Underwriting the Social Contract: Distributive Justice & Health Care Reform

The Pickle Statement

As health care costs climbed exponentially in the 1980’s, so did the cost of health insurance plans. As a result, employers began to enroll their employees in managed care organizations, and many Americans were forced to leave their traditional indemnity type plans. With the advent of the health maintenance organization, there is a financial incentive for the underutilization of care. (Blumstein, 1996; Davis & Shoen, 1996).

In order to reduce financial risk, health insurance companies have restricted enrollment to individuals in poor health. By covering the minimal standards of treatment and excluding high risk groups altogether, major US insurance companies have realized that the health insurance market can a be an extremely ample industry. The public sector absorbs the cost of unreimbursed care for chronic care in America (Robert Wood Johnson Foundation, 1996). Based upon these findings, it seems clear that the money being removed from the health care marketplace is fattening the pockets of CEOs and majority stockholders.

Recent trend towards localized government leaves individuals without a financial safety net. This is the least efficient manner to handle health care costs, and evades the premise that medical care is a natural right in a civilized society. Few Americans feel secure within the current system. The rising costs of medical care contributed to the recent market changes in both the administration and delivery of health services. The financial incentive to shroud only the healthiest individuals ignores the fact that medical care is a social good.

Health Insurance Portability Act of 1996

Two years after the Clinton Health Plan was defeated in Congress, Senator Ted Kennedy and Nancy Kassebaum introduced the Kennedy-Kassebaum Bill in response to growing concerns about selective enrollment procedures used by health insurance companies in the private sector. In the final version of the Bill, insurance companies must limit preexisting condition clauses to twelve months. It has been estimated that this provision of the Bill will abet an estimated 150,000 Americans rep health insurance coverage.

There are many levels of the underinsured, including those without any coverage; effective policy must address the needs of the total population without shifting costs from one disadvantaged person to another. Kennedy-Kassebaum fails to address the cost issue—the primary concern for those at risk for losing their health insurance. It does nothing to befriend the uninsured accumulate a decent health policy, and then provides no solution to the critical issue at hand— cost

Since Kennedy-Kassebaum does nothing to control the cost of health insurance and medical care in America, the Bill fails to acknowledge to the issue of greatest concern to the citizens of this country: the cost of medical care. The Bill looks towards the states to develop consumer protections and weakens the regulatory role of the federal government. The majority of the American public is unaware of the fancy footwork involved with this legislation, and the demographics of the population it is intended to protect. In order to assess the utility of this Bill, it is critical to identify the populations at risk for loosing health insurance coverage and the underinsured.

Kassebaum-Kennedy focuses on a slim fraction of the uninsured population, and those who would be eligible for COBRA continuation (Consolidated Omnibus Reconciliation Act of 1974). Of the 41 million uninsured Americans, only about 150,000 are expected to aid from this legislation. The Health Insurance Portability and Accountability Act of 1996 is really nothing more than smoke and mirrors since it fails to address the proper issue at hand—the simple fact that the cost of quality health care in America is becoming a privilege that only the wealthy can afford.

The Cost of Care for Pre-existing Conditions

An individual with high blood pressure may just require prescription medication. Cancer patients in remission may require chemotherapy, and a person suffering with a degenerative disease may be alive to in treatment studies. Each condition requires individualized treatment that cannot be based upon the simple economic/cost-benefit analysis used in the utilization review process by large insurance companies. Clearly, the most effective treatment for one patient may not be the best for another. The time required for utilization review may present additional health risks and complications to a patient suffering from a chronic health condition.

Twelve months without insurance coverage may be financially devastating to some patients, and 63% of Americans have already forgone some type of medical treatment within the last year due to financial constraints. Publicity surrounding Kennedy-Kassebaum has hailed the bill as the “be all and end all in progressive legislation, however, in actuality it will only help about 150,000 people.

Unique studies have found that the majority of the uninsured population simply cannot afford to pay the premiums (Donelan et. al., 1996; Hoffman & Rice, 1996). According to their data, only 1% of the Uninsured population is due to original health status and exclusionary preexisting clauses, yet an overwhelming number of insured respondents reported an inability to receive medical care for chronic conditions. The majority of Americans with chronic illness are covered by some type of insurance, yet they are still subject to the utilization review process and access problems that deny or delay medically well-known treatment (Donelan, et. al., Hoffman & Rice, 1996).

Underwriting the Solidarity Principle

Traditional forms of insurance underwriting required that the contract explicitly area which illness or services are not covered by the policy, in advance. If the underwriter did not specifically dwelling a certain condition in the contract, the insurer was held to the terms of the contract and required to pay for services utilized by the policyholder (Stone, 1994, as cited in Durant, 1996).

Increasing numbers of for-profit and non-profit insurance companies began to control costs by refusing to insure individuals who they felt would spend more services. Insurers began to require health survey status questionnaires (refer to attachment A), and even began implementing AIDS and genetic testing to identify high-risk individuals (Brunetta, as cited in Gutmann & Thompson, 1996). In the 1980s, large insurance companies began including sexual orientation as a high-risk category, by using actuarial sound criteria. Such criteria concluded that gay men were a higher risk for contracting AIDS virus and refused to write policies for anyone believed to be homosexual, (Stone, 1994 as cited in Durant, 1996).

