Determining if Leave Counts towards FMLA

At Linton and Associates, we are always thinking of new things to inform the public about that could benefit their health, well-being, and wallets. Being that Flu season is in full effect, we thought that we would take the time to explain President Clinton’s mandated FMLA laws.

This blog posts explains the FMLA laws and touches on how your ‘leave of absence’ qualifies towards FMLA.

Breaking Down FMLA

Being that not everyone out there knows what the FMLA is we are going to start with a quick and simple explanation of it. The Family and Medical Leave Act (FMLA) was established in 1993 by President Clinton.

In short, it allows you 12 weeks of paid absence from your full-time job. 

You don’t get to miss 12 weeks from your part-time gig at the burger joint. Pneumonia or not, if you miss that much time from a part time job, you are going to get let go.

During these 12 weeks, you receive full pay for your usual work week. While this is typically a five-day work week, if you have a job that often works you 6 or 7 days a week, then you will be compensated for those as well.

Of course, you don’t get to just take an FMLA leave of absence whenever you want. So when does your leave of absence begin to qualify towards the FMLA and those 12 weeks of paid absence?  

Determining if Your Absence Qualifies

We say qualifies because honestly who wouldn’t want sick pay? Sure, being sick is no good, but being the optimists that we are at Linton and Associates we tend to look for the light in the darkness. In this case, that light is the FMLA.

If you are forced to take a leave of absence from your career because of a serious illness or health issue, then you will qualify for deduction of time from your 12 weeks maximum allotted sick pay. 

If a very bad strain of the flu puts you on bed rest for two weeks, then you don’t need to be worried about not getting paid because the FMLA will kick in.

However, the FMLA is called the Family and Medical Leave Act for a reason. If a family member falls ill and you are forced to care for them or handle a family members passing or another tragic event in the family, then you also qualify under the FMLA and would be able to be paid. 

New Mexico’s Health Insurance Safety Net

With so many changes to health insurance and the laws behind regulating who gets what, it is important to continue our coverage of these changes to keep you well-informed.  

Among these changes are some alterations to the pre-existing health insurance safety net. 

The first thing we will be covering in this blog post what a health insurance safety net actually is and the purpose it serves.

The Safety Net

The health insurance safety net was created to help insure the small group of people who were ineligible for health insurance. The reasons for this can vary from an employer not providing it to lack of funding to afford it on their own.

Sometimes, it can even be the insurance company’s refusal to take them on as a client because of a pricey preexisting condition. 

These ‘high risk’ individuals as they are called could essentially lose money for the insurance company and though it may not be fair that is how it has worked for quite awhile. Luckily, the safety net has been able to help some of the people in the high risk pool.

Typically, each state has one of these safety nets in place. Here, in New Mexico, that safety net comes in the form of The Alliance. 

They are a unique, non-profit organization here in New Mexico whose sole purpose is to help people and small businesses that do not normally qualify for health insurance get insured. They offer a choice of insurance types -- from HMOs to PPOs -- among other great features including:

•  Your choice in medical plans. They don’t throw you in what is cheapest. Instead, they give you options and that allows you to pick what best fits you and your lifestyle.
• No health screening. This means that you don’t need to be worried about being rejected from a company because of a pre-existing condition. This is a good thing being that some companies have the gall to call pregnancy a pre-existing condition.
• A very good benefits plan that will cover all of your bases. This means you get a physician, reoccurring visits to the doctor’s office, and even access to prescription drugs if you are sick.
• You aren’t stuck with one plan. You have to option to change annually.
• Probably one of the best features for small business employers is groups as small as 1 or 2 employees have been covered, and these only require 50% of eligible employees to be on the plan.

Getting health care can be tough in today’s day and age, but with The Alliance here to help you may not be as far away from a good health plan than you first thought.  

Getting Health Insurance with a Preexisting Condition

Health problems are a pretty big deal and it is no wonder why they can be absolutely terrifying even with health insurance coverage. What happens if you have health problems with no insurance though? 

It happens all over the country and while the health care reform is hoping to lessen the numbers of those that go without the option for health care, it can still be quite a challenge to attain the care you need for your conditions.

There are many factors as to why a company can deny your health insurance coverage, but typically it will come down to one simple factor. Just how much are you going to cost them? 

An insurance company wants you to pay in without them having to ever payout much. It is how they make their money and why many companies will deny coverage to those with preexisting health conditions.

