HMO vs. PPO

I have been getting a ton of questions lately about what is the difference between an HMO vs. PPO.  Well nowadays things are not as cut and dry as they use to be considering now there are HMO Open Access and POS.  But, lets talk strictly about HMO--Health Maintenance Organization--and PPO--Preferred Provider Organization.

HMO

•  A very tightly controlled network.
• Must have primary physician refer you to any specialist
• No out of network coverage
• Price is usually lower than a PPO

PPO

• Broad network
• Free to see specialists without a referral
• Out of network coverage to some extent
• Price is usually higher than an HMO due to more extensive network

Now I will say that if you want to save some money and don't mind a smaller network, a good compromise would be to go with a HMO Open Access Plan (HMO OA).  Most HMO OA Plans allow you to see specialists with out a referral and have a better network than a tradition HMO.  The only downside is that there is usually no out of network coverage.  Let's face it though your employees and you should always be utilizing the in network benefits because even if you have an out of network the benefits are going to be significantly reduced.

Sun Sentinel's Health Reform Article

This morning's Sun Sentinel had a great article in it about Florida and the Health Care Reform.  I thought I would share it with all of you:

"Feds may act if Florida stalls on health-reform law

Hoping legislation will be repealed, Scott rejects grants, blocks compliance

By: William E. Gibson, Staff Writer

WASHINGTON ——

If Florida leaders refuse to carry out the new national health care law, Uncle Sam is prepared to take charge on behalf of the state's consumers.

One year after President Barack Obama signed the health care overhaul into law, federal officials are urging Florida and other reluctant states to shape it to meet their needs and to take advantage of millions of dollars of federal planning grants. Failure to participate, officials warned this week, means a loss of state control.

Florida and other states, for example, must show by 2013 they are set up to provide a health insurance exchange, an online service for consumers to compare coverage plans and shop for affordable rates. If states are unwilling or unprepared, the law requires U.S. officials to step in and make a federally run exchange available for residents at the start of 2014.

But Florida Gov. Rick Scott, backed by fellow Republicans in the Legislature who strongly oppose "ObamaCare," has refused $2 million in federal planning money and ordered state agencies not to implement the law. In addition, Florida has challenged the law in federal court, in a lawsuit filed before Scott was elected in November.

The standoff reflects an ongoing political debate and a high-stakes gamble by Scott and other critics, who are counting on Congress to repeal the law or federal courts to rule it unconstitutional. Other states are quietly preparing to comply, even while challenging some of the law's provisions in court.

"Of all the states, Florida is obviously one that has been the most reluctant to get out in front and engage in innovative ways to exercise their flexibility to implement the law," said Paul Dioguardi, director of intergovernmental affairs at the U.S. Department of Health and Human Services, in an interview this week.

"What Governor Scott is really leaving on the table is the ability to implement the law of the land in a way that makes sense for Florida," Dioguardi said. "What we're left with is this federal fallback mechanism, which would be a missed opportunity for them to do it in a good Florida way."

Scott, who also refused more than $2.4 billion of federal high-speed-rail money, is trying to wean Florida from federal aid and to block mandates imposed by the health care law. Those mandates, scheduled to take effect in 2014, include expansion of Medicaid and requirements that individuals obtain health insurance.

The governor has told reporters in Tallahassee that state officials were "not going to spend a lot of time and money" to implement the law. But he promised that "the state won't be caught flatfooted. We'll be ready" if it should be upheld by the courts.

In the meantime, he has refused a $1 million grant to plan for the insurance exchange and another $1 million grant designed to track premiums to prevent unreasonable rate hikes.

"We believe the federal law is unconstitutional, in which case it won't be enforced," said Jack McDermott, spokesman for the Florida Office of Insurance Regulation.

A federal judge in Pensacola has declared the law unconstitutional, though the law has been upheld by other courts. The U.S. Supreme Court is expected to ultimately settle the matter.

The law's proponents accused Scott on Wednesday of resisting implementation out of political spite.

"It's purely a result of his venom toward the fact that it was passed," said U.S. Rep. Debbie Wasserman Schultz, D-Weston. "I think he needs to stop acting childish, be a grown-up and do what he is supposed to do to make sure the state is ready to implement the law."

Republicans in Congress vowed Wednesday to keep pressing for repeal.

