CalCPA ProtectPlus

Many people in the Medicare program may find themselves lost in a maze of paperwork and unanswered questions. On occasion we post helpful information from Medicare’s website. The Medicare website provides a wealth of information to those that need help understanding the many facets of how Medicare works. Below you will find information about how Medicare works with other insurances. Recently we shared information from the Medicare website that explained the difference between primary and secondary payer. The following information is also from the Medicare website and explains what conditional payments are. We hope you find this information beneficial. To find more useful tools from Medicare, click here to visit their site.

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What’s a conditional payment?

How Medicare recovers conditional payments

Today one may find themselves bogged down under endless “to-do” lists at work and feeling as though they can’t come up for air. With the increasing number of heart disease cases in America and other health related issues today, it is important that we keep our bodies healthy. However, this entails work on our part. No time for working out? You can’t go for a 30 minute walk after work or on the weekends? How about some simple exercises right at your own desk at work? It may sound impossible and you may worry about people seeing you, but moving our bodies around during the day, leads to a healthier you.

An article in WebMD quoted Joan Price, author of The Anytime, Anywhere Exercise Book, to say “We are made to move, not sit at a desk 12 hours a day. As ergonomic as your desk or chair may be, sitting produces back pains, headaches, and listlessness. You become less productive.”

With this in mind, we may wonder what we could possibly do at work that would actually be considered productive exercise. This is the first in the series of two articles on this topic. This week covers aerobics at work as well as some low impact exercises and next week will cover stretching at work and other helpful tips.

Following is information from WebMD, by Jean Lawrence, that will help give you some ideas of how you can get up and move while at work.

Reach for the Sky

Stretching exercises are a natural for the desk-bound, to ease stress and keep your muscles from clenching up. Here are a few suggestions:

• Sitting tall in your chair, stretch both arms over your head and reach for the sky. After 10 seconds, extend the right hand higher, then the left.
• Let your head loll over so that your right ear nearly touches your right shoulder. Using your hand, press your head a little lower (gently, now). Hold for 10 seconds. Relax, and then repeat on the other side.
• Try this yoga posture to relieve tension: Sit facing forward, then turn your head to the left and your torso to the right, and hold a few seconds. Repeat 15 times, alternating sides.
• Sitting up straight, try to touch your shoulder blades together. Hold, and then relax.
• You get to put your feet up for this one! To ease the hamstrings and lower back, push your chair away from your desk and put your right heel up on the desk. Sit up straight, and bend forward just until you feel a gentle stretch in the back of your leg. Flex your foot for a few seconds, and then point it. Bend forward a little farther, flex your foot again, and hold for 10 seconds. Repeat on the other side. (continue reading…)

Many people in the Medicare program may find themselves lost in a maze of paperwork and unanswered questions. On occasion we post helpful information from Medicare’s website. The Medicare website provides a wealth of information to those that need help understanding the many facets of how Medicare works. Below you will find information about how Medicare works with other insurances. Over the next couple of weeks we will share additional information from the Medicare website regarding conditional payments. We hope you find this information beneficial. To find more useful tools from Medicare, click here to visit their site.

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If you have Medicare and other health insurance or coverage, each type of coverage is called a “payer.” When there’s more than one payer, “coordination of benefits” rules decide which one pays first. The “primary payer” pays what it owes on your bills first, and then sends the rest to the “secondary payer” to pay. In some cases, there may also be a third payer.

What it means to pay primary/secondary

• The insurance that pays first (primary payer) pays up to the limits of its coverage.
• The one that pays second (secondary payer) only pays if there are costs the primary insurer didn’t cover.
• The secondary payer (which may be Medicare) may not pay all the uncovered costs.
• If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.

Paying “first” means paying the whole bill up to the limits of the coverage. It doesn’t always mean the primary payer pays first in time. If the insurance company doesn’t pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should’ve made.

If you have questions about who pays first, or if your insurance changes, call the Medicare Coordination of Benefits Contractor.

Note: Tell your doctor and other health care providers if you have coverage in addition to Medicare. This will help them send your bills to the correct payer to avoid delays.

