This is an interesting article from the Miami Herald on a possible/probable cause for high prescription prices.
http://www.miamiherald.com/business/story/849177-p2.html
Wednesday, January 14, 2009
Monday, January 12, 2009
CMS requirements
Employers, health carriers, and their health insurance brokers are busy during a usual quiet time due to the government requiring dependent SSN's on all covered employee's. Extra requirements mean extra costs.
Tuesday, January 6, 2009
Benefits Solutions
Benefits Solutions to Health Insurance Dilemma
by J. Keith Johnson
Benefits Representative- Olathe, KS
Colonial Life
Rapidly rising health care costs and the plight of the uninsured have reached the status of nearly daily mention in most news media. As health care costs continue to increase, many businesses are moving toward high-deductible major medical plans in an effort to better manage benefits program costs. Yet this approach can put employees at greater financial risk, forcing them to pay the expanding difference between what their health insurance covers and what their medical care costs. In addition, premiums for employer-sponsored health insurance have been rising four times faster on average than workers’ earnings since 2000.1
While that’s bad enough news for workers with health insurance, it’s a potential disaster for those who don’t have health coverage to help buffer these costs. A recent Census Bureau report estimated 47 million Americans have no health coverage.2 Still more worrisome is the fact that most uninsureds belong to a family with at least one working member. 3
The good news is employers have access to two solutions to meet this health coverage dilemma:
§ A voluntary supplemental health insurance plan can help fill gaps in coverage under a high-deductible major medical plan, such as increased deductibles and out-of-pocket maximums.
§ A group limited benefit hospital confinement indemnity insurance plan for employees who don’t have access to major medical insurance through their workplace or their spouse’s workplace.
Voluntary Supplemental Health Insurance
With voluntary supplemental health insurance, businesses can offer their employees a solution to help fill coverage gaps and protect employees against increasing out-of-pocket expenses. These products typically pay lump-sum benefits for medical expenses resulting from inpatient hospitalization and rehabilitation unit or outpatient services, diagnostic testing, doctor’s office visits and wellness checkups. For example, an employee who has to go into the hospital may have to pay a $1,500 deductible before health insurance kicks in — money the employee has to pay up front. With voluntary supplemental health insurance, the employee would receive a lump-sum benefit payment for the inpatient confinement and could use it to help pay for the deductible.
Group Limited Benefit Hospital Confinement Indemnity Insurance
This type of insurance is a group product that provides benefits to help insureds pay many routine, noncatastrophic health care expenses. It’s not major medical coverage, and it isn’t a replacement for major medical coverage. Offered through the workplace at group rates, this plan can meet the need for affordable, limited and clearly defined health benefits for full-time and part-time workers who don’t have access to major medical insurance and need some coverage for basic, routine medical expenses. Coverage is available for:
Doctor’s office visits
Outpatient diagnostic and lab tests
Inpatient hospital stays
Surgery
Prescription drugs
With either plan, benefits communication plays a critical role in successful implementation. Consistent, clear communication through group and one-on-one meetings with employees helps ensure they understand what their plan covers and what it doesn’t. This leads to much greater satisfaction with the benefits plan. A quality voluntary benefits provider can deliver this service at no direct charge to the employer.
Rising health care costs and the resulting plight of the working uninsured are not likely to go away anytime soon. But innovative products like voluntary supplemental health insurance and group limited benefit hospital confinement indemnity insurance provide workable solutions for the health care cost issue.
About the Author
J. Keith Johnson is an agent for Colonial Life. A veteran of more than six years in the insurance and benefits industry, Mr. Johnson is responsible for marketing Colonial Life’s products, programs and services in the Kansas/Missouri area.
Colonial Life & Accident Insurance Company is a market leader in providing insurance benefits for employees and their families through their workplace, along with individual benefits education, advanced yet simple-to-use enrollment technology and quality personal service. Colonial Life offers disability, life and supplemental accident and health insurance policies in 49 states, the District of Columbia and Puerto Rico. Similar policies, if approved, are underwritten in New York by a Colonial Life affiliate, The Paul Revere Life Insurance Company. Colonial Life is based in Columbia, S.C., and is a subsidiary of Unum Group.
