Preventive Care Made Easy

 

Many adults have postponed addressing their ongoing health concerns or annual screenings this past year due to the coronavirus pandemic. However, yearly screenings identify and reduce your risk for other diseases and certain chronic conditions. That’s why getting screened regularly is worth a lifetime of good health. 

It’s easy to lose track of the preventive services we need now, especially if you’re feeling healthy. However, staying on top of these services and understanding your health plan benefits will help you maintain or possibly improve your health.

The following tips can help you stay on track to manage your preventive health: 

1. Learn which screenings you need
Each year at your annual checkup, talk to your primary care provider (PCP) about any upcoming screenings you need based on your age, gender and health history. For example, common screenings for adults age 65 and older include cervical cancer, breast cancer, colorectal cancer and fasting blood sugar. Annual preventive dental and vision exams are also recommended and critical to your overall health. Resources like the Office of Disease Prevention and Health Promotion (ODPHP) offer online tools to help you identify screenings you may need based on your demographics. 

2. Confirm your health plan coverage
Ask your PCP if the services you need are preventive. For example, if you’re not experiencing any symptoms of a certain illness or following up on any previous care, preventive services with an in-network provider are often covered at no additional cost. That being said, always double check to make sure your health plan covers the services you are requesting. If you are a COSE MEWA member through Medical Mutual, confirm your coverage by logging onto My Health Plan, our secure member website, or by calling the Customer Care number listed on your member ID. 

3. Take charge of follow-up care
After your appointment, find out when you will receive your screening results. If your PCP doesn’t call you with the results, call their office and ask if the results are available. If you don’t understand the results, ask your PCP or nurse to explain them to you. Then, be sure to mark down when you’re due for your next screenings. You can set reminders on your phone or mark them down on a calendar. Staying on top of your preventive care makes all the difference in your health. 

4. Know that Telehealth appointments are an option
Telehealth, also known as telemedicine, has been gaining popularity with healthcare providers and patients alike. Telehealth appointments allow you to stay connected with your provider and obtain needed medical care through live video chats using a computer or mobile device. Although you won’t be able to have the same tests performed as you would in person, the doctor can still answer your questions and concerns and determine if you require further care. 

For more information, please talk to your doctor. If you are a COSE MEWA member through Medical Mutual, use our provider search tool to get started. To learn more about the benefits offered through a COSE MEWA health plan, please contact your broker or your Medical Mutual Sales representative. 


The material provided is for your information only. It does not take the place of your doctor’s advice, diagnosis or treatment. You should make decisions about your care with your doctor. What is covered by your health insurance will be based on your specific benefit plan.

Sources: American Public Health Association, the Office of Disease Prevention and Health Promotion

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  • Next up: Preventive Care Made Easy
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  • Preventive Care Made Easy

     

    Many adults have postponed addressing their ongoing health concerns or annual screenings this year due to quarantining during the coronavirus pandemic. Though it’s important to practice social distancing and enforce face mask use to protect from COVID-19, yearly screenings identify and reduce your risk for other diseases and certain chronic conditions. That’s why getting screened regularly is worth a lifetime of good health. 

    It’s easy to lose track of the preventive services we need now, especially if you’re feeling healthy. However, staying on top of these services and understanding your health plan benefits will help you maintain or possibly improve your health.

    The following tips can help you stay on track to manage your preventive health: 

    1. Learn which screenings you need

    Each year at your annual checkup, talk to your primary care provider (PCP) about any upcoming screenings you need based on your age, gender and health history. For example, common screenings for adults age 65 and older include cervical cancer, breast cancer, colorectal cancer and fasting blood sugar. Annual preventive dental and vision exams are also recommended and critical to your overall health. Resources like the Office of Disease Prevention and Health Promotion (ODPHP) offer online tools to help you identify screenings you may need based on your demographics. 

    2. Confirm your health plan coverage
    Ask your PCP if the services you need are preventive. For example, if you’re not experiencing any symptoms of a certain illness or following up on any previous care, preventive services with an in-network provider are often covered at no additional cost. That being said, always double check to make sure your health plan covers the services you are requesting. If you are a COSE MEWA member through Medical Mutual, confirm your coverage by logging onto My Health Plan, our secure member website, or by calling the Customer Care number listed on your member ID. 