U.S. Rep. Allen West, R-Plantation, called the law "a costly and unworkable maze of new federal agencies and empowered federal government bureaucrats who determine the what, when, where and how of health care."

U.S. Sen. Marco Rubio, R-Fla., said the law "is adding to our nation's debt, destroying jobs and threatening current coverage plans that people are satisfied with."

Meanwhile, provisions are gradually kicking in, and other states are tapping federal grants designed to help consumers, prevent fraud, develop the health care work force and prepare for the insurance exchanges.

"You can play catch-up, but the longer you wait, the harder it gets," said Alan Weil, executive director of the National Academy for State Health Policy, an independent group of state policymakers.

Weil said most states are eager to run the exchanges, which will be funded by the federal government. But he said Floridians might be better served by a federal exchange.

"If a reluctant state doesn't want to do it," he said, "it may be better for the consumer for an enthused federal government to take the lead.""

Health Living RECIPE Collection

I was to attend a good friend's birthday party the other day and wanted to bring a delicious but yet healthier appetizer for everyone to munch on prior to dinner.  I of course starting looking over all my favorite recipe sites like CookingLight.com, EatingWell.com, Self.com, etc.  I ended up finding this wonderful recipe for Creamy Mushroom Phyllo Triangles.  They were absolutely a hit at the party and no one even guessed they were healthy, so here it is for you to bring to your next bash. 

Yield: 48 triangles (serving size: 2 triangles)

Ingredients

• 3/4  cup  dried porcini mushrooms (about 3/4 ounce)
• 1  pound  button mushrooms
• 1  large onion, cut into 1-inch pieces (about 8 ounces)
• 2  tablespoons  olive oil
• 1  teaspoon  dried oregano
• 3/4  teaspoon  salt
• 1/2  teaspoon  freshly ground black pepper
• 1/4  teaspoon  freshly grated nutmeg
• 6  ounces  1/3-less-fat cream cheese
• 1/2  cup  finely chopped flat-leaf parsley
• 24  (18 x 14-inch) sheets frozen phyllo dough, thawed
• Olive oil-flavored cooking spray

Preparation

Cover porcini mushrooms with boiling water in a bowl. Let stand 1 hour. Drain well; chop.
Place half of button mushrooms in a food processor; pulse 8 times or until finely chopped. Remove from processor. Repeat procedure with remaining button mushrooms. Add onion to processor; pulse 8 times or until finely chopped.

Heat oil in a large nonstick skillet over medium heat. Add onion; sauté 5 minutes. Add button mushrooms; cook until mushrooms are tender and liquid evaporates (about 10 minutes). Stir in porcini mushrooms, oregano, salt, pepper, and nutmeg; cook for 2 minutes. Remove from heat. Add cheese; stir until cheese melts. Stir in parsley.

Preheat oven to 375°.

Place 1 phyllo sheet on a large cutting board or work surface (cover remaining phyllo to prevent drying). Cut sheet in half lengthwise; lightly coat with cooking spray. Fold each phyllo piece in half lengthwise to form a (3 1/2-inch-wide) strip. Spoon a level tablespoon of mushroom mixture onto 1 short end of each strip, leaving a 1-inch border. Fold 1 corner of edge with 1-inch border over mixture, forming a triangle; continue folding back and forth into a triangle to end of strip. Repeat procedure with remaining phyllo, cooking spray, and mushroom mixture. Place triangles, seam side down, on baking sheets coated with cooking spray. Lightly coat tops with cooking spray.

Bake at 375° for 20 minutes or until golden. Serve warm.

Nutritional Information

Calories: 49 (37% from fat)

Fat: 2g (sat 0.8g,mono 1g,poly 0.2g)

Protein: 1.5g

Carbohydrate: 6.2g

Fiber: 0.5g

Cholesterol: 3mg

Iron: 0.6mg

Sodium: 97mg

Calcium: 7mg

HealthCare Reform Breakdown CONT.

More from Mike Vogel's Florida Trend article:

"NEW REGULATIONS

Closed Counter
Before: Employees could use their health savings account, flex savings account or health reimbursement account money to pay for over-the-counter meds.

Now: If workers want to spend their money on over-the-counter purchases, they’ll need a doctor’s prescription.