By limiting enrollment to the healthiest members of society, selective enrollment undermines the solidarity principle of health insurance (Davis & Shoen, 1996; Snow, 1996; Stone, 1994). By eliminating those who were suspect of using more services than their healthier counterparts use, insurance companies are able to offer rock bottom prices for young, healthy individuals. By excluding preexisting conditions and requiring obvious individuals to purchase high-risk policies, the number of uninsured and underinsured Americans continues to grow exponentially (Durant, 1996).

More individuals are choosing not to purchase insurance simply because they cannot afford it. Even among those with employer based health coverage, the policies frequently exclude coverage for long-term illness or care of chronic conditions (MSNBC News Forum, 1996). Without a standard definition of preexisting conditions, these clauses serve as “wildcards” since they allow insurers to deny coverage for any illness that “manifested itself before the issuing date of the policy (Stone, 1994 as cited in Durant, 1996).

This statement allows insurers to deny treatment for benefits and services for the policyholder for undiagnosed illnesses or conditions of which they were unaware. As a result, the insurers began to demand medical histories of applicants and their families in order to identify high risk individuals (please refer to attachment A).

Legitimacy of Distributive Justice

While there is a legitimate role of government to distribute scarce resources among the nation’s neediest individuals, sadly this is not the cause for the mismanagement of medical dollars in the United States today. There is a big distinction between an individual being denied prescription medication at their local pharmacy due to a cost-effective formulary developed by their Managed Care Organizations (MCOs), than an individual being denied a liver transplant because healthy livers are a scarce resource. While both may have equally devastating consequences, it is more difficult to rationalize a lost life based upon rigid cost benefit analysis and utilization decisions made according to formulas and cost-benefit analysis of treatment protocols.

“The political controversy over the distribution of health care in the United States is an instructive problem in distributive justice. Good health is care is necessary for pursuing most other things in life. Yet equal access to health care would require the government to not only redistribute resources from the rich, healthy to the abominable, and infirm, but also restrict the freedom of doctors and other health care providers. Such redistributions may be warranted, but to what level, and to what extent? ” Gutmann & Thompson (Page 178).

Blendon and his colleagues have reported similar findings in public opinion polls from 1992 and 1994 (Blendon et. al., 1992; Blendon et. al., 1994). A recent peep by the American Medical Association found cost to be of paramount trouble to an overwhelming number of Americans (Donelan et. aI., 1996). Of the 40 million uninsured Americans, only 1% attributes their failure to acquire health insurance coverage to their preexisting conditions. Among the uninsured, cost is cited as the well-known obstacle in obtaining health insurance coverage. Only 1% of the uninsured attributes their lack of coverage to a preexisting condition.

Based upon these democratic principles of distributive justice, consistent idea polls demonstrate the legitimate role and public desire for government regulation of the health care industry. It has become clear that the federal government must intervene in order to protect natural law rights, the social contract, and the Constitution of the United States. Regulation is needed to protect the individual freedoms, liberty, and the pursuit of “health, happiness, and the American Dream.”

If America is to be the “Land of Opportunity,” then clearly individual health and wellness should be an ideal to reach for. Unusual models of distributive justice emphasize public consensus as a legitimate role for government intervention. According to a number of studies by Blendon and his colleagues, the public has reported an overwhelming general concern about health care in this country, (1992, 1993, 1994, 1995, 1996).

State civil courts are backed up with cases where HMOs have violated the First Amendment (gag orders), the Fourteenth Amendment (due process), and the rights of protected classes under the Americans with Disabilities Act. Countless examples of “anecdotal” evidence appear as headlines everyday across the country. (New York Times, 1996; The New York Daily News, 1996; Long Island Newsday, 1996; LA Times, 1996; Picayne Times, 1996; Columbia Spectator, 1996; Columbia University Record, 1996; US News & World Reports, 1996; Newsweek 1996; Healthline, 1996; The Tennessean, 1996; The Albany Times, 1996; The Nashville Scene, 1996). In their entirety, these case reports represent the human tragedy that lies beneath the web of the very worst of American capitalism: corporate greed.

Identifying Populations At-Risk

A study by The Lewison Group in 1996 reveals insight into the private individual health insurance market. Clearly, individuals choosing to purchase health insurance policies for several hundred dollars each month expect their health care needs and expenditures to exceed that amount Regardless of health status, a young healthy 25 year used who purchases an individual health insurance policy can request to pay well over $300.00 monthly for a health insurance policy with Empire Blue Shield Blue Cross (based upon 1996 rates, novel rates available from the New York State Insurance Department).

Since individual policies are not addressed in the Health Insurance Portability and Accountability Act of 1996 (HIPA), an individual policy with Blue Cross Blue Shield of Tennessee excludes preexisting conditions for 24 months (enrollment booklet available upon expect). The critical markets in need of reform are the adversely selected individual insurance market, and the state’s most vulnerable populations: children; the elderly; the chronically ill; the uninsured; and the underinsured.

For the millions of individuals who have lost their employer based coverage, the cost of private health insurance is prohibitively expensive. Many individuals opt out of the individual market and apply for public assistance when the need arises. Those who have retained their health insurance coverage through their employers are being moved into managed care despite their efforts to support their indemnity style plans (Davis & Shoen, 1996; The Lewison Group, 1996).