For more information about Colonial Life’s products and services or opportunities with the company, call J. Keith Johnson 913-205-6396 or visit www.coloniallife.com.
# # #
1 The Henry J. Kaiser Family Foundation, 2006 Employee Health Benefit Survey, September 26, 2006.
2 U.S. Census Bureau report, Aug. 28, 2007.
3 California Health Care Foundation, 2005.
4 “Growth Potential of Small Business Markets,” LIMRA, 2006.
5 “Statistics of U.S. Business,” U.S. Census Bureau, 2004.
by J. Keith Johnson
Benefits Representative- Olathe, KS
Colonial Life
Rapidly rising health care costs and the plight of the uninsured have reached the status of nearly daily mention in most news media. As health care costs continue to increase, many businesses are moving toward high-deductible major medical plans in an effort to better manage benefits program costs. Yet this approach can put employees at greater financial risk, forcing them to pay the expanding difference between what their health insurance covers and what their medical care costs. In addition, premiums for employer-sponsored health insurance have been rising four times faster on average than workers’ earnings since 2000.1
While that’s bad enough news for workers with health insurance, it’s a potential disaster for those who don’t have health coverage to help buffer these costs. A recent Census Bureau report estimated 47 million Americans have no health coverage.2 Still more worrisome is the fact that most uninsureds belong to a family with at least one working member. 3
The good news is employers have access to two solutions to meet this health coverage dilemma:
§ A voluntary supplemental health insurance plan can help fill gaps in coverage under a high-deductible major medical plan, such as increased deductibles and out-of-pocket maximums.
§ A group limited benefit hospital confinement indemnity insurance plan for employees who don’t have access to major medical insurance through their workplace or their spouse’s workplace.
Voluntary Supplemental Health Insurance
With voluntary supplemental health insurance, businesses can offer their employees a solution to help fill coverage gaps and protect employees against increasing out-of-pocket expenses. These products typically pay lump-sum benefits for medical expenses resulting from inpatient hospitalization and rehabilitation unit or outpatient services, diagnostic testing, doctor’s office visits and wellness checkups. For example, an employee who has to go into the hospital may have to pay a $1,500 deductible before health insurance kicks in — money the employee has to pay up front. With voluntary supplemental health insurance, the employee would receive a lump-sum benefit payment for the inpatient confinement and could use it to help pay for the deductible.
Group Limited Benefit Hospital Confinement Indemnity Insurance
This type of insurance is a group product that provides benefits to help insureds pay many routine, noncatastrophic health care expenses. It’s not major medical coverage, and it isn’t a replacement for major medical coverage. Offered through the workplace at group rates, this plan can meet the need for affordable, limited and clearly defined health benefits for full-time and part-time workers who don’t have access to major medical insurance and need some coverage for basic, routine medical expenses. Coverage is available for:
Doctor’s office visits
Outpatient diagnostic and lab tests
Inpatient hospital stays
Surgery
Prescription drugs
With either plan, benefits communication plays a critical role in successful implementation. Consistent, clear communication through group and one-on-one meetings with employees helps ensure they understand what their plan covers and what it doesn’t. This leads to much greater satisfaction with the benefits plan. A quality voluntary benefits provider can deliver this service at no direct charge to the employer.
Rising health care costs and the resulting plight of the working uninsured are not likely to go away anytime soon. But innovative products like voluntary supplemental health insurance and group limited benefit hospital confinement indemnity insurance provide workable solutions for the health care cost issue.
About the Author
J. Keith Johnson is an agent for Colonial Life. A veteran of more than six years in the insurance and benefits industry, Mr. Johnson is responsible for marketing Colonial Life’s products, programs and services in the Kansas/Missouri area.
Colonial Life & Accident Insurance Company is a market leader in providing insurance benefits for employees and their families through their workplace, along with individual benefits education, advanced yet simple-to-use enrollment technology and quality personal service. Colonial Life offers disability, life and supplemental accident and health insurance policies in 49 states, the District of Columbia and Puerto Rico. Similar policies, if approved, are underwritten in New York by a Colonial Life affiliate, The Paul Revere Life Insurance Company. Colonial Life is based in Columbia, S.C., and is a subsidiary of Unum Group.