Implication: Employees and doctors won’t bother with prescriptions for runny noses, so employees will ratchet down the money they park in accounts.

Class Distinctions
Before: Businesses could put their employees in different “classes” with different coverage for each class. A restaurant company, for instance, might put wait staff in one class and chefs, administrative staff and executives or owners in another.

Now: All are treated equally — or companies will pay significant penalties down the road if they “discriminate” in favor of highly paid employees. That raises concerns that some companies may drop coverage altogether rather than absorb the cost of adding dozens of employees, says Robert Pariseau, president of West Florida operations in Tampa for benefits company AGIS.

Exception: Companies can grandfather their existing plans — and avoid the penalties — provided they don’t make substantive changes to the plans such as increasing the share of the premium employees pay for coverage by more than 5%. That rule against major changes could force employers to give up grandfather status rather than absorb rising insurance costs. How many companies will seek or maintain grandfather status is unclear. The rules aren’t finished and the size of the penalties won’t be announced until the middle or later part of this year, giving companies a year to decide what to do. “Penalties could be huge,” Barber says. Some companies, if they can’t offer key talent a better plan or some healthcare perk, instead pay bonuses so high-value employees can obtain the coverage they want on their own. “They’re having to think outside the box to maintain their competitive advantage in recruiting talent,” Farmer says.

Care Standards
New: Small-business insurers must pay out 80 cents of every premium dollar for patient care. Insurers of larger employers have to pay out 85%.

Implication: Insurers will see margins pressured and so may cut back on broker commissioners, administrative costs or services to businesses and their employees. “I don’t see how the service gets better if they have to cut the administrative costs, maybe drastically,” Pariseau says. “It’s a low-margin business anyway.”

Tax Credit
New: A tax credit for small companies of up to 35% of their premium cost. “It’s a good deal. It’s better than a deduction,” Barber says. "

HealthCare Reform Breakdown CONT.

Continuation of Mike Vogel's article from FloridaTrend.com...

"NEW HEALTHCARE MANDATES

Kid CoverageBefore: No government mandate on how old an employee’s children can be before coverage expires.

Now: If a plan covers employees’ kids, coverage must be offered up to age 26.

Ounce of PreventionBefore: Employers and their insurers settled how much of preventive care — checkups and the like — was covered.

Now: Insurance has to cover 100% of certain preventive care.

Pre-ExistingBefore: People with pre-existing conditions could have treatment of that condition excluded from coverage under certain circumstances.

Now: No exclusions for pre-existing conditions up until age 19 and no exclusions over 19 starting in 2014.

Caps
Before: Companies could cap the maximum benefits they would pay. Typical plans capped employee coverage at $1 million to $5 million lifetime.

Now: Unlimited lifetime maximum for “essential” benefits.

The Bottom LineNew mandates raised rates 1.5% to 4% this year. “It’s obviously a factor,” says Steven Barber, an employee benefits lawyer and partner with Shutts & Bowen in Tampa, but “if nothing had happened, the costs would have gone up anyway.”

Indeed, the law-related increases came atop a 10% to 13% increase attributed to medical care cost rises. Employers responded with maneuvers such as raising deductibles and out-of-pocket maximums. That kept their cost increases to 6% to 9%. .."

HealthCare Reform Breakdown

Today I was reading up on the Health Care Reform just to see if anything new has come about since I last checked.  I didn't find anything new that I thought would benefit you substantially; however, I did come across this great article by Mike Vogel from FloridaTrend.com written a few months back that is extremely helpful.  He breaks down in very simple terms some of items that are being altered due to the Reform.  Over the next week or so I will be showcasing pieces of article to help you better understand the changes.

Here is the kickoff of Mike's fabulous article,

"Florida’s small-business owners are making like Scarlett O’Hara. When it comes to preparing for 2014 — when the bulk of the new healthcare law kicks in — they’ll think about it tomorrow.

The year 2014 is when the individual mandate and its penalties take hold along with insurance exchanges. For now, owners and managers are focusing on staying in business. Lacking the HR staff and time of larger companies, they feel they have enough to do absorbing this year’s health insurance rate increases. The sentiment is “we’ll worry about 2014 when it gets here,” says employee benefits adviser Steve Farmer, a senior vice president with Wallace Welch & Willingham in St. Petersburg. It’s not sloth; owners want to see what the courts and a Republican House and more balanced Senate do — and who is president in 2013..."