    3. Take charge of follow-up care
    After your appointment, find out when you will receive your screening results. If your PCP doesn’t call you with the results, call their office and ask if the results are available. If you don’t understand the results, ask your PCP or nurse to explain them to you. Then, be sure to mark down when you’re due for your next screenings. You can set reminders on your phone or mark them down on a calendar. Staying on top of your preventive care makes all the difference in your health. 

    4. Know that Telehealth appointments are an option
    If you are still uneasy about being in a doctor’s office during this time, ask your PCP if you can conduct your appointment digitally. Telehealth, also known as telemedicine, has been gaining popularity with healthcare providers and patients alike. Telehealth appointments allow you to stay connected with your provider and obtain needed medical care through live video chats using a computer or mobile device. Although you won’t be able to have the same tests performed as you would in person, the doctor can still answer your questions and concerns and determine if you require further care.   

    For more information, please talk to your doctor. If you are a COSE MEWA member through Medical Mutual, use our provider search tool to get started. To learn more about the wellness benefits offered through a COSE MEWA health plan, please contact your broker or your Medical Mutual Sales representative. 


    Sources: American Public Health Association, the Office of Disease Prevention and Health Promotion

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  • Next up: The Pros and Cons of Drug Testing
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  • The Pros and Cons of Drug Testing

    Here's what you need to know about the possible effects various drug testing policies might have on your workplace.

    A plumbing company, a mechanist, and a landscaper are all down on their luck. It sounds like the beginning of an excellent “dad joke?” But these companies reported symptoms of a middling work force: lower productivity, increased accidents, absenteeism, and higher turnover. And, as it turns out, these symptoms are typical of a gap in workplace policy, namely a bad or non-existent drug testing policy.

    If you recall the article title, you may have already guessed that these companies were candidates to study the effects of drug testing in the workplace. The characteristics that plagued our participants are typical of underdeveloped company drug policies; they weren’t necessarily the “bad seeds,” but more of a cross-section of industries with various sized gaps in their drug programs.

    The results of this and other studies have been generally uniform in measuring drug testing’s effects on metrics like workplace happiness, safety, and profits and losses. Looking at the data for these and other companies, we can look at ways that certain drug testing policies might affect your company.

    The cost of not testing

    First, let’s discuss the price tag of not having a drug policy in place. The most common illicit substances and substance classes that employers test for include: amphetamines, opiates, barbiturates, cannabinoids (though nationwide cannabis reform is changing the discussion here), cocaine, benzodiazepine, and oxycodone. Generally speaking, chemical dependence on these substances has been linked to serious workplace accidents, missed work, loss of production, theft and turnover, as well as more pernicious problems such as poor decision making and lower co-worker morale.

    All these effects impact a company’s bottom line. From an employer’s perspective, risk of accidents translates to more workers’ compensation claims, higher insurance rates, and legal expenses. Absenteeism breeds turnover, compounding recruiting and training costs. All of this contributes to a negative public perception and can damage a company’s goodwill.

    So shouldn’t you drug test then? At first glance, there is much to be gained by drug testing of some sort, but …

    Not all testing is equal

    Not all drug testing is equally effective, nor indicative of the same risks. As a baseline, the Substance Abuse and Mental Health Services Administration (SAMHSA) sets drug testing procedural guidelines. Following these guidelines can make drug testing more cost effective and put you on firm legal footing. Beyond that, employers must decide when to test, as well as how often.

    As a rule, there are three types of drug testing: 1) pre-employment applicant testing, 2) for-cause employee testing, and 3) random testing. Each have their own benefits and drawbacks, and there is no reason why an employer can’t employ all three to varying degrees, with certain limitations.

    Pre-employment testing. One hospital study measured applicant drug test metrics. Those who tested positive for illicit drugs upon application had a 28% higher turnover rate and a 64% higher rate of disciplinary action against them. And yet, the study showed no correlation between pre-employment drug test results and job performance (meaning attendance and productivity).

    Despite the mixed results of pre-employment drug testing efficacy, this type of test is the most prevalent, likely because it’s the most obvious gatekeeping tool. But if job performance is your primary concern, pre-employment testing may not be the best option – or at least not something you should use in isolation for its low predictive ability to determine whether employees will be a negative for the company.

