2815 Coburg Road Eugene OR 97401 ph: 345-0338

4J Benefits and Wellness Newsletter

Prepared by Mike Caley 687-3244 January 10, 2007 Issue No. 216

EXERCISE – NOW’S THE TIME (back to top)
A fine article in the December 2006 Duke Medicine HealthNews entitled Use It or Lose It: It’s Never Too late to Start, highlights the fact that Americans are losing the battle against overweight and obesity. In summary of that article:

• 63% of U.S. adults were overweight or obese in 2005 compared to 58% in 2001.
• Extra weight increases the risk for serious health conditions including diabetes, heart disease, cancer, arthritis, hypertension, thyroid disorders, stroke, lung disease, asthma, and kidney disease.

  An interesting parallel exists between the rate of overweight/obesity and rate of regular exercise

• Over 60% of American adults fail to exercise regularly; 25% do not exercise at all
• Only 21.9% of men and 17.5% of women do regular strength training
• By age 75 the number of people who participate in some form of moderate physical exercise on a regular basis drops to about 20% with women more likely to be inactive than men

As the title of the article implies however, its purpose is not to just decry the alarming state of the weight and lack of exercise dynamic but to reinforce the idea that now is the time to start exercising if one is not now already doing so, regardless of age. In summary, positive potential outcomes of beginning/maintaining a regular exercise routine include:

• An inactive person who starts exercising after age 40 can slash his or her risk for coronary heart disease by about 55%
• Women, age 25-44 who did resistance training twice a week were more likely slow down the accumulation of visceral fat in the abdomen that is associated with heart disease
• Those more physically active in mid-life are more mobile in old age
• And, contrary to popular belief, moderate exercise will not harm or strain the heart among those with mild high blood pressure

In short, a lifestyle that incorporates regular physical activity – the most strenuous that your physician feels is safe for you – and that includes strength training and stretching of major muscle groups, will most likely increase both the quantity and quality of your years.

THIRD-PARTY LIABILITY–A FOLLOW-UP (back to top)
In last month’s newsletter I explained the concept of third-party liability with a proven strategy for dealing with the request from the insurance company to document that a claim was/was not the result of an accident for which another party (individual or insurance carrier) should be liable. A recent example of the importance of dealing with such a request in a timely manner has crossed my desk and warrants this follow-up article.

Failure to respond to a request for information by the insurance carrier and to keep the medical provider informed that you are actively working with the carrier to get the claim resolved and paid can result in a bill for services being turned to a collection process. A recent case such as this resulted in a garnishing of an individual’s wages.
It is important to understand that such an action is not one brought by the insurance carrier but rather by the provider whose billing system includes a process for using collection agencies to recover payment for unpaid accounts.

Please attend to requests by the insurance carrier for additional information on a claim in a timely and proactive manner to prevent unpleasant consequences. Call me if you have questions.

COORDINATION OF BENEFITS–HOW IT WORKS (back to top)
Coordination of Benefits (COB) is a difficult concept to understand or explain but I make an attempt every couple of years – and it’s that time again.

For those of you covered on the district plan that also have double coverage under a plan with your spouse or domestic partner, you probably have a COB provision that provides enhanced coverage – in many cases 100 percent. Here is how it works.

When you visit a medical provider they will, in most cases, bill both your primary and secondary insurance plans for the services provided. The primary plan will pay first (deductibles and coinsurance percentages apply fully).
Then the secondary plan will view the claim as if they were the only insurance in place and, like the primary plan, apply deductibles and coinsurance percentages, but since they will, in most cases, only have to pay a smaller amount to the provider to cover the remaining charges, than they would were they the only insurance in place, they then apply the amount they have saved to a “Credit Savings” account in your name. Over the course of the plan year, that accrued “credit savings” amount can be used to reimburse you, via check, for any eligible but uncovered medical expenses. In most cases the only eligible expenses that will be or have been not covered during the plan year are the deductibles that a member has paid. These then become eligible for reimbursement by the secondary plan.

So, depending on the amount of plan usage you experience during the remainder of the plan year after the deductible has been met, the insurance carrier may reimburse you for some, or all, of the deductible paid earlier. All of the 4J Regence plans have full COB and “Credit Savings” provisions. If your secondary coverage is with a spouse’s or domestic partner’s non-4J plan, you will have to read their plan book or contact their carrier to find if that plan coordinates benefits similarly.

MENTAL HEALTH BENEFITS (back to top)
In the January 3 issue of the Register-Guard there was an article regarding mental health benefits in Oregon. Specifically, a bill passed by the Oregon Legislature requires that there be parity (no difference) between coverage for mental health conditions and physical conditions as of January 1, 2007. What the article does not make clear is that plans are to implement on plan renewal dates that occur on or after that date -- for us that will be on October 1, 2007.

Michael Caley
Licensed-Staff Benefits Coordinator
Eugene School District 4J
200 North Monroe
Eugene, OR 97402-4295
Phone: W: 541-687-3244 H: 541-485-1493
fax: 541-687-3687 e-mail: caley@4j.lane.edu