Know Your Options

They key to getting health care when you already have some kind of health condition is to know your options and not give in easily. Obviously, your first step is to talk to your employer, find out if they have health care options, and determine what you need to do to get on the plan. 

Ask if your employer is considering adding a company health care plan in the future and respectfully make your case and explain your situation. A decent employer may be more understanding than you might think.

The reason why getting insurance through your job is your best option is because an insurance company by law cannot exclude you on a group policy because of your health condition. 

Of course, we aren’t all in the same position and many of you may not have the option to turn to your employer, so what now? 

Now you work because if you don’t work hard and push for yourself, you will not see any results and be stuck without health insurance.

You will have to contact a lot of insurance companies and be prepared to pay the fees and costly payments of having your very own policy. 

At Linton and Associates, we have prepared a list of health care providers in New Mexico that may very well be able to assist you with your dilemma. 

Be sure to check it out here. Remember that if you have any questions or concerns, feel free to contact us and we would be more than happy to assist you in any way we can. 

Group Insurance vs. Individual Insurance – It’s Not a Competition

With the Health Care Reform passed, most everyone has had a few questions on how and why things are changing and how it will affect them. 

At Linton and Associates, we have tried to answer these questions for you, but in the end there are always more to be answered.

For instance, which is better -- group insurance plans or individual insurance plans?

 Honestly, it is not about which is better but about which is better for you. In this blog post, we are going to break down what group insurance plans are and what individual insurance plans are as well as help you to identify which best suits you because, come 2014, everyone will have to be insured.

Group Insurance Plans

Group insurance isn’t something that you, as an individual, just goes out and buys; it is the most popular of insurance plans and most commonly seen in practice at the office. Group insurance is the type of health insurance that is offered to you through a company.

You pay a small portion of the premium and you get what is called employee benefits. Since your boss is dealing with the insurance company, you don’t have to worry about them, excluding some type of healthcare from the plan because of a defect in your family history.  

So, why do insurance companies offer group insurance? Well, simply put, it’s because though there is a chance of loss to be factored in. 

For the most part, health care with employees promotes good health and makes them less likely to grow severely ill with regular doctor’s checkups and such.

Not to mention that all the employees paying a monthly premium makes for good money in the insurance world. In short, group insurance is a win-win – that’s a win for both the insurance company and the people.

Individual Insurance Plans

These plans are designed for individuals. Most often, the people who opt to purchase them are either self-employed or unemployed. These plans are expensive due to being high risk for most insurance companies, and these factors have actually led to many companies not offering this service any longer. 

However, if you are self-employed and cannot access a group insurance plan, there is not always a choice, which is why many Americans go without health insurance every year.

When it comes to choosing health insurance, it always comes down to what you need and have available. 

Many people would prefer employee benefits, but they do not always have the option and so they then can choose to try and qualify for the individual plan or just not have it at all.

Linton and Associates is a firm supporter of the health care reform because everyone should have access to insurance, so we are here to help with specific group insurance solutions and individual insurance solutions that will hopefully fit your budget and needs. 

Invest in Your Future with Retirement and Healthcare Knowledge

 It is hard enough to think about the next few weeks let alone your retirement years from now. But, it is important to educate yourself now about retirement and health care so you can make smart decisions that will impact on how comfortable you are in the future and how much enjoyment you can get from your retirement.

With this in mind, we have prepared a few tips to ensure a much smoother retirement process, especially where your healthcare is concerned.

Tried and True Investment Tips

Here are some things to think about when it comes to retirement planning and health care issues in the future:

• So you’ve worked at some big business company for 30 years and are expecting a pension and full range of sweet benefits to be coming your way once you retire. Well, you just got laid off, the company just cancelled their 401k plans because well, have you seen the economy lately? It might not happen to you, but it could so whatever you do, so don’t put all your eggs in one basket. Have some other retirement options outside of work in process.
• Work towards Medicare. Why? Simply put, in this economy, it is the smartest thing to do. Medicare is big and likely to stay afloat. It’s simple, critical, and the realist way of looking at things, but it’s the truth.
•  Of course, you could always work a little longer. Sure, it’s not quite ideal and probably wasn’t part of the plan. However, things don’t often go to plan and this can help you to put away more of a savings to help live off of if that pension should fall through.
• When considering your health in the long term, try and remember that eventually you could wind up with a care giver or in an assisted living home. Why does this matter? Mainly because these kinds of long-term care cost a lot of money. They offer insurance in this too. Sometimes though, it can be viewed as a scam because you can’t know for sure if and when you will need it and might end up paying into it for nothing. However, it is also an investment that could be very beneficial should you need it.