    For-cause testing. Justifications for cause-based testing include post-accident testing, determining fitness for a particular duty (especially safety-sensitive roles), and patterns of behavior that create a “reasonable suspicion” of drug abuse. For-cause testing seems to strike a fair balance between employer interests and worker freedom; however, it lacks the gatekeeping function of pre-employment testing and, as we shall see, also lacks benefits of randomized testing. It also can subject employers to liability risks for employment discrimination if they fail to accurately document the reasons for the test.

    Random testing. Here’s where things get interesting. The deterrent effect of a looming, random drug test is obvious, but lost in first impressions is this: the actual frequency of testing doesn’t affect the benefits of a random drug test policy. In one study, occupational groups who were randomly tested reported substantially lower accident rates than the untested groups, regardless of test frequency.

    So, it turns out you can reap the benefits of randomized drug testing without incurring the cost of frequent testing. The threat of a future random test appeared to have just as much positive effect as actually testing the employees.

    Interestingly, the study also found that the positive impact is stronger with white-collar professionals, as well as operations and technical workers. And in a meta study, ongoing random drug testing showed reduction in overall drug-positive results: from 13.6% of the workforce in 1988 to 4.4% in 2016.

    Random testing benefits are many, but random testing is also the most intrusive as it affects employee lifestyle outside of work.

    This begs the question: what do workers think of drug testing, randomized or otherwise? Does it affect workplace happiness and morale?

    A working-class hero

    Worker happiness may not be your bottom line, but it’s an extremely reliable indicator of conditions that do affect bottom line. Major characteristics of job satisfaction include: recognition of individual effort, quality and safety of physical environment, proper supervision, and connection with coworkers.

    These characteristics of high job satisfaction inversely relate to workplace symptoms associated with inefficient drug policies. Not surprisingly, then, studies have shown that employees are generally in favor of a fair drug testing policy. Those in safety-sensitive jobs prefer drug testing 95% of the time; healthcare workers, 92%; technical and mechanical workers, 81%; and even those in low safety-risk office positions support some form of drug testing 69% of the time.

    Gatekeeping against workers’ use of dangerous drugs has a significant effect on employee job satisfaction, which makes sense. Employees appreciate an environment that is safe and companionable, and an employer who works hard to maintain and improve upon the status quo.

    The Bottom Line

    Let’s return to our plumber, mechanist and landscaper. How did their testing (or lack of testing) affect their businesses? The measure there was the bottom line—and the reports were eye-opening.

    After standardizing drug testing, Jerry Morland’s landscaping company recorded an extra $50,000 per year in increased productivity. W.W. Gay Mechanical Contractors saved $100,000 on workers’ compensation premiums. Warner Plumbing saved $385,000 its first year because its work culture began to draw experienced, degreed mechanics, boosting productivity. In fact, Warner now has a waiting list for hires, saving it $20,000 a year in personnel advertising costs.

    As we’ve observed already, balance is key to a beneficial drug testing policy. From a strictly business sense, of course, return on investment must be considered. Alongside projected boosts in productivity, an employer should also consider the hard costs of testing. What methods of testing will you employ? How often? What types of drugs will you test for? More common drugs like cocaine and marijuana likely warrant screening—but what about some of those “fringe” substances that are rarer but may be more dangerous?

    It’s an exercise in number crunching and projections. But, with a bit of fine-tuning, there can be large margins to add to your bottom line in addition to the intangibles.

    State law and the ADA

    Although no federal or state law prohibits drug testing, a small number of states do have unique restrictions on the practice (Ohio not among them). Additionally, there may be drug testing requirements placed on private companies who secure government work.

    Finally, as always, you should have a good relationship with an employment attorney. Work with your attorney to familiarize yourself with employment law, particularly where drug testing affects hiring and firing decisions. Notably, under the Americans with Disabilities Act (ADA) individuals with a history of substance abuse may qualify as having a disability, so a change in employment status based on drug test results may be seen as discrimination.

    This article is meant to be utilized as a general guideline for drug testing of employees. Nothing in this blog is intended to create an attorney-client relationship or to provide legal advice on which you should rely without talking to your own retained attorney first.  If you have questions about your particular legal situation, you should contact a legal professional. Nick Weiss of The Gertsburg Law Firm can be reached at 440-528-1233 or nweiss@gertsburglaw.com.