For more information about Colonial Life’s products and services or opportunities with the company, call J. Keith Johnson 913-205-6396 or visit www.coloniallife.com.
# # #
1 The Henry J. Kaiser Family Foundation, 2006 Employee Health Benefit Survey, September 26, 2006.
2 U.S. Census Bureau report, Aug. 28, 2007.
3 California Health Care Foundation, 2005.
4 “Growth Potential of Small Business Markets,” LIMRA, 2006.
5 “Statistics of U.S. Business,” U.S. Census Bureau, 2004.
Saturday, December 6, 2008
Communication will solve the health care crisis.
As my wife is fond of saying to me, "communication is key".
One of the main reasons we find ourselves in the state we're in is because people do not understand insurance products, especially health insurance products. If we had automobile insurance built in a similar fashion to health insurance, no one could afford to own a car, much less drive one.
Imagine getting a starter or muffler installed for a $20 copay. Need a transmission or engine overhaul? As long as you were in your automotive repair network, you get 80/20 coinsurance until your deductible is met. Have existing accident damage? As long as you can get in an employer group where the carrier has to accept you, you get your car fixed. No matter that you weren't part of the original underwriting, Everyone helps pay your expenses. After all, isn't that what America is all about?
Now I know this sounds ridiculous, but no more ridiculous than for people to expect healthcare delivered this way for little or no cost.
The American public needs an education. I'm afraid it will come at the expense of the healthcare/insurance industry collapsing. No one knows what procedures cost, where they can get cost effective care, care provider success/mortality rates, what insurance carriers pay claims best, and how money works within the system.
HDHP/HSA's are a great first step because a policyholders self interest requires that they ask these questions. At this time they cannot get all the answers, but more and more light is being shed on the situation.
As agents that have our clients best interests at heart, we must continue to fight the good fight. If we continue to promote, communicate, and educate, we know that understanding will provide a sensible answer.
One of the main reasons we find ourselves in the state we're in is because people do not understand insurance products, especially health insurance products. If we had automobile insurance built in a similar fashion to health insurance, no one could afford to own a car, much less drive one.
Imagine getting a starter or muffler installed for a $20 copay. Need a transmission or engine overhaul? As long as you were in your automotive repair network, you get 80/20 coinsurance until your deductible is met. Have existing accident damage? As long as you can get in an employer group where the carrier has to accept you, you get your car fixed. No matter that you weren't part of the original underwriting, Everyone helps pay your expenses. After all, isn't that what America is all about?
Now I know this sounds ridiculous, but no more ridiculous than for people to expect healthcare delivered this way for little or no cost.
The American public needs an education. I'm afraid it will come at the expense of the healthcare/insurance industry collapsing. No one knows what procedures cost, where they can get cost effective care, care provider success/mortality rates, what insurance carriers pay claims best, and how money works within the system.
HDHP/HSA's are a great first step because a policyholders self interest requires that they ask these questions. At this time they cannot get all the answers, but more and more light is being shed on the situation.
As agents that have our clients best interests at heart, we must continue to fight the good fight. If we continue to promote, communicate, and educate, we know that understanding will provide a sensible answer.
Wednesday, December 3, 2008
Government now requires SSN on dependents
Office of Financial Management/Financial Services Group
DATE: June 23, 2008
SUBJECT: Collection of Social Security Numbers (SSNs), Medicare Health Insurance Claim Numbers
(HICNs) and Employer Identification Numbers (EINs) (Tax Identification Numbers) –
ALERT
This ALERT is to advise that collection of SSNs, HICNs, or EINs for purposes of compliance with the reporting requirements under Section 111 of Public Law 100-173 is appropriate.
SSNs and EINs:
The SSN is used as the basis for the Medicare HICN. The Medicare program uses the HICN to identify Medicare beneficiaries receiving health care services, and to otherwise meet its administrative responsibilities to pay for health care and operate the Medicare program. In performance of these duties, Medicare is required to protect individual privacy and confidentiality in accordance with applicable laws, including the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act Privacy Rule. Please note that The Centers for Medicare & Medicaid Services (CMS) has a longstanding practice of requesting SSNs or HICNs for coordination of benefit purposes.