[Information Source]

Prescription Drug Covered Expense is the expense you incur for a covered prescription drug, but not more than the maximum amounts described in items i. and ii. below. Expense is incurred on the date you receive the service or supply.

Prescription drug covered expense does not include any expense in excess of: (i) the drug limited fee schedule for drugs dispensed by non-participating pharmacies; or (ii) the prescription drug negotiated rate for drugs dispensed by participating pharmacies or by the mail service program.

Today one may find themselves bogged down under endless “to-do” lists at work and feeling as though they can’t come up for air. With the increasing number of heart disease cases in America and other health related issues today, it is important that we keep our bodies healthy. However, this entails work on our part. No time for working out? You can’t go for a 30 minute walk after work or on the weekends? How about some simple exercises right at your own desk at work? It may sound impossible and you may worry about people seeing you, but moving our bodies around during the day, leads to a healthier you.

An article in WebMD quoted Joan Price, author of The Anytime, Anywhere Exercise Book, to say “We are made to move, not sit at a desk 12 hours a day. As ergonomic as your desk or chair may be, sitting produces back pains, headaches, and listlessness. You become less productive.”

With this in mind, we may wonder what we could possibly do at work that would actually be considered productive exercise. This is the first in the series of two articles on this topic. This week covers aerobics at work as well as some low impact exercises and next week will cover stretching at work and other helpful tips.

Following is information from WebMD, by Jean Lawrence, that will help give you some ideas of how you can get up and move while at work.

The article asks the question: can you actually go beyond working out the kinks and get some meaningful exercise in your cubicle?

Kelli Calabrese, MS, an exercise physiologist and spokesman for the American Council on Exercise, says yes. Calebrese believes in 60-second or 10-minute bursts of aerobic exertion. “This is cardio– if you get in your [target] heart rate zone,” she says. (continue reading…)

Participating Hospital is a hospital which has a claims administrator’s Participating Agreement in effect with the claims administrator, as appropriate, at the time services are rendered. Participating hospitals agree to accept the negotiated rate as payment in full for covered services. Participating hospitals agree to participate in procedures established to review the utilization of hospital services. Hospital services determined to be unnecessary, according to these utilization review procedures, are not covered by the plan. A list of participating hospitals is available upon request from the plan administrator, as appropriate.

Do you suffer from headaches, fatigue, dizziness, dry skin, dry mouth or thirst? These are all signs of dehydration. Since water makes up about 60 percent of our body weight, it is important that we drink water each day. We can go without food for almost two months, but without water only a few days. Our body completely depends on water intake in order to function properly. Here are some ways that water helps our body:

• flushes toxins out of our vital organs
• carries nutrients to our cells
• helps us to feel full if we are trying to loose weight
• boosts our metabolism -especially if the water is ice cold because your body has to work to warm the water up, which burns a few calories in the process
• our heart doesn’t have to work as hard to pump blood throughout our body if we drink enough water
• helps prevent muscle cramping and lubricates joints in the body
• helps reduce fine lines and wrinkles in our face since it hydrates skin cells and plumps them up
• helps to flush out impurities and improves circulation in blood flow which in turn leaves our face looking rested, clean and glowing
• helps dissolve waste particles and passes them smoothly through our digestive tract
• helps our body by diluting the salts and minerals in our urine that lead to kidney stones
• provides a moist environment for ear, nose and throat tissues

So you may wonder just how much water is enough. Some experts say that you divide your weight (in pounds) by two and the resulting number is the number of ounces of water you need each day. For example, if you weigh 150 lbs., you should drink 75 ounces of water daily. The most common is the 8×8 rule – eight 8-ounce glasses of water per day. These are just two of the the many theories and there are several more out there. It is a question that probably each nutritionist or doctor will have a different answer to…since the answers are based on a variety of  factors. (continue reading…)

If you are someone that is putting one or two teaspoons of sugar in each cup of coffee you consume a day, you may want to read this article. Sugar is in added in so much of the food we eat, to be adding sugar on top of that may eventually lead to health problems. It seems that lately sugar has been making headline news as well as a contributor to American obesity and unhealthy lifestyles. People are becoming more aware of the dangers of too much sugar consumption, especially with the ongoing battle of attempts to ban super-sized sodas in New York City.