    An audit of your policies can help you avoid the pain of lawsuits. The Gertsburg Law Firm now offers CoverMySix, a one-stop legal audit for your business, led by award-winning litigators and in-house counsel. CM6 minimizes your exposure to lawsuits, investigations, disgruntled employees and customers, and all the damage that comes with them. Learn more about how to protect your business from lawsuits at covermysix.com.

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  • Next up: Remember Your Health Insurance ABCs
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  • Remember Your Health Insurance ABCs

    Knowing how to manage your healthcare plan can save you and your business time and money. Whether you’re looking to join a COSE MEWA plan through Medical Mutual or have been a member for years, it is important to review your plan information periodically to make sure you are getting the most out of it. Here are a few tips to get you started.

    A – Amounts matter
    How much you pay for different services throughout the year can depend on what you’ve already spent in relation to your plan’s deductible and other key amounts. Here are some simple explanations for the amounts you typically need to know and how they work.

    Copay: These are the flat fees you pay each time you go to the doctor or fill a prescription. Copays do not count toward your deductible.
    Deductible: This is what you will pay per year for medical bills and prescriptions before your healthcare plan starts sharing the cost. Once you meet your deductible, your costs are determined by your plan’s coinsurance.
    Coinsurance: This is the set percentage of your medical expenses you will pay after you reach your deductible. You pay this percentage until you reach your plan’s out-of-pocket limit.
    Out-of-pocket limit: This is the limit for how much you will pay per year for services covered by your plan. Once you reach this limit, all covered services are paid by Medical Mutual at 100%.

    Remember, only services that are covered by your health plan will count toward these amounts.

    B – Browse your plan benefits 
    Before you have a service or procedure, be sure to review the benefits covered by your plan. There are two documents you can use to understand your benefits—your Summary of Benefits and Coverage (SBC) and your Medical Plan Description (MPD), which explain your plan’s costs, benefits, healthcare services and more.

    C – Compare costs
    Medical costs can vary based on several factors—like having the same test at a different location. Medical Mutual offers My Care Compare, an online tool to help you evaluate how different factors may affect costs for a wide range of medical services. It’s especially important when you need lab tests, which may be subject to your plan’s lab Coverage Maximum.

    D – Don’t go out of network
    Services performed by in-network healthcare providers usually cost significantly less than those that aren’t. In fact, some services may not be covered at all when you use a non-network provider. Always take the time to make sure your provider is in your network before you schedule a treatment or procedure.

    E – Engage online

    My Health Plan, Medical Mutual’s secure member website, helps you easily keep track of claims and deductible amounts. It's also where you can review your Explanation of Benefits (EOB) statements after you have services.

    If you are a COSE MEWA member through Medical Mutual, creating your My Health Plan account is simple. Just visit MedMutual.com/Member and click Register for an Account. To learn more about other benefits offered through a COSE MEWA health plan, please contact your broker or your Medical Mutual Sales representative. 

     
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  • Next up: Remember Your Health Insurance ABCs
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  • Remember Your Health Insurance ABCs

     

    Knowing how to manage your healthcare plan can save you and your business time and money. Whether you’re looking to join a COSE MEWA plan through Medical Mutual or have been a member for years, it is important to review your plan information periodically to make sure you are getting the most out of it. Here are a few tips to get you started.

    A – Amounts matter

    How much you pay for different services throughout the year can depend on what you’ve already spent in relation to your plan’s deductible and other key amounts. Here are some simple explanations for the amounts you typically need to know and how they work.

    • Copay: These are the flat fees you pay each time you go to the doctor or fill a prescription. Copays do not count toward your deductible.
    • Deductible: This is what you will pay per year for medical bills and prescriptions before your healthcare plan starts sharing the cost. Once you meet your deductible, your costs are determined by your plan’s coinsurance.
    • Coinsurance: This is the set percentage of your medical expenses you will pay after you reach your deductible. You pay this percentage until you reach your plan’s out-of-pocket limit.
    • Out-of-pocket limit: This is the limit for how much you will pay per year for services covered by your plan. Once you reach this limit, all covered services are paid by Medical Mutual at 100%.

    Remember, only services that are covered by your health plan will count toward these amounts.

    B – Browse your plan benefits

    Before you have a service or procedure, be sure to review the benefits covered by your plan. There are two documents you can use to understand your benefits—your Summary of Benefits and Coverage (SBC) and your Medical Plan Description (MPD), which explain your plan’s costs, benefits, healthcare services and more.