The EIN is the standard unique employer identifier. It appears on the employee’s federal Internal Revenue Service Form W-2, Wage and Tax Statement received from their employer. The Medicare program uses the EIN to identify businesses. The establishment of a standard for a unique employer identifier was published in the May 31, 2002 Federal register, with a compliance date of July 30, 2004.
A new Mandatory Insurer Reporting Law (Section 111 of Public Law 110-173) requires group health plan insurers, third party administrators, and plan administrators or fiduciaries of self-insured/selfadministered group health plans to report, as directed by the Secretary of the Department of Health and Human Services, information that the Secretary requires for purposes of coordination of benefits. The law also imposes this same requirement on liability insurers (including self-insurers), no-fault insurers and workers’ compensation laws or plans. Two key elements that will be required to be reported are SSNs (or HICNs) and EINs. In order for Medicare to properly coordinate Medicare payments with other insurance and/or workers’ compensation benefits, Medicare relies on the collection of both the SSN or HICN and the EIN, as applicable.
As a subscriber (or spouse or family member of a subscriber) to a group health plan arrangement, your SSN and/or HICN will likely be requested in order to meet the requirements of P.L. 110-173 if this information is not already on file with your insurer. Similarly, individuals who receive ongoing reimbursement for medical care through no-fault insurance or workers’ compensation or who receive a settlement, judgment or award from liability insurance (including self-insurance), no-fault insurance, or workers’ compensation will be asked to furnish information concerning their SSN and/or HICN and whether or not they (or the injured party, if the settlement, judgment or award is based upon an injury to someone else) are Medicare beneficiaries. Employers, insurers, third party administrators, etc. will be asked for EINs.
To confirm that this ALERT is an official Government document and for further information on the mandatory reporting requirements under this law, please visit the CMS website at www.cms.hhs.gov/MandatoryInsRep.
MMSEA111AlertSSNandHICNandEINcollection062308final
DATE: June 23, 2008
SUBJECT: Collection of Social Security Numbers (SSNs), Medicare Health Insurance Claim Numbers
(HICNs) and Employer Identification Numbers (EINs) (Tax Identification Numbers) –
ALERT
This ALERT is to advise that collection of SSNs, HICNs, or EINs for purposes of compliance with the reporting requirements under Section 111 of Public Law 100-173 is appropriate.
SSNs and EINs:
The SSN is used as the basis for the Medicare HICN. The Medicare program uses the HICN to identify Medicare beneficiaries receiving health care services, and to otherwise meet its administrative responsibilities to pay for health care and operate the Medicare program. In performance of these duties, Medicare is required to protect individual privacy and confidentiality in accordance with applicable laws, including the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act Privacy Rule. Please note that The Centers for Medicare & Medicaid Services (CMS) has a longstanding practice of requesting SSNs or HICNs for coordination of benefit purposes.
The EIN is the standard unique employer identifier. It appears on the employee’s federal Internal Revenue Service Form W-2, Wage and Tax Statement received from their employer. The Medicare program uses the EIN to identify businesses. The establishment of a standard for a unique employer identifier was published in the May 31, 2002 Federal register, with a compliance date of July 30, 2004.
A new Mandatory Insurer Reporting Law (Section 111 of Public Law 110-173) requires group health plan insurers, third party administrators, and plan administrators or fiduciaries of self-insured/selfadministered group health plans to report, as directed by the Secretary of the Department of Health and Human Services, information that the Secretary requires for purposes of coordination of benefits. The law also imposes this same requirement on liability insurers (including self-insurers), no-fault insurers and workers’ compensation laws or plans. Two key elements that will be required to be reported are SSNs (or HICNs) and EINs. In order for Medicare to properly coordinate Medicare payments with other insurance and/or workers’ compensation benefits, Medicare relies on the collection of both the SSN or HICN and the EIN, as applicable.