Natural sugars are found in our fruits, vegetables, milk and grains. These foods are good to have in our diets since they contain important minerals, vitamins and carbohydrates that our body needs. Added sugars are found in processed foods that we eat, and many Americans are consuming this type of food on a daily basis.

In fact, when we go to the grocery store and think we are doing a great thing by purchasing the reduced fat peanut butter, we need to take a moment to look at the nutrition label, because there is a good chance the sugar content will be higher than the regular peanut butter. Other processed foods high in sugar content that are common items on our grocery list are: soft drinks, juice, jams, syrup, some yogurts and cereals. Food is marketed in a way that we think things are good for us, but we need to be the smart consumer and read the labels. (continue reading…)

We are inundated with news reports stating how unhealthy Americans are and that cardiovascular diseases are on the rise. Recently in the news there were reports on the rise in salt intake showing that three quarters of adults worldwide consume almost double the daily recommended amount of salt in their diets.

Last week this rise in salt intake was presented by the Harvard School of Public Health researchers at the American Heart Association’s Nutrition, Physical Activity and Metabolism and Cardiovascular Disease Epidemiology and Prevention 2013 Scientific Sessions, thus the reason for the salt buzz in the media. The researchers noted that the increase in sodium intake may have been responsible for 2.3 million heart-related deaths worldwide in 2010.

According to the American Heart Association, an estimated one in three Americans who will develop high blood pressure, a high-sodium diet could be the reason.  The American Heart Association points out that

In some people, sodium increases blood pressure because it holds excess fluid in the body, creating an added burden to the heart.  Too much sodium in the diet may also have other harmful health effects, including increased risk for stroke, heart failure, osteoporosis, stomach cancer and kidney disease (1)

On a global scale, sodium intake from commercially prepared food, table salt, soy sauce, and salt added during food preparation, averaged nearly 4,000 mg a day in 2010. The World Health Organization recommends less than 2,000 mg a day of sodium; the American Heart Association recommends less than 1,500 mg a day.

With so many articles out there on the news and blogs, just like this one, it can be challenging to learn the facts. The American Heart Association breaks down the salt facts in a way that is easy to understand and provides helpful tools to learn to read nutrition labels and how to reduce sodium in your diet. The facts are out there and it is up to us to learn and educate ourselves and our loved ones so that we can live a healthier life.

(1) He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2008.

[Information Source]

Eating healthy is something many people strive for yet they are not sure how to do it. The Academy of Nutrition and Dietetics annually sponsors an educational campaign in March, for the past forty years, called National Nutrition Month®. The purpose of the campaign is to draw attention to how important it is to make healthy food choices and to develop other healthy habits such as regular physical activity. The campaign provides a wealth of nutritional information that can help enrich lives and promote healthy lifestyles. This year National Nutrition Month® has the theme of “Eat Right, Your Way, Every Day”.

The Academy of Nutrition and Dietetics provides valuable information to help guide people to healthy habits. The links below are just a few highlights from the Academy of Nutrition and Dietetics that can get you started on the road to a healthier life!

20 Ways to Enjoy More Fruits and Vegetables

Eating Right for a Healthy Weight

Eating Right for Older Adults

[Information Source]

First in a series of interviews that will be displayed across the CalCPA Protect Plus social media sites. In this clip, Mr. Chuck Gielow, Chairman of the Board of the Group Insurance Trust, interviews Ms. Patricia Cochran, Co-Chair of the Health Care Conference and member of the Board of Trustees of the Group Insurance Trust. The Health Care Conference was held on January 30, 2013 by the Education Foundation of the California Society of CPAs. Ms. Cochran discusses the importance of the Health Care Conference to California CPAs and how the Group Insurance Trust can be of benefit to members of CalCPA in the health care field.

February 1, 2013 marks the 10^th anniversary of National Wear Red Day®, which was created by the American Heart Association, along with the National Heart, Lung and Blood Institute. The day draws attention to the number one killer of women: heart disease. According to the American Heart Association’s campaign, Go Red for Women, heart disease is the cause of 1 in 3 deaths in women each year, which is approximately one woman every minute. The American Heart Association’s Go Red for Women movement helps spread awareness about heart disease in women and educates people about the disease so that the facts are learned. Knowing the truth about the disease will help prevent the disease and save lives.