2011 Gator Gala SUCCESS

I had the wonderful privilege of helping to plan the 1st Palm Beach Gator Club Gala that took place in February.  It was such a blast getting to know the Gala Committee Board and brainstorming with them about this enchanting evening.  The night was spectacular; full of fantastic silent and live auction prizes, delicious food from Lyon and Lyon catering, beautiful art exhibits to wander through at the Norton Museum of Art, and speeches by President of the University of Florida Dr. J. Bernard Machen and our Florida Opportunity Scholars Winner Heather Beller.

Here are some fantastic pictures captured by Morgan Mitchell Photography:

The proceeds from the GATOR GALA will benefit the Palm Beach County Gator Club Scholarship Fund, which has provided over One Quarter Million Dollars in scholarship funds over the past 6 years, & the Florida Opportunity Scholars Program.

A special thanks goes out to all the vendors, volunteers, and gala committee members--Sonja, Brian, Kenny, Barbara, Elaine, Dawn, and Kyle--for allowing me to help plan such a great event.

Heart-Healthy Living

I read this great article on FoodNetwork.com about things to do to keep your heart healthy.  A healthy heart means a healthier you and fewer trips to the doctors which means a happier you!!!  Also, it means hopefully your body will be able to fight off more diseases to keep your health insurance premium rates from going up based on the health of your group.  Saving your money and your heart=WIN WIN.  Here's the article:

"Eight easy steps for better health

 
Take control of your health by adopting food and lifestyle changes. Eating sensibly with some modifications, as well as exercising, can keep your heart strong and healthy. Follow some of our suggestions below and your heart will love you for it.

Eat Fruits & Vegetables
Not only are fruits and vegetables high in vitamins, minerals and fiber, they're also very low in calories and high in antioxidants, which can help prevent chronic disease. Fill up on an abundance of these delicious and beneficial foods every day.

Focus on Fiber
Fiber refers to the indigestible carbohydrates we eat and is found in fruits, vegetables and unrefined grains. It keeps the body's digestive system running smoothly and helps the body feel full, a key to weight management. Most importantly, soluble fiber, which is found in oats, nuts, seeds, apples, pears and berries, helps lower cholesterol.

Go for Low-Fat Dairy
To reduce the amount of saturated fat and calories in your diet, replace high-fat dairy products (such as whole milk, cheese, sour cream and cream cheese) with skim or 1% milk, low-fat yogurt, Neufchatel and low-fat cheeses.

Watch Your Sodium Intake
Sodium can raise blood pressure. The largest portion of sodium in Americans' diets comes from processed foods. By cooking fresh food at home, you can cut back on sodium dramatically. Also try removing the salt shaker from the table, using herbs and spices for flavor and cooking with half as much salt as in the past. If you use canned soups, broths and sauces, select low-sodium versions.

Eat the Right Fats
Cut back on saturated fats (found in meats and full-fat dairy products) and avoid trans fats (found in some commercially baked goods and fried foods, and listed on labels as partially-hydrogenated). Stick with unsaturated such as monounsaturated or polyunsaturated fats. Monounsaturated fats are mainly found in olive and canola oils, nuts, avocados and olives. Polyunsaturated fats can be found in corn, soybean, safflower or sunflower oils.

Go for Omega-3 Fatty Acids
Research has shown that omega-3s lower triglycerides (fat in the blood), help maintain the "good" cholesterol, and decrease the risk of sudden heart attacks, blood clots and stroke. These compounds are found in fatty fish (salmon, mackerel, herring, sardines) and plant foods (flax seeds, walnuts).

Get Moving
Extra pounds and inactivity can put stress on the heart and create other health problems. Exercise is key to weight management. Try to aim for at least 30 minutes of moderate exercise a day. Not only will it help shed some pounds, but it will also raise "good" cholesterol and triglyceride levels.

Have Some Wine
Alcohol in wine, beer and distilled spirits has been shown to protect the heart in some studies by increasing HDL, or "good" cholesterol. Additionally, heart-healthy polyphenols (antioxidants) occur in both red and white wine. If you don't drink, it's best not to start now, but if you do, have moderate amounts. That means one drink per day if you are a woman or two drinks per day if you are a man."