As a subscriber (or spouse or family member of a subscriber) to a group health plan arrangement, your SSN and/or HICN will likely be requested in order to meet the requirements of P.L. 110-173 if this information is not already on file with your insurer. Similarly, individuals who receive ongoing reimbursement for medical care through no-fault insurance or workers’ compensation or who receive a settlement, judgment or award from liability insurance (including self-insurance), no-fault insurance, or workers’ compensation will be asked to furnish information concerning their SSN and/or HICN and whether or not they (or the injured party, if the settlement, judgment or award is based upon an injury to someone else) are Medicare beneficiaries. Employers, insurers, third party administrators, etc. will be asked for EINs.
To confirm that this ALERT is an official Government document and for further information on the mandatory reporting requirements under this law, please visit the CMS website at www.cms.hhs.gov/MandatoryInsRep.
MMSEA111AlertSSNandHICNandEINcollection062308final
Monday, December 1, 2008
Wall Street Journal article, Beware the pitfalls of early retirement.
Almost everyone fantasizes about swapping the cubicle and BlackBerry for a life of leisure while they're young enough to enjoy it.
Millions work long hours to make the fantasy a reality, and in these rough economic times, others have simply taken buyouts. But America's patchwork health-care system is making those transitions harder.
Too young to qualify for Medicare and rarely covered by employers, early retirees can face premiums they never dreamed of -- triple or more what they paid while working.
And that's for the healthy ones. Others, who suffer from middle-age ailments like arthritis or back pain, wind up paying far more -- if they aren't simply rejected. Researchers at the Commonwealth Fund found that in 2007 about 35% of people between the ages of 50 and 64 were uninsured or underinsured, up from 26% five years ago.
Bought Out, Left Out
In the decades after World War II, most retirees could count on generous health perks. But over the past two decades, the situation has changed. Today, just 29% of large private companies provide insurance to younger retirees, according to the Kaiser Family Foundation. This spring, the Society for Human Resource Management found that less than half of workers laid off or bought out were offered health benefits.
That leaves many younger retirees with only one place to go: the individual-insurance market, which is hardly friendly terrain for fiftysomethings.
Unlike in employer plans, where all members pay similar premiums, here each consumer gets examined for risk. Insurers often react to minor pre-existing health conditions the way an auto insurer reacts to accidents -- by charging steep rates or rejecting the applicant.
Health-care advocates have documented instances of older people being denied coverage because of high blood pressure or mild depression after the death of a spouse. "I used to joke that just living past 45 was a pre-existing condition," says Anthony Wright, executive director of the advocacy group Health Access California.
Higher Age, Higher Risk
Insurance executives defend underwriting practices as necessary to keep up with the costs of care, pointing out that age makes customers riskier to insure. "It's not like we're running a pirate ship," says Richard Collins, president of UnitedHealthcare's individual-insurance unit.
Although states prohibit insurers from dropping consumers who develop health problems after enrollment, they do let insurers purge those who allegedly commit fraud on applications -- leading some companies to comb patients' medical records for signs they should have known a problem was looming.
Fortunately, some younger retirees tame the frontier. Holding on to group coverage helps: Retirees willing to work self-employed can get group rates in 13 states.
For those with health issues who must use the individual market, Carolyn McClanahan, a financial planner in Jacksonville, Fla., recommends applying for a special insurance pool that each state holds open to consumers for the 36 days after they exhaust their COBRA coverage -- while benefits there can be spotty, the pools can't reject anyone.
Early retirees also can boost their underwriting odds by losing belly fat and going over their medical records with physicians for errors.
Email: letters@smartmoney.com
Copyright 2008 Dow Jones & Company, Inc. All Rights Reserved
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit
www.djreprints.com
Millions work long hours to make the fantasy a reality, and in these rough economic times, others have simply taken buyouts. But America's patchwork health-care system is making those transitions harder.
Too young to qualify for Medicare and rarely covered by employers, early retirees can face premiums they never dreamed of -- triple or more what they paid while working.
And that's for the healthy ones. Others, who suffer from middle-age ailments like arthritis or back pain, wind up paying far more -- if they aren't simply rejected. Researchers at the Commonwealth Fund found that in 2007 about 35% of people between the ages of 50 and 64 were uninsured or underinsured, up from 26% five years ago.