These are all things to keep in mind where health care and retirement are concerned. At Linton and Associates, we realize that the ideal situation isn’t always the real one.

 This is why we work to educate the people about the truth behind what is going on in the insurance world. We want everyone to make the most informed decisions about their insurance purchases and future.

How Your Small Business can Benefit from the Health Care Reform

From the very beginning, there has been a lot of talk about the Health Care Act. There have been the naysayers and those in full support of it. 

People have called it many names and screamed that it is unconstitutional. That is until the Supreme Court declared it constitutional.

At Linton and Associates, we support the Health Care Reform because it can help to bring quality health care to those who previously did not have access to it. 

As for small business owners out there, it can help you, too. You just need to know what to do and how to reap the benefits. This blog will show you some of those answers.

Rules…Always Rules

The biggest and most obvious rule put into play by the Health Care Reform is, of course, mandated insurance, but that does not really affect businesses. It just impacts the individual employee, which is why we are bringing it up. Employers should keep in mind that it may be in everyone’s best interest for them to begin providing health insurance through the state exchanges.

Next, we have the rule that affects businesses with 50 or more employees. Now you may be thinking, “Why talk about a bigger business, should not this just be covering the smaller businesses?” 

What is big and what is small? Everyone has their opinions on the matter. Sure, 50 employees is quite a lot to someone with 10, but it’s nothing compared to one with 100. The bottom line is that this next part is important.

If your business has 50 or more employees, you absolutely must provide them with substantial health care (60% coverage at the very least and the fees cannot be more than 9.5% of the families salary).  If you do not follow this rule, then you will face fines and these are very steep fines as they start at about $40,000. Yes, that is a lot of zeros, so please if you have 50 or more employees or will by 2014, get them covered.

Contact us as we can help you get ready for these changes and set you up with affordable health care coverage.

Reaping the Rewards

Okay, so the rewards may not seem that great. However, there is a major way to benefit from this whole ordeal if you are a small business (which is defined as having fewer than 25 employees that average less than $50,000 a year).

Thanks to that tax credit from 2010 staying in play, it pays to insure your employees. You can get a substantial tax credit and build towards a nice return, which is always good. 

Linton and Associates Guide to Health Care Terms

If you have been to a health insurance office, talked to a representative on the phone, or ever made a claim on your policy in order to have your insurance company cover something, then you have probably heard a few different health insurance terms at some point or another. 

But, did you understand them or did they perhaps leave you feeling baffled?

At Linton and Associates, we want our customers to be as informed about what their health care involves and what all the technical ‘stuff’ means. This is why we have prepared the is guide to some of the more commonly used health insurance terms and have even explained them for you in plain English.

Key Health Care Terms and What They Mean

There are many health insurance terms and, while we can’t cover them all, we are sharing the ones we find most common and relevant below:

• Alternative Care is the action of visiting a chiropractor or homeopathic doctor for medical treatment. Not all health insurance will cover alternative care treatments.
• The Carry-Over Deductible allows the last three months of the current years deductible to be brought over into next year provided you haven’t used it all up.
• Co-pays are the fees you must pay when visiting your physician; it is typically a small amount anywhere between $10 and $40 per visit.
•  A Deductible is typically the amount you pay per calendar year to be provided health insurance.
• The Gate-Keeper is your primary doctor i.e., the expert you visit for all your medical needs and who decides if you get the prescription or referral that you are requesting.
•  Indemnity is a term used to describe a plan that covers loss, injury, and damages incurred. The amounts that are covered will vary depending on the plan.
• Insurance Broker is a company or individual that sells insurance policies. Linton and Associates is a great example of an Insurance Broker.
•  Limitations are the coverage limits that each plan has and these vary from plan to plan.
• The Waiting Period is the time that you must wait while employed with a company to fall under the company’s health insurance benefits. It is essentially a probationary period that can be compared to the type of waiting period that some companies call ‘training period.’

When it comes to medical insurance terms, the list is extensive. 

At Linton and Associates, we don’t like to keep our customers in the dark, which is why we hope that this glossary has some light on a few things. 

Remember, if you have any questions, always feel free to contact us and we would be happy to help you.