Access to Medical Care

As routine practice, HMOs thunder or delay care for all services that are not outright medically well-known. Growing numbers of individuals have suffered irreparable harm, and many have died awaiting approval from their HMO’s (The New York Times, 1996; Long Island Newsday, 1996; The Tennessean, 1996; Healthline, 1996). It is hardly a secret that HMOs have fallen short of their promise to provide comprehensive health care for the “whole” individual by emphasizing preventative medicine, using medical management to coordinate care. There is substantial evidence that individuals with chronic conditions receive substandard care in HMOs.

A four-year longitudinal study of medical outcomes found that the elderly, the poor, and persons with chronic conditions were in better health when covered by fee-for-service plans compared with a control group covered in HMOs (Ware et. al., 1996). New statistics released in Washington, DC by the American Medical Association and the Robert Wood Johnson Foundation revealed the grunt costs of individuals with chronic conditions account for 75% of direct medical expenditures in the United States (Hoffman & Rice, 1996; based upon the National Medical Expenditures Survey; raw data available on CD from the Department of Health and Human Services Washington, DC). 45% of the American population suffers from at least one chronic illness.

If managed healthcare has been found to deliver inadequate care to this population, then we are looking at 100 million individuals who are potentially facing personal and financial crisis as they are moved into managed care. The public already accounts for the largest payment of direct medical expenditures, which means the millions of dollars being made by for-profit insurance companies are not being circulated into the economy to assist in public health costs care. The industry made a 14.8% profit in the 3rd quarter of 1996, however these medical dollars were removed from health care and used to fatten the pockets of CEO’s and majority stockholders (Healthline, 1996).

Based upon a new report from the Robert Wood Johnson Foundation, the direct costs for persons with chronic conditions describe 69.4% of national expenditures in personal health care (Robert Wood Johnson Foundation, 1996). Their direct medical costs are estimated at $4672.00 annually compared with $817.00 annually for individuals with acute illness (Hoffman & Rice, 1996; based upon National Medical Expenditures Stare 1987, not adjusted for inflation). This population is the most vulnerable to complications in their health and with their source of payment. Spacious insurance companies only provide adequate coverage for acute illness (Donelan et al., 1996; Hoffman et. al, 1996).

Medicaid Managed Care

Following Tennessee’s lead, many states have enrolled their medically indigent populations in Medicaid Managed Care Organizations (MCOs). In Daniels v. Wadley, (926 F. Supp. 1305), the court held that TennCare violated the Due Process Clause of the Fourteenth Amendment since such procedures eliminate fair hearings and independent medical review of disputes. The court found the pattern of routine denials of care by MCOs participating in the states TennCare program to violate the Medicaid Act since it compounded the problem of institutionalized waiting periods for medical appeals pending independent review by the Medical Review Unit (MRU), (42 U.S.C. § 1396 (a)(8)).

Furthermore, the court ordered federal injunctive protection to participants and beneficiaries because no state law may preempt federal law by depriving individuals of their constitutional rights. The Department of Health and Human Services (HHS) was ordered to revise its utilization review procedures for TennCare recipients in keeping with the Medicaid Act (42 U.S.C. § 1396 (a) (8)) ensuring due process protections for all covered beneficiaries by requiring “services are provided with ‘reasonable promptness,’” (926 F. Supp. 1305).

This case is one of 543 civil suits pending in the state courts for violations of the Medicaid Act (based upon a Lexis-Nexis search performed December 26, 1996). With the passing of H.R. 3507 into public law, (The Welfare Reform Bill) private citizens will glean little reprieve in the federal courts, so any attempts to hold states accountable for violations of federal law will be feeble at best (Denkeret. al., 1996).

Managed care has shown itself to be a farce of “medical management” in light of all the condemning evidence to the contrary. Timothy Icenogle, a medical doctor in the state of Arizona commented in 1981, “We play sort of an advocacy role. I think the public demands something more from physicians than to unbiased be a blob of bureaucrats, and I think we have to take a stand now and then. Our role essentially as patient advocate, is to snarl them, well, just because the insurance company is not going to pay, that is not the slay of all the resources,” (Icenogle, as cited in Gutmann & Thompson, 1996). Never has this statement been needed more than it is today. Unfortunately, as more insurance companies refuse to pay for medical treatment, fewer resources become available for patients in desperate need of financial assistance. As Judge Kessler eloquently stated as she handed down her decision in Salazar v. District of Columbia, No. 93-452, December 11, 1996, “slow every fact found herein is a human face and the reality of being poor in the richest nation on earth, (936 F. Supp. Slip op. At 3).

Perhaps most distressing is the lack of accountability for mismanaged healthcare and improper denials of medically necessary treatment. HMOs claim immunity under ERISA, and leaving individuals without recourse in a sea contractual language and lengthy court calendars. It is evident that individuals protected under the Medicaid Act are not fundamentally different from other populations entrapped in the maze of managed care. They are simply those who have “had their day in court.”

Due Process Protections

Since all Americans are theoretically entitled to due process protections under the constitution of the United States, it seems the federal courts are long overdue for making such a public statement. We are wasting precious time and losing millions in valuable human resources as we await decisions to be handed down from state courts. The Supreme Court of the United States has agreed to hear New York’s request for an ERISA (Employee Retirement Income Security Act of 1985) waiver, making health maintenance organizations liable for medical malpractice in the state of New York.