Bought Out, Left Out
In the decades after World War II, most retirees could count on generous health perks. But over the past two decades, the situation has changed. Today, just 29% of large private companies provide insurance to younger retirees, according to the Kaiser Family Foundation. This spring, the Society for Human Resource Management found that less than half of workers laid off or bought out were offered health benefits.
That leaves many younger retirees with only one place to go: the individual-insurance market, which is hardly friendly terrain for fiftysomethings.
Unlike in employer plans, where all members pay similar premiums, here each consumer gets examined for risk. Insurers often react to minor pre-existing health conditions the way an auto insurer reacts to accidents -- by charging steep rates or rejecting the applicant.
Health-care advocates have documented instances of older people being denied coverage because of high blood pressure or mild depression after the death of a spouse. "I used to joke that just living past 45 was a pre-existing condition," says Anthony Wright, executive director of the advocacy group Health Access California.
Higher Age, Higher Risk
Insurance executives defend underwriting practices as necessary to keep up with the costs of care, pointing out that age makes customers riskier to insure. "It's not like we're running a pirate ship," says Richard Collins, president of UnitedHealthcare's individual-insurance unit.
Although states prohibit insurers from dropping consumers who develop health problems after enrollment, they do let insurers purge those who allegedly commit fraud on applications -- leading some companies to comb patients' medical records for signs they should have known a problem was looming.
Fortunately, some younger retirees tame the frontier. Holding on to group coverage helps: Retirees willing to work self-employed can get group rates in 13 states.
For those with health issues who must use the individual market, Carolyn McClanahan, a financial planner in Jacksonville, Fla., recommends applying for a special insurance pool that each state holds open to consumers for the 36 days after they exhaust their COBRA coverage -- while benefits there can be spotty, the pools can't reject anyone.
Early retirees also can boost their underwriting odds by losing belly fat and going over their medical records with physicians for errors.
Email: letters@smartmoney.com
Copyright 2008 Dow Jones & Company, Inc. All Rights Reserved
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit
www.djreprints.com
Tuesday, November 25, 2008
Family Medical Leave Act, Final Rule
ESA News Release: [11/14/2008]Contact Name: David James or Dolline Hatchett Phone Number: (202) 693-4676 Release Number: 08-1703-NAT
Final rule brings two-year public process to close with common sense reforms for modern workforce
WASHINGTON - The U.S. Department of Labor will publish a final rule on Nov. 17 to update its regulations under the 15-year-old Family and Medical Leave Act (FMLA) - a measure that will help workers and their employers better understand their rights and responsibilities, and speed the implementation of a new law that expands FMLA coverage for military family members.
"This final rule, for the first time, gives America's military families special job-protected leave rights to care for brave service men and women who are wounded or injured, and also helps families of members of the National Guard and Reserves manage their affairs when their service member is called up for active duty," said U.S. Secretary of Labor Elaine L. Chao. "At the same time, the final rule provides needed clarity about general FMLA rights and obligations for both workers and employers."
"This common sense, balanced rule is the product of a two year-long transparent process involving about 20,000 public comments and reflects the careful consideration of the views of FMLA's stakeholders," said Victoria A. Lipnic, assistant secretary for the Labor Department's Employment Standards Administration.
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 rule also contains technical changes that reflect decisions by the U.S. Supreme Court and lower courts.
Featured final rule actions implementing the statutory expansion of FMLA for military families:
Military Caregiver Leave: Implements the requirement to expand FMLA protections for family members caring for a covered service member with a serious injury or illness incurred in the line of duty on active duty. These family members are able to take up to 26 workweeks of leave in a 12-month period.
Leave for Qualifying Exigencies for Families of National Guard and Reserves: The law allows families of National Guard and Reserve personnel on active duty to take FMLA job-protected leave to manage their affairs - "qualifying exigencies." The rule defines "qualifying exigencies" as: (1) short-notice deployment (2) military events and related activities (3) childcare and school activities (4) financial and legal arrangements (5) counseling (6) rest and recuperation (7) post-deployment activities and (8) additional activities where the employer and employee agree to the leave.
