Health Care and Disability

Disability claims often happen on the job, and typically can fall into short term or long term based on the severity of the injury. When you suffer from a situation that results in requiring you to leave work for an extended period of time, the most common period initially is within the first 90 days of when the injury occurs. Most companies recognize that if your disability lasts longer than three months, the disability period is considered long term and falls into that category for coverage if you are insured.

According to the US Social Security Administration, disability is something most people do not like to think about. But the chances that you will become disabled probably are greater than you realize. Studies show that a 20-year-old worker has a 3 in 10 chance of becoming disabled before reaching full retirement age. A huge amount of information about collecting disability payments based on qualifications for Social Security can be found at this website:  http://www.ssa.gov/pubs/10029.html#a0=0.

According to State Farm, But what would happen if you become disabled or ill and could not work How would you...

•Pay your bills?
•Make your monthly rent or mortgage loan payments?
•Buy your groceries?
•Make your car payments?
•Provide for your children's education?
•Save for retirement?

Most people don't realize the risk of becoming disabled, permanently or temporarily, at some point in their lives. But the reality is that at age 40, your chances of becoming disabled for 90 days or more prior to age 65 is 43%. (Source: 2004 Field Guide, National Underwriter). When evaluating the chances of disability, you should carefully consider sources of available funds:

1.) Employer coverage--How long would the business continue to pay you? How much would they pay you? When would your employer have to hire a replacement? Could the business afford to pay both?

2.) Using savings--If you saved 10% of your income each year, one year of total disability could wipe out 10 years of savings. Can you afford that?

3.) Obtaining a loan--Without an income, who will lend you money?

4.) Working Spouse or Partner--Can your spouse or partner earn enough and be a companion, parent, private nurse, and employee - all at the same time?

5.) Selling investments--Will a sale under forced conditions bring a true value? What will their value be at the time you are disabled?

6.) Collecting Social Security--You cannot collect benefits until the end of the fifth full calendar month of total disability and only if it is expected to last 12 months or more. What will you do if your disability doesn't meet those requirements? Even if it does, can you wait six months for payment?

7.) Counting on friends, family or charity--Would these sources have funds for you to use? Do you want to depend on them?

Many different disability insurance products are available to help protect you and your family against severe financial hardship that may accompany a disability. Much more options can be found at this site: http://www.statefarm.com/insurance/disability/disability.asp.

If you were to become disabled tomorrow and couldn't work for two or three months, would you have enough savings to cover your living expenses during that time? If not, you may want to consider short-term disability insurance, according to Insure.com. Plus, 1 in 7 people can expect to be disabled for five years or more before retirement. Statistics like that should make short-term disability insurance a vital piece of your overall financial plan.

What is short-term disability insurance? Short-term disability insurance pays a percentage of your salary if you become temporarily disabled, meaning that you are not able to work for a short period of time due to sickness or injury (excluding on-the-job injuries, which are covered by workers compensation insurance). A typical short-term disability insurance policy provides you with 40 to 65 percent of your pre-disability base salary, according to the Life and Health Insurance Foundation for Education. The National Association of Insurance Commissioners estimates that these benefits generally last between three and six months. Most short-term disability insurance policies have a "cap," meaning you receive a maximum benefit amount per month. Short-term disability insurance policies also have a limit on the amount of time you can receive benefits — up to two years, according to the Insurance Information Institute (III).

Short-term disability insurance, which is most often purchased as part of a group at work, can be paid by either the employer or the employee. Group short-term disability insurance policies are "guaranteed issue," meaning you do not have to take a medical exam to buy coverage, according to Insure.com. You can start receiving money from your short-term disability insurance policy with a waiting period of 0 to 14 days after becoming sick or disabled, according to the III. The actual time for coverage to kick in depends on whether you suffer an illness or injury. If you suffer an injury, your benefits will be paid immediately. If you suffer an illness, it may take longer because of the need to show that the illness is grave enough to be disabling.

For example, if you severely injure yourself by falling off a ladder at your house, your benefits would kick in immediately. However, if you suffer from a serious illness and can't go to work, your insurance may not kick in until eight days after you became ill. Your employer may have additional restrictions as to when your short-term disability insurance policy kicks in. For example, your employer may require you to use all of your sick days before you begin receiving payments from your short-term disability insurance policy. You also may receive retroactive benefits if you have a condition that worsens over time. Let's say you have a cold and you took three sick days at work. If your cold evolves into pneumonia, hospitalizing you for three weeks and preventing you from performing your job duties, you could receive disability pay retroactive to your first sick day. A huge amount of information on this topic can be found at this website: http://www.insure.com/articles/disabilityinsurance/short-term-disability.html.

According to this website: http://employeebenefits.about.com/od/ancillaryinsurance/a/STDBascis.htm, if you are an employer, you can create a policy dictating that employees use sick days before going on short term disability for an extended illness. You can also require documentation from a doctor to prove an illness or injury. Different short term disability plans dictate different terms for qualifications. The main terms are listed below:

•Employees need to work for the employer for a certain amount of time before coverage kicks in.
•Employees need to work full-time, usually 30 hours or more a week.

The following are part of what a short term disability plan benefits package may include:

•Percentage of weekly salary paid out (typically between 50% - 70% of weekly salary).
•Duration of short term disability benefits (typically between 10 to 26 weeks).
•Maximum amount of time covered under this disability program.