When HMOs deny care from patients, it is ludicrous to maintain individual physicians liable for the utilization decisions made by decentralized corporate review boards. It is time to take a serious look at tort reform, and demand action by the Supreme Court as they approach the date of New York’s ERISA hearing. A blanket court ruling upholding Daniels v. Wadley, and Salazar v. District of Columbia is desperately needed to avoid an avalanche of liability suits filed in area courts. The court must uphold Daniels v. Wadley, and Salazar v. District of Columbia if further lives are to be saved in medicine rather than wasted away in the utilization review procedures. While we wait patiently for District of Columbia circuit court to order injunctive relief, the number of individuals suffering irreparable harm due to the systematic denial of medical care grows larger each day.

The history of Medicaid Managed Care does not provide a very optimistic gape into the future of TennCare recipients and Medicaid beneficiaries in states around the country. Dating back to the implementation of the Arizona Health Care Cost Containment System (AHCCCS) in 1981, there are documented cases where “people reportedly died for lack of medical treatment before their eligibility was determined,” (Varley, as cited in Gutman & Thompson, I 996). This leaves me to wonder why the states continue to enroll their most vulnerable populations into a system of managed care that has proven to be a disaster.

Perhaps worthy of comment is that Arizona is the only region to have voted Republican in every election since 1948—certainly provides insight into the conservative morale of the position. Although Arizona was the last state to accept the Medicaid cost sharing incentive proposed by the federal government in 1966, it was the first state to force its medically indigent population into managed care in 1981.

Violating Federal Law

Rigid pre-certification requirements and nonspecific utilization review procedures place strategic barriers to access medical treatment and services in Health Maintenance Organizations (HMOs). Pre-certification requirements are strategic barriers incorporated into the “sunless box” of utilization review that institutionalizes exclusionary waiting periods and routine denials of medically necessary treatment. According to federal law, “care and services are to be provided in a manner consistent with the simplicity of administration and the best interests of recipients,” (42 U.S.C. § I 396a (a) (19)). Clearly, such rigid pre-certification requirements that complicate administrative processing and paperwork on the part of the enrolled beneficiaries is a violation of United States Code.

Furthermore, using primary care providers as a mechanism to limit access to specialists not only complicates administrative processing, but limits enrolled beneficiaries choice of health professionals beyond what is available to the general public in the geographic area (42 U.S.C. § 1 396a (a)(30)(A)). Certainly referral procedures do not “assure that recipients will have their choice of health professionals within the plan to the extent possible and appropriate,” (42 U.S.C. § 434.29). Under this provision, it seems that any individual, especially those with chronic health conditions or disabilities should be allowed to choose a primary care provider with more expertise than a nurse practitioner. I will argue that a neurologist is more familiar with the unique needs of a patient with Multiple Sclerosis than a nurse practitioner is with exiguous to no knowledge specific to the medical management of degenerative

Under the Medicaid Act of 1966, covered beneficiaries may appeal any utilization review decision which denies care or limits services. The Medicaid Act gives individuals the right to a fair hearing in front of an unprejudiced independent Medical Review Unit (MRU). Furthermore, the Medicaid Act clearly states that medical services for a Medicaid beneficiary may not be terminated until the said beneficiary receives such a hearing

Conclusion

The country as a whole must realize what Contemplate Kessler told her courtroom. Her words are certainly words I will not forget—certainly worth being quoted at length:

“This case is about people—children and adults who are sick, awful, and vulnerable—for whom life, in the memorable words of poet Langston Hughes, “ain’t been no crystal stair”. It is written in the dry and bloodless language of “the Iaw”—statistics, acronyms of agencies and bureaucratic entities, Supreme Court case names and quotes, official governmental reports, periodicity tables, etc. But let there be no forgetting the precise people to whom this bloodless language gives voice: anxious working parents who are too poor to bag medications or heart catheter procedures or lead poisoning screening for their children, AIDS patients unable to get treatment, elderly persons suffering from chronic conditions like diabetes and heart disease who require constant monitoring arid medical attention. Behind every fact found herein is a human face and the reality of being poor in the richest nation on earth. (Plug op. At 3). -Judge Gladys Kessler, December 11, 1996.

Patients are routinely being denied medical care– and being forced into a system that incorporates long waiting periods into their physician contracts and handbooks (Green, 1996). The private for-profit insurance industry has single-handedly undermined the solidarity principle of health insurance by using strict underwriting techniques, ridiculous treatment protocols; inconsistent definitions of chronic illness and rigid utilization review procedures unavailable to the consumer; and inconsistent definitions of “chronic illness” and “emergency” (Dallek, 1996). It is an industry which justified using sexual orientation to avoid covering AIDS patients, calling such methods “actuarially sound.” The privatization of a public good has removed millions of dollars from the healthcare marketplace with “medical loss ratios” of 57% compared to 85% in the traditional health insurance market

Although a slim portion of the general public is unable to obtain health insurance coverage due to a preexisting condition, the more critical issue remains the cost of coverage. The cost of medical care will remain an issue since recent legislative efforts evade the issue. Recent changes in the delivery of health services is of grave concern and different options must be considered in order to find more effective ways to provide public and private assistance—MANAGED CARE IS NOT THE ANSWER!!! FOR-PROFIT HEALTH CARE IS NOT THE Respond! PRIVATIZATION IS NOT THE ANSWER!