ADDITIONAL REGULATORY PROVISIONS:
The Ragsdale Decision/Penalties: The updated rule contains technical changes to be consistent with the U.S. Supreme Court's decision in Ragsdale v. Wolverine World Wide Inc. The court ruled that the regulation's so-called "categorical" penalty (requiring an employer to provide 12 additional weeks of FMLA-protected leave after the employee had already taken 30 weeks of leave) was inconsistent with the statutory limit of only 12 weeks of FMLA leave and contrary to the law's remedial requirement that an employee demonstrate individual harm. The new rule removes these penalties and clarifies that if an employee suffers individual harm because the employer did not follow the notification rules, the employer may be liable.
Waiver of Rights: The department has finalized its longstanding position that employees may voluntarily settle their FMLA claims without court or departmental approval. However, prospective waivers of FMLA rights will continue to be prohibited.
Serious Health Condition: While the rule retains the six individual definitions of "serious health condition," it adds guidance on some regulatory matters. First, it clarifies that if an employee is taking leave involving more than three consecutive calendar days of incapacity plus two visits to a health care provider, the two visits must occur within 30 days of the period of incapacity. Second, it defines "periodic visits to a health care provider" for chronic serious health conditions as at least two visits to a health care provider per year.
Light Duty: At least two courts have held that an employee uses up his or her 12-week FMLA leave while on a "light duty" assignment. Under the final rule, time spent in "light duty" work does not count against an employee's FMLA leave entitlement, and the employee's right to job restoration is held in abeyance during the light duty period. If an employee is voluntarily doing light duty work, he or she is not on FMLA leave.
Perfect Attendance Awards: The final rule changes how perfect attendance awards are treated to allow employers to deny a "perfect attendance" award to an employee who does not have perfect attendance because he or she took FMLA leave - but only if the employer treats employees taking non-FMLA leave in an identical way.
Employer Notice Obligations: The final rule consolidates all employer notice requirements into a "one-stop" section of the regulations to clear up some conflicting provisions and time periods. Further, the final rule clarifies and strengthens the employer notice requirements to employees in order that employers will better inform employees about their FMLA rights and obligations, and allow for a smoother exchange of information between employers and employees.
Employee Notice: The final rule modifies the current provision that had been interpreted to allow some employees to notify their employers of their need for FMLA leave up to two full business days after an absence, even if they could provide notice sooner. Under the final rule, the employee must follow the employer's normal and customary call-in procedures, unless there are unusual circumstances.
Medical Certification Process (Content and Clarification): The final rule, which is the result of significant stakeholder feedback (including a September 2007 meeting at the department on "medical certifications"), recognizes the advent of the Health Insurance Portability and Accountability Act (HIPAA) and the applicability of HIPAA's medical privacy rule to communications between employers and employees' health care providers. Responding to concerns about medical privacy, the rule adds a requirement that limits who may contact the health care provider and bans an employee's direct supervisor from making the contact.
The public can view the entire text of the final rule as it will appear in the Federal Register at: http://www.federalregister.gov/page2.aspx#reg_W.
For further information about the FMLA and the proposed regulations, visit the Wage and Hour Division's Web site at www.wagehour.dol.gov
Final rule brings two-year public process to close with common sense reforms for modern workforce
WASHINGTON - The U.S. Department of Labor will publish a final rule on Nov. 17 to update its regulations under the 15-year-old Family and Medical Leave Act (FMLA) - a measure that will help workers and their employers better understand their rights and responsibilities, and speed the implementation of a new law that expands FMLA coverage for military family members.
"This final rule, for the first time, gives America's military families special job-protected leave rights to care for brave service men and women who are wounded or injured, and also helps families of members of the National Guard and Reserves manage their affairs when their service member is called up for active duty," said U.S. Secretary of Labor Elaine L. Chao. "At the same time, the final rule provides needed clarity about general FMLA rights and obligations for both workers and employers."
"This common sense, balanced rule is the product of a two year-long transparent process involving about 20,000 public comments and reflects the careful consideration of the views of FMLA's stakeholders," said Victoria A. Lipnic, assistant secretary for the Labor Department's Employment Standards Administration.