    C – Compare costs

    Medical costs can vary based on several factors—like having the same test at a different location. Medical Mutual offers My Care Compare, an online tool to help you evaluate how different factors may affect costs for a wide range of medical services. It’s especially important when you need lab tests, which may be subject to your plan’s lab Coverage Maximum.

    D – Don’t go out of network

    Services performed by in-network healthcare providers usually cost significantly less than those that aren’t. In fact, some services may not be covered at all when you use a non-network provider. Always take the time to make sure your provider is in your network before you schedule a treatment or procedure.

    E – Engage online

    My Health Plan, Medical Mutual’s secure member website, helps you easily keep track of claims and deductible amounts. It's also where you can review your Explanation of Benefits (EOB) statements after you have services.

    If you are a COSE MEWA member through Medical Mutual, creating your My Health Plan account is simple. Just visit MedMutual.com/Member and click Register for an Account. To learn more about other benefits offered through a COSE MEWA health plan, please contact your broker or your Medical Mutual Sales representative.

     

     

     

     

     

     

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  • Next up: Reporting for Reform - How to Comply with Upcoming IRS Reporting Requirements
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  • Reporting for Reform - How to Comply with Upcoming IRS Reporting Requirements

    As part of healthcare reform, the Internal Revenue Service (IRS) added sections 6055 and 6056 to the Internal Revenue Code. Starting in 2016, the IRS requires insurance companies to collect any missing Social Security numbers for members and dependents covered by fully insured health plans. “Typically, insurance carriers have only needed employees’ Social Security numbers, not those of spouses or dependent children,” says Patricia Decensi, General Counsel at Medical Mutual. “However, the IRS will soon require that information to verify that everyone in the United States is covered.” The information will be used to enforce the part of healthcare reform that says everyone in the United States has to have health insurance—or qualify for an exemption. In addition, it will allow the IRS to verify whether certain employers offer “minimum essential coverage” for their employees. The requirements are based on two key factors. 

    As part of healthcare reform, the Internal Revenue Service (IRS) added sections 6055 and 6056 to the Internal Revenue Code. Starting in 2016, the IRS requires insurance companies to collect any missing Social Security numbers for members and dependents covered by fully insured health plans.

    “Typically, insurance carriers have only needed employees’ Social Security numbers, not those of spouses or dependent children,” says Patricia Decensi, General Counsel at Medical Mutual. “However, the IRS will soon require that information to verify that everyone in the United States is covered.”

    The information will be used to enforce the part of healthcare reform that says everyone in the United States has to have health insurance—or qualify for an exemption. In addition, it will allow the IRS to verify whether certain employers offer “minimum essential coverage” for their employees.

    The requirements are based on two key factors.

    First is the funding structure of the health plan. Some employers are self-funded and pay their own claims, while others are fully insured through their carrier. The funding structure determines whether employers have to do their own reporting under Section 6055, the individual mandate.

    Second is the number of full-time employees. Section 6056, the employer pay or play rule, only applies to employers with 50 or more full-time employees. That includes full-time equivalents. Those employers will have to report to the IRS in early 2016 to prove they offer health coverage that complies with healthcare reform. And that applies even if they were exempt this year.

    “Fully insured employers can rely on their insurance carrier to report for them for 6055, and they will only need to report for 6056 if they are subject to pay or play,” Decensi says. “Self-funded employers, on the other hand, are responsible for all reporting to the IRS, regardless of pay or play.”

    All fully insured employers should work with their carrier to understand their responsibilities, according to Decensi. Insurance companies are obligated by law to reach out directly to employees if the required information is still missing. Plus, those employees or dependents could end up seeing money come out of their next year’s tax return if their coverage isn’t verified.

    Medical Mutual is planning to reach out to its fully insured customers, including those enrolled in COSE plans, to let them know who is missing Social Security numbers. Self-funded customers are encouraged to consult with their tax advisor or legal counsel.

    “Our goal is to comply with the new rules while keeping the impact on our members to a minimum,” says Decensi.

    COSE members with questions about the new requirements should contact their broker or call the COSE Benefits Group at (440) 878-5930. They should also watch for webinars from Medical Mutual later this fall about the actual forms and steps to take for reporting. 

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