Over the next few weeks we will feature articles from the American Heart Association that will inform our readers what causes heart disease, whether women of all ethnicities have the same risk level, survival rates, statistics, warning signs and prevention of the disease. It is important to arm ourselves with the facts so that we can help ourselves and those around us to live heart healthy lives.

The following information is from the American Heart Association.

It’s true: Heart disease is the No. 1 killer in women. Yet, only 1 in 5 American women believe that heart disease is her greatest health threat.

Here are some more unsettling facts:

• Heart disease causes 1 in 3 women’s deaths each year, killing approximately one woman every minute.
• 90 percent of women have one or more risk factors for developing heart disease.
• Since 1984, more women than men have died each year from heart disease and the gap between men and women’s survival continues to widen.
• The symptoms of heart disease can be different in women vs. men, and are often misunderstood.
• While 1 in 31 American women dies from breast cancer each year, 1 in 3 dies of heart disease.

It’s time to focus on finding, and becoming the solution. Here’s what you need to know about the causes of heart disease and ways you can prevent it.

What causes heart disease?

Heart disease affects the blood vessels and cardiovascular system. Numerous problems can result from this, many of which are related to a process called atherosclerosis, a condition that develops when plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke. (continue reading…)

January 2013

The Group Insurance Trust of the California Society of CPAs has helped California CPAs and their employees and families with health care insurance needs since 1959 and its operations have grown over the years. In 2012, the Trust offered self-insured medical, dental and vision plans and health savings arrangements with total premiums of approximately $50 million.

As we enter 2013, the Trust is watching developments on both the federal and state levels in health care reform. There has never been a time of greater uncertainty in the health care marketplace.

The Trust’s new CEO, Ron Lang, follows health care reform proposals closely and has identified a number of proposals that may affect the Trust and those it serves. His understanding of this complex subject is very impressive. He is backed in his efforts by our experienced staff and contractors and keeps the Board of Trustees up to date on developments. As proposals become more tangible, the Trust will continue to monitor developments and take appropriate actions.

December 2012 was a bitter sweet time for me personally since I retired at the end of the year as Chairman of the Board after 15 years in that role. I became Chairman of the Trust in 1997 right after finishing my term as President and Chairman of the Board of CalCPA. This month caps off over 30 years of leadership in CalCPA, including the last 15 with the Trust. I suspect I will miss it. Thank you for the opportunities you have provided to me.
The Trust is in good hands. The 12 CPAs who make up the Board of Trustees have experience with the Trust ranging from two to more than 40 years.

I wish you all good health and prosperity in 2013 and the years ahead.

Gale L. Case, CPA, CFE
Chairman of the Board
Group Insurance Trust of the
California Society of CPAs

Many people are familiar with chickenpox and may have had it as a young child. But are you aware the virus that causes chickenpox remains in your body in an inactive state for years and can reactive and cause a condition called shingles? It is called the varicella zoster virus. To give you an idea of how common shingles is, according to the Centers for Disease Control, almost 1 out of every 3 people in the United States will develop shingles and there are an estimated 1 million cases each year in the United States (CDC.gov).

People that are at risk of developing shingles are:

• Anyone at any age who has recovered from chickenpox
• People over 60 years of age have a higher risk (about half of all cases are among people over 60 years old)
• People with weakened immune systems – such as certain cancer and human immunodeficiency virus (HIV)
• People who receive immunosuppressive drugs (i.e. steroids)

Symptoms

WebMD lists the following three stages of shingles:

Prodromal stage (before the rash appears)

• Pain, burning, tickling, tingling, and/or numbness occur in the area around the affected nerves several days or weeks before a rash appears. The discomfort usually occurs on the chest or back, but it may occur on the belly, head, face, neck, or one arm or leg.

• Flu-like symptoms (usually without a fever), such as chills, stomachache, or diarrhea, may develop just before or along with the start of the rash.

• Swelling and tenderness of the lymph nodes may occur. (continue reading…)