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Your health insurance needs literally skyrocket once you intertwine your life with others’ by starting a family and whether yours is a extinct one, a single parent one or one you’re adopting, there are a few things that you’ll need to know about the road ahead. Finding an appropriate family health care idea is going to be crucial simply because there’s miniature to nothing that provides security better than peace of mind.

Accidents happen, especially inside active families and if your spouse or child children were to fall ill or be injured, the burdens of mounting medical bills could quickly become insurmountable. That’s why taking the time to select and purchase a family-oriented health care coverage should be at the top of any new household’s priority list.

The younger the family, the more time they tend to spend in their doctor’s offices, so health insurance goes from the luxury it might’ve been back in college to a must have. So much so that one of the most often cited reasons for switching or staying with employers is whether or not a current workplace provides health benefits.

Even if you‘re required to pay a portion of your plan’s premiums, group health care benefits are a less expensive option than being forced to find affordable healthcare on your own. Especially considering that the average health insurance covered employee pays honest twenty percent of the total costs of their medical care.

But when a group plan isn’t available, even trying to settle which sort of health care coverage to salvage then coordinating that coverage between two working parents, can be quite a challenge. There really are no substitutes for studying the on hand options carefully, asking every question you can think of then getting as many unbiased quotes as you possibly can before deciding on an indemnity carrier.

For many younger families, finding HMO, PPO or alternate managed care coverage turns out to be their most inexpensive option, but that doesn’t mean that consumers won’t need to compare the flexibility and costs of the plans they’re offered.

If it happens that you’re both self-employed and the sole provider for your family, then you’ll definitely need a health insurance for small business plan, because not only your children and family but your business and your workforce depend on your continued well-being.

Health insurance plans structured specifically to address the needs of limited business are also a perk that can benefit you attract quality employees. Just as with health insurance coverage for families, the monthly expenses associated with a health benefits package for a diminutive business can vary substantially from one indemnity carrier to the next, so any time that you spend doing research will definitely be time well spent.

Many web sites that offer family health insurance plans design doing comparisons easy because they allow you to specify your monthly limit and then give you information that allows you to do a point-by-point comparison.

When you’re searching for an affordably-priced family health insurance plan:

• Carefully consider each plan offer’s out-of-pocket expenditure limits in as well as its deductibles.
• Make distinct that you’ve accurately calculated your monthly household budget.
• Be 100% not to forget to figure in the value you’ll place on your peace of mind.
• Find out if which health plan offers cover prescription purchases.
• Get comparisons of help package’s premiums, deductibles, co-insurance rates, lifetime and out-of-pocket limits.
• If you’re considering plans with proscribed care physician’s networks, don’t forget to check to find out if your popular general practitioners are in its Doctor’s Directory.
• Consider taking on a higher deductible if you’ve determine that a particularly attractive health plan won’t otherwise meet your budget. Or, if your family is unable to afford it then at the very least, buy into a catastrophic loss health care plan.

If you don’t currently carry a family health insurance plan for reasons of expense, they can be far more affordable and more valuable than many of us might judge. So, while you’re shopping for family-oriented health insurance coverage, try and remember that in the end, what you’ll be paying for is your own peace of mind and that if there were anything more precious to you than your spouse or children you wouldn’t have found your way here in the first station.

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Pet Medical Insurance

Questions to Ask Before You Steal a Pet Health Insurance Plan

Twenty years ago, if you suggested getting a pet health insurance policy, most pet owners would have taken it as a joke.

Not anymore. As veterinary treatments have gotten more advanced and sophisticated — and vet bills for serious conditions can quickly add up to thousands — buying pet health insurance is something to consider
Don Klingborg, DVM, is associate dean for extension and public programs and director of the Center for Continuing Professional Education at the University of California Davis School of Veterinary Medicine. He tells WebMD that only about 5% of U.S. pet owners have pet insurance. But in other countries, he says, pet medical insurance has caught on among a mighty higher percentage of the population.

One reason for the difference is the trend is newer here. Pet insurance appeared only about 15 years ago, but it is slowly building. Today, there are a handful of companies and organizations, including ASPCA, that offer plans.

If you have a unusual kitten or puppy — or an older pet about whose health you have concerns –here are some questions to assume before you buy a pet health insurance policy. And if you do decide to lift pet insurance, here are some tips you can exercise to help you choose a plan.

What is pet insurance?
“Pet insurance is very grand like human insurance,” says Jo Sullivan, executive vice president of external affairs for ASPCA, New York. She notes that the same general principles and array of options exist.

“Pets live longer and longer lives these days, thanks to advances in medical care,” she says. As treatment options have become more sophisticated and more widely available, they’ve also become more expensive. Veterinarians now routinely perform hip replacements and administer cancer treatments, Sullivan says. “But longevity definitely comes with a tag tag.”

Which types of pets are covered by pet health insurance?
Pet insurance plans primarily are for dogs and cats, Sullivan says. She’s not aware of any plans that cover more exotic or uncommon household pets, such as ferrets or snakes. “Everyone,” she says, “seems to be sticking to primary companion animals.”