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 rule also contains technical changes that reflect decisions by the U.S. Supreme Court and lower courts.
Featured final rule actions implementing the statutory expansion of FMLA for military families:
Military Caregiver Leave: Implements the requirement to expand FMLA protections for family members caring for a covered service member with a serious injury or illness incurred in the line of duty on active duty. These family members are able to take up to 26 workweeks of leave in a 12-month period.
Leave for Qualifying Exigencies for Families of National Guard and Reserves: The law allows families of National Guard and Reserve personnel on active duty to take FMLA job-protected leave to manage their affairs - "qualifying exigencies." The rule defines "qualifying exigencies" as: (1) short-notice deployment (2) military events and related activities (3) childcare and school activities (4) financial and legal arrangements (5) counseling (6) rest and recuperation (7) post-deployment activities and (8) additional activities where the employer and employee agree to the leave.
ADDITIONAL REGULATORY PROVISIONS:
The Ragsdale Decision/Penalties: The updated rule contains technical changes to be consistent with the U.S. Supreme Court's decision in Ragsdale v. Wolverine World Wide Inc. The court ruled that the regulation's so-called "categorical" penalty (requiring an employer to provide 12 additional weeks of FMLA-protected leave after the employee had already taken 30 weeks of leave) was inconsistent with the statutory limit of only 12 weeks of FMLA leave and contrary to the law's remedial requirement that an employee demonstrate individual harm. The new rule removes these penalties and clarifies that if an employee suffers individual harm because the employer did not follow the notification rules, the employer may be liable.
Waiver of Rights: The department has finalized its longstanding position that employees may voluntarily settle their FMLA claims without court or departmental approval. However, prospective waivers of FMLA rights will continue to be prohibited.
Serious Health Condition: While the rule retains the six individual definitions of "serious health condition," it adds guidance on some regulatory matters. First, it clarifies that if an employee is taking leave involving more than three consecutive calendar days of incapacity plus two visits to a health care provider, the two visits must occur within 30 days of the period of incapacity. Second, it defines "periodic visits to a health care provider" for chronic serious health conditions as at least two visits to a health care provider per year.
Light Duty: At least two courts have held that an employee uses up his or her 12-week FMLA leave while on a "light duty" assignment. Under the final rule, time spent in "light duty" work does not count against an employee's FMLA leave entitlement, and the employee's right to job restoration is held in abeyance during the light duty period. If an employee is voluntarily doing light duty work, he or she is not on FMLA leave.
Perfect Attendance Awards: The final rule changes how perfect attendance awards are treated to allow employers to deny a "perfect attendance" award to an employee who does not have perfect attendance because he or she took FMLA leave - but only if the employer treats employees taking non-FMLA leave in an identical way.
Employer Notice Obligations: The final rule consolidates all employer notice requirements into a "one-stop" section of the regulations to clear up some conflicting provisions and time periods. Further, the final rule clarifies and strengthens the employer notice requirements to employees in order that employers will better inform employees about their FMLA rights and obligations, and allow for a smoother exchange of information between employers and employees.
Employee Notice: The final rule modifies the current provision that had been interpreted to allow some employees to notify their employers of their need for FMLA leave up to two full business days after an absence, even if they could provide notice sooner. Under the final rule, the employee must follow the employer's normal and customary call-in procedures, unless there are unusual circumstances.
Medical Certification Process (Content and Clarification): The final rule, which is the result of significant stakeholder feedback (including a September 2007 meeting at the department on "medical certifications"), recognizes the advent of the Health Insurance Portability and Accountability Act (HIPAA) and the applicability of HIPAA's medical privacy rule to communications between employers and employees' health care providers. Responding to concerns about medical privacy, the rule adds a requirement that limits who may contact the health care provider and bans an employee's direct supervisor from making the contact.
The public can view the entire text of the final rule as it will appear in the Federal Register at: http://www.federalregister.gov/page2.aspx#reg_W.
For further information about the FMLA and the proposed regulations, visit the Wage and Hour Division's Web site at www.wagehour.dol.gov
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