the Worldwide Benefits Network at the New Jersey Hospital
at 760 Alexander Road. Cost: $40. Call 212-630-5278.
For the past 17 years, since the dawn of mandated continual
Hunter has been translating the alphabet soup of governmental dictates
into workable systems for individual companies. His talk will include
such current changes in claims procedures for ERISA,
benefit arrangements, and modifications of COBRA regulations.
says Hunter, "these new regulations concerning HIPAA, COBRA, and
ERISA have just twitched the system…streamlining it, making
times more urgent, but the fundamental mandates remain in place."
Here is rundown of continual healthcare programs, and an overview
of how each works to keep employees covered by health insurance as
they switch jobs or leave the workforce altogether.
Omnibus Budget Reconciliation Act, the goal was to afford an
the option of continuing his health benefits, temporarily at least,
despite loss of job, retirement, divorce, and several other
While this much of the law has filtered through to communal
many of the most important details still lurk in the darkness, leaving
great holes in what we may rosily picture as a seamless medical safety
First, not everyone qualifies. Firms with fewer than 20 employees
may claim a COBRA exemption. If an employer chooses to set up a group
healthcare policy, his workers are not covered under COBRA. Most
downsized or fired from firms that do offer healthcare insurance are
eligible, but those let go because of "gross misconduct" are
not. And if a firm goes bankrupt there remains no group to insure,
and employees are out of luck.
Second, COBRA stands only as a temporary, last resort. After
from the employer and his group policy, the employee has 60 days to
file for COBRA protection, and it typically lasts only 18 months (36
at most under certain conditions). While you have it, COBRA protection
broadly extends after termination, to you, your dependents and your
spouse; even if you retire or divorce or go on Medicare. But coverage
does not flow endlessly.
Finally, comes the cost. An employee’s contribution to the firm’s
healthcare insurance, even though it is risen lately in many
is usually a small percentage of his employer’s cost. Under COBRA,
the employee faces the severe sticker shock of the entire cost of
his group premium — – his old contribution plus his ex-employer’s
share. Add to that another two percent given to the employer for
and you’ve got a monthly bill that will probably render you ready
for the doctor forthwith. Says Hunter, "COBRA guarantees you the
right to coverage — it does not give you the right to cheap
To brush up on the COBRA basics before attending the seminar, go to
www.deferred.com/cobracoverage or vtvt.essortment.com/cobrainsurance.
typically associated with retirement benefits and thus the heavy IRS
regulatory hand in its administration. The goal of this bill is to
assure that the employee benefits plans are established and maintained
in a fair manner. The IRS doesn’t require or even suggest standards;
their concern is simply with a just administration of the plan. But
the employer’s healthcare programs may be very much involved.
Hunter points out that under ERISA’s new medical benefits claims
things have been greatly accelerated. For example, under the new
if an urgent-care claim request is received incomplete, the
employer has only 24 hours to inform the claimant and another 72 hours
to decide if the claim is valid or not. Those seeking the specific
retirements and benefits plan for any United States employer, can
find it by visiting the home page of www.erisa.com
the Health Insurance and Accountability Act of 1996 was designed to
boost accessibility to healthcare. Basically, it reaffirms and
the COBRA continuity law, allowing the individual to pick up at his
own cost the insurance from his group plan. The nice addition here
is that it is not strictly temporary. Once your 18 month COBRA limit
is finished, you have the right to pick up an individual policy with
the same insurer. And the insurance company must take you on as a
customer. But if you thought 100 percent of your old group rate was
high, wait until you get hit with that first individual premium.
While workers moving from company to company may gasp at healthcare
premiums they pay on the individual policies to which they are
under HIPAA, employers have found plenty to grumble about too. Within
the regulations are what its authors call "totally sweeping reform
of medical and financial recording." The aim was patient’s rights:
giving the patient easy access to her own files, while not opening
them to the prying eyes of others. To achieve this, HIPAA has set
up standardized electronic recording methods, anti-fraud devices,
and a host of privacy guards. This makes the employer, as one
with individual medical records, an upholder of ever-changing
rights and subject to high fines if this privacy is violated.
Hunter states that while it may be possible for a firm’s current human
resources personnel to handle all the new and advancing healthcare
regulations, outsourcing may prove a simpler, even more economical
— Bart Jackson
Township to help purchase the Carson Road Woods. This, the largest
corporate donation the township has ever received, will help set aside
187 acres along Carter and Province Line roads for open space. Valued
at $8.4 million, the property was targeted for sale to housing
and $3 million is the fundraising goal for private donations.
"The Carson Road Woods is a treasure that should be
Squibb, "so we’re very pleased to be able to assist in this
in open space."
"Bristol-Myers Squibb is a great neighbor and friend to Lawrence
Township residents," says Pamela Mount, township mayor. "The
corporation’s philanthropy has helped the township launch many
from tree planting to public safety grants to today’s generous gift
of funds to purchase land for open space."
Trenton Central High School has teamed up with Rider
University’s Minding Our Business summer program to help develop the
entrepreneurial skills of Trenton area teenagers. In a program made
possible by a grant from
at projects to include marketing wares at flea markets at the Martin
Luther King Middle School. Goals include strengthening team, and
skills, elevating academic performance, increasing interest in
college, and building self-esteem. Members of the Metropolitan Trenton
African American Chamber of Commerce will mentor each of the
on June 23 were
Sales & Logistics Company in New Brunswick, and
at Alexander Park.
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