What services does pet health insurance cover?
Basic plans offer reimbursement for accident or illness expenses only. But there are plans that cover such routine needs as vaccinations. Coverage on some plans may include dental care, flea prevention, prescription medicines, and common medical screening tests, such as blood work, fecal examination, and urinalysis .

With all plans, there can be caps or limitations on coverage. For instance, a company may pay only up to a certain amount per incident of illness or per accident.

Sometimes, pre-existing conditions are excluded. “Some of the higher-quality programs will waive pre-existing,” Sullivan says. Or a plan may not exclude a favorite pre-existing condition that requires fairly inexpensive treatments, she adds. Sullivan suggests that before you get a plan, you should ask about pre-existing condition coverage.

How much does pet health insurance cost?
Costs vary. Typically the fees are paid monthly and there may also be an annual fee.

Online quotes are easily accessible. For instance, an ASPCA basic plan for a one-year-old mixed Beagle puppy living in Los Angeles would cost $8.99 a month with an annual issuance fee of $10.50. It’s a level 1 opinion, which is basic accident coverage. Boosting coverage to accident and illness would increase the premium to $26.64 a month. A plan that adds wellness care would be $43.23 a month. The premiere plan, with the most extensive coverage, is $72.01 per month.

John Tait, DVM, president of the American Animal Hospital Association, says it’s important to ask if the premium changes as the pet ages. “Most,” he says, “are flat premiums that don’t change as the pet ages.”

How much does pet health insurance pay?
Pet health insurance plans range from basic to deluxe, and the coverage varies from understanding to plan. Typically, pet insurance plans are set up with a deductible that ranges from $100 to considerable higher. Then, Sullivan says, much like the human “fee-for-service” or indemnity model, the plans provide an 80% reimbursement for covered expenses.

Plans are likely not to pay for “cosmetic” procedures, Klingborg says. For instance, ear crops, often performed on show dogs, won’t likely be covered unless they are medically essential.

Plans offered online often include a schedule of coverages.

How can I find a reputable provider of pet insurance policies?
Asking your vet to recommend a view is a good first step. They’re not permitted to sell pet insurance, Sullivan says, so you don’t have to worry about them pushing “their” plan. She also tells WebMD that your vet will likely recommend a plan that other clients have had success with.

No single organization, as yet, sets policy or standards for pet health insurance, but plans are regulated state by situation by the state attorney general’s office. Sullivan says you can call your state attorney general’s office and ask if any complaints have been filed against the company or companies you are considering.

You can also ask others with the conception to tell you about their experiences.

What should I look for when shopping for a pet insurance policy?
It sounds obvious, but try to fit the policy to your pet’s needs and your own. If you can easily handle routine vaccination expenses for one pet, you may not need a wellness coverage policy.

But if you have four dogs or cats, such a plan might be cost-effective.

If you have questions after reading the marketing material, call the company and ask what is covered and what isn’t.

If you have more than one pet, Sullivan suggests you ask if you can get a group rate. Two dogs in a single household might pick up a group rate, but it’s less likely to be given to a dog and a cat under the same roof.

When should I buy pet medical insurance?
”’Better late than never is one approach,” Klingborg says. “However, it would make sense to look into it if you are bringing a original animal home.”

“A lot of these companies focus on wellness care,” Klingborg says. “So they will often provide very good reimbursement for the vaccination series and for spaying and neutering. All of those [services] are associated with fewer animal [health] problems in the future.”

If you wait, a health condition in an older dog or cat might rule out coverage.

Sullivan, for instance, can’t get coverage for her 16-year-old Lab, who has heart disease and a history of ear and knee problems.

You might ask your vet if your particular breed has a tendency for determined health problems, especially expensive or complicated problems, Tait says. “Saint Bernards and German Shepherds are prone to orthopedic problems,” he says. “Boxers are prone to heart problems. Puny dogs, like pugs, often have breathing problems.”

What are the pluses of covering my pet?
With a good coverage plan, you will be less likely to face substantial veterinary bills, of course. Also, your pet may be healthier if you are more likely to seize advantage of wellness checkups.

“It brings someone else’s wallet to the table,” says Klingborg, “particularly when you are facing an emergency situation.” Many animals are euthanized, he says, because owners simply can’t pay a large or unexpected vet bill.

Is pet insurance really worth it?
The answer hinges on a lot of factors, including personal finances and your own comfort with financial risks, say Tait and Klingborg. “I think it is a matter of personal risk tolerance, as the decision is with most other forms of insurance,” Tait says. Those with high risk tolerance may look at the premiums and decide not to use the money. They could effect the amount of the premium into savings and prepare that way for future health care expenses.

But animal owners with shameful risk tolerance may see the insurance as a plot to reduce that risk, especially if they have pets that may be prone to expensive health problems. For some, Klingborg say, having the insurance takes some of the uncertainty out of the future. “We can’t predict the future,”’ he says, “and insurance is there to help individuals when the unexpected happens to them.” Having the insurance, he says, might make the difference between saving an animal and having to make the painful decision to euthanize it.

But from a purely financial point of view, some experts contend that pet insurance premiums may not be wise for all animal owners. In a review in Consumer Reports, experts advised readers not to buy the insurance for managing checkup costs alone and advised owners with older animals to think affordable accident-and-illness policies (rather than more comprehensive plans) or to deposit the cost of premiums into an interest-bearing account instead.

Are there other ways to pay for costly for medical emergencies?
If you’re faced with a large bill, some veterinarians offer payment plans, sometimes at gross interest, Sullivan says.

Another option is to ask if your veterinarian works with a pet-care financing company. Many of these offer low-interest or no-interest plans if the balances are paid within a specified number of months, typically 3 to 18.

Source: Net

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This is a list of companies that hire telecommuters (for remote or virtual jobs) and companies that have hired telecommuters in the past – both as freelance telecommuters and remote workers as well as regular virtual employees.

When visiting the company websites, search for original job openings with the keywords “telecommuting”, “remote”, “home”, and “virtual”. Note that not all these companies are hiring telecommuters or remote workers at the moment and vacancies change often.

Aetna Life Insurance – http://www.aetna.com
Allegiance Health Care- http://www.baxter.com
AG Communication – http://www.agcs.com
Air Products and Chemicals, Inc. – http://www.airproducts.com
American Airlines – http://www.aa.com
American Express – http://www.americanexpress.com
Ameritech – http://www.ameritech.com
Allergan – http://www.allergan.com
Allstate Insurance – http://www.allstate.com
Apple Computer – http://www.apple.com
Arbitron Ratings Inc. – http://www.arbitron.com/jobs/home.htm
Art & Logic – http://www.artlogic.com
AT&T – http://www.att.com/employment/cpa.html
Bank of America – http://www.bofa.com/batoday/batoday.html
Banker’s Trust – http://www.bankerstrust.com
Baxter Healthcare – http://www.baxter.com
Bell South – http://www.bellsouth.com
Beneficial Corporation – http://www.profitable.com
Berlitz Translation Services – http://www.berlitz.com
Blue Cross/Blue Shield – http://www.bluecross.com
CFW Communications – http://www.cfw.com
Chevron – http://www.chevron.com
CIGNA – http://www.cigna.com
Cincinnati Bell – http://www.cinbelltel.com
CISCO Systems, Inc. – http://www.cisco.com
Citibank – http://www.citibank.com
Compaq Computer Corporation – http://www.compaq.com
Computer Curriculum Corp. – http://www.cccnet.com (Email: jobs@cccnet.com)
Connext Inc. – http://www.connext.com
Creative Freelance -http://www.freelancers.com
Creative Labs – http://www.soundblaster.com – Engineers.
Creative Freelancers- http://www.freelancers.com/

Dell Computer – http://www.dell.com
Diamond Multimedia Systems, Inc. – http://www.diamondmm.com – Software engineers, technical support, marketing and sales.
Digital Equipment Corporation – http://www.digital.com
Digital News – http://www.digitalnews.com
Digital Origin Inc.- http://www.digitalorigin.com
DSP TEchnology, Inc. – http://www.dspt.com – Software and application engineers.
DuPont – http://www.dupont.com
Ernest & Young, L.L.P. – http://www.ey.com
Eastman Kodak Company – http://www.kodak.com
EasyCom – http://www.easycom.com
Edify Corp. – http://www.edify.com -
Electronics for Imaging, Inc. – http://www.efi.com – Web developers and QA.
En Pointe Technologies – http://www.enpointe.com – Sales staff.
Equitable Life Assurance – http://www.equitable.com
Fannie Mae – http://www.fanniemae.com
Farallon Computing – http://www.farallon.com
The Federal Government – http://www.jobsingovernment.com

Gannett – http://www.gannett.com
GEICO – http://www.geico.com – They offer telecommuting and other flexible schedules.
General Electic Nuclear Energy – http://www.ge.com – Primarily looking for Engineers.
GTE – http://www.gte.com
GE Plastics- http://www.ge.com
Globalink Language Services http://www.lhsl.com/jobs/
Gymboree Corp. – Job Hotline 1-800-222-7758.
Hewlett-Packard – http://www.hp.com Software and hardware design engineers, manufacturing engineers, product marketing, sales development, finance and human resource professionals.
Hello Direct, Inc. – http://www.hello-direct.com
Honeywell – http://www.honeywell.com
Hughes Aircraft – http://www.hughes.com
Hypermedia Group, Inc. – http://www.hmg.com
IBM – http://www.ibm.com – programmers, user-centered design programmers, technical and customer service support., IBM also uses the services of contractors on a regular basis.
Inktomi Corp. – http://www.inktomi.com – Computer engineers.
Inprise – formerly Borland Inc.
/gi/dynamic/offsite.htm? site http://www.inprise.com/about/
Insignia Solutions, Inc. – http://www.insignia.com – Technical support, sales and customer service.
Intel – http://www.intel.com – Engineers.
Intellicorp, Inc. – http://www.intellicorp.com – SAP consultants.
Interactive Systems – http://www.interactivesystems.com
Intracorp – http://www.intracorp.com

JCPenney – http://www.jcpenney.com
Jet Propulsion Laboratory – http://www.jpl.nasa.gov/hrext/employment/
John Hancock Insurance – http://www.johnhancock.com
Johnson & Company – http://joandco.com/about/helpWanted.html
Journal Graphics – http://www.journalgraphics.com/Jobs/Current.htm
Knight-Ridder Information, Inc. – http://www.krinfo.com -
San Jose Mercury News – http://www.sjmercury.com -
LAM Research Corp. – http://www.lamrc.com -
Lanier Worldwide Inc.- http://www.lanier.com
Lawrence Livermore National Laboratory – http://www.llnl.gov – Computer engineers and optical electrical engineers.
LINK Resources Corporation – http://www.linkresources.com
Lucent Technologies- http://www.lucent.com/work/culture.html
Lumisys, Inc. – http://www.lumisys.com

Macromedia Inc. – http://www.macromedia.com
MacWEEK – http://www.zdnet.com
Maxtor Corp. – http://www.maxtor.com
McGraw Hill – http://www.mcgraw-hill.com
Meridian Data, Inc. – http://www.meridian-data.com
Merrill Lynch – http://www.ml.com/
Microsoft Corp. – http://www.microsoft.com
Molecular Devices Corp. – http://www.moldev.com
National Association of Insurance Commissioners – http://www.naic.com -
NEC Electronics, Inc. – http://www.nec.com – Telecommuting program handled on a case by case basis.
Netframe Systems, Inc. – http://www.netframe.com – They are looking for hardware and software engineers.
Netscape Communications Corp. – http://www.netscape.com The jobs hotline is 1-415-937-2783.
NewsBank – http://www.newsbank.com/
Newsbytes News Service – http://www.newsbytes.com/
Nike – http://www.nike.com
Nortel (Northern Telecom) – http://www.nortel.com/
Oacis Healthcare Systems – http://www.oacis.com – They are looking for
software development, clinical system and applications engineers.
Oak Technology, Inc. – http://www.oaktech.com – IC design and software
engineers.
Octel Communications Corp. – http://www.octel.com
Oracle Corp. – http://www.oracle.com
The Olsten Corporation – http://www.olsten.com/employ/index.html
Ortho-McNeil Pharmaceutical http://www.oracle.com

Pacific Bell – http://www.sbc.com
PC Week – http://www.zdnet.com
Peoplesoft, Inc. – http://www.peoplesoft.com – Software developers, back, consulting and trainers
Prime Computer Systems: http://www.primecomputer.net
Philips C&P Division – http://www.philips.com
Quantum Corp. – http://www.quantum.com
Quintus Corp. – http://www.quintus.com – Looking for quality assurance
engineers, professional services consultants and technical abet engineers.
Radius, Inc. – http://www.radius.com
The RAND Corporation: http://www.rand.com/careers/
Raytheon Systems – http://www.raytheon.com/rsc -
Remedy Corp. – http://www.remedy.com
Rockwell International Corporation – http://www.rockwell.com/jobs

Santa Cruz Operation, Inc. – http://www.sco.com
Sears, Roebuck & Co. – http://www.sears.com
The Seattle Times- http://www.seattletimes.com/
SEEQ Technology, Inc. – http://www.seeq.com -
Siemens Business Communication Systems, Inc. – http://www.siemens.com -
Sprint – http://www.trek.com
Sun Microsystems – http://www.sun.com
Symantec Corp. – http://www.symantec.com
Tab Products Co. – http://www.tabproducts.com
Texas Instruments – http://www.ti.com
UMI/Data Courier – http://www.umi.com
Unigroup Inc. – http://www.unigroup.com
United Press International – http://www.upi.com

Vanstar Corporation – www.skillnet.skillset.com/inacom
Verifone, Inc. – http://www.verifone.com
Verizon formerly Bell Atlantic – http://www.verizon.com
VirtualStaff – http://www.virtualstaff.com
Xerox – http://www.zerox.com
Xyratex- http://www.xyratex.com
Zitel Corp. – http://www.zitel.com

With seventy percent of health ailments being preventable, employers are getting serious about keeping their employees healthy. They are offering cash, cruises, vacation days and gift cards as incentives.

Highmark, a Blue Cross/Blue Shield licensee offers its employees 225.00 a year to get medical assessments and free nutrition and health coaching. The program is for all employees. They don’t have to be obese. The goal is to keep fit employees fit and help obese employees get fit.

Freedom One Financial Group offers a four-day cruise to Jamaica for employees that line up with specific weight loss or body fat reduction goals. After a three months challenge, 36 out of 70 employees had lost 30 pounds.

A few years ago, General Motors came up with the numbers for the increasing costs of hiring obese workers. The cost was approximately 1.4 billion annually. Therefore, employers are using money as the great motivator that will end up saving them billons in healthcare costs.

Approximately 65 percent of adults are overweight. In 2000, obesity costs for American companies reached a whopping 56 billion for that year alone. It is estimated that this cost will go up. 29 percent of newly hired employees were obese in the year 2000. As 2006 arrived, 29 percent had risen to 39 percent. Not only does obesity influence health care costs, but workforce productivity and equipment wear and tear.

In the past, employers had to pay for obesity related diseases for people ages 50-65. The numbers are getting lower. Younger people are becoming more obese as they enter the workforce. Now employers pay for the obesity related diseases of employees ages 25 to 65.

For now, these programs are having a small, but noticeable effect on the obesity of workers. Some companies have seen bigger changes in the heath of its employees. However, companies are still in an experimental stage for now. America’s obesity spot is complex and has been going on for years. It will take years to really see the stout payoffs of weight loss efforts. It will take the dedication of employer and employee, one day at a time, trading in a Big Mac for a Jamaica cruise.