It’s also important to know the rules of the states where you have employees. While short term disability is not a requirement in most places, some states such as Hawaii, New Jersey, New York and Rhode Island mandate that short term disability benefits are provided for up to 26 weeks. You may also want as an employer a long term disability program in place once an employee’s short term disability ends. If an employee is still out of work due to illness or injury, a long term disability can help even further.

According to Smart Money, a typical group plan offered by an employer will replace up to 60% of your salary. Supplemental plans and individual policies will often cover up to 70% or 80%. (No plan will cover all of your salary for fear you will have little or no incentive to get back to work.) Benefits typically last for a set number of years (say five years) or until you reach retirement age. (Benefits typically stop around retirement age since once you retire, you would no longer be dependent on the income you generated by working, anyway.) If you pay the premium out-of-pocket meaning your employer doesn't cover the tab benefits are tax free.

Long term disability policies vary greatly. While some are iron-clad and pay benefits when you need them, others have more holes than a pasta strainer. Folks trying to save some money with a leaner plan may find it ultimately worthless. Typically, the cheaper plans have very strict definitions of disability, making it difficult to claim benefits over many years. Unless you're self employed, the first thing you should do is figure out if your employer provides long-term disability insurance in the first place. About half of mid- to large-sized firms offer benefits that last for at least five years, according to America's Health Insurance Plans.

As mentioned above, the typical group plan covers up to 60% of one's income. (This is offset by any other benefits you may receive from social security or worker's comp.) But the amount may actually be far less than that. That's because most group plans have a benefit cap of, say, $5,000 a month or $60,000 a year. Another surprise for many is that bonuses don't usually make it into the equation. A group plan will only insure your regular salary. Another shortcoming: Most group policies limit the amount of time it will pay benefits if you can't perform your job duties to just two years. After that, you'll need to prove you can't hold down job. Not only does this keep costs down for your employer, but the idea is that you can get new job training during those initial two years that you receive benefits

Long-term disability insurance kicks in once your short-term disability benefits run out. Unfortunately, there are no state laws that require employers to provide long-term disability, but it's estimated that half of all midsized to large firms do provide at least some insurance, according to Smart Money. If you do decide to buy an individual long-term disability plan or to supplement your employer-based insurance, be sure to find out how much short-term disability coverage you have. There's no reason to pay a premium for a long-term disability policy with a short elimination period of, say, 60 days when you have short-term coverage for six months.

If you are self-employed or not covered by your employer, it clearly makes sense to consider purchasing an individual plan. But even if you are covered at work you may want to consider supplementing what you've got: After all, you probably can't afford to live on just 60% of your salary. An individual plan will allow you to insure another 10% to 20% of your income. And in some cases, you may even be able to get individual coverage for a six-figure salary and a bonus something you'll never get with a group plan, according to Smart Money. Much more detail about disability insurance can be found at this site: http://www.smartmoney.com/plan/insurance/do-you-need-disability-insurance-17318/.

To factor how much you should consider paying for disability insurance, AARP has an online calculator to help you at this site: http://www.aarp.org/money/insurance/disability_insurance_calculator/. Here is a list of items you need to consider when calculating what amount of coverage you should purchase:

1.) Monthly net income--This calculation is done on an individual basis. Do not include your spouse's income.

2.) Current monthly living expenses--Remember to include your home or rent payments, food, clothing, gas, phone and other monthly expenses.

3.) Your monthly expenses while you are disabled--This amount is usually a little less than your original monthly expenses. The default value for this field is calculated as 70% of your current monthly expenses. You should keep in mind, however, that many expenses such as your mortgage, rent, utilities and food will most likely remain the same as before you were disabled.

4.) The number of months you expect a disability will prevent you from working--A common mistake is to underestimate the time it takes to get back to work.

5.) Your current monthly disability coverage--Make sure to include any disability coverage supplied by your employer.

6.) Length of coverage--Number of months that your current monthly coverage will last.

7.) What you expect for the average long-term or annual inflation rate--A common measure of inflation in the U.S. is the Consumer Price Index (CPI). From 1925 through 2011 the CPI has a long-term average of 3.0% annually. Over the last 31 years highest CPI recorded was 13.5% in 1980. If you are disabled for a short period of time, inflation is usually not a very important factor. However, you may need to consider the effect of inflation if you remain disabled for more than a few years.

If you are fortunate to live your entire life without suffering from a disabling event, you are fortunate as the odds can be stacked against you, especially if you work at a job that has significant stress or potential injury from the type or work you do for a living--for example warehouse, mill, or dock work, coal mining, policeman, fireman, or first responder, and many more high risk occupations. Be very careful at all times where you work, and always follow safety precautions. However, it is inevitable that many people get injured or sick and need extra financial assistance during extended leave from work. When you calculate what you need if you cannot work due to these types of situations, make sure that you protect yourself financially as much as possible. Even though you may never need it, the peace of mind from having extra coverage is worth the few dollars each month.

Until next time.

Health Care and Mono

They call it the kissing disease, but actually mononucleosis is an illness that can be contracted by exposure to someone who is carrying the bug in their system without having any direct personal contact. Mononucleosis, or mono, is often spread by saliva and close contact, according to the National Institutes for Health (NIH). It occurs most often in those age 15 to 17. However, the infection may develop at any age. Mono is usually linked to the Epstein-Barr virus (EBV), but can also be caused by other organisms such as cytomegalovirus (CMV).

According to WebMD, "mono," is a common viral illness that can leave you feeling tired and weak for weeks or months. Mono goes away on its own, but lots of rest and good self-care can help you feel better. It is most often seen in adolescents and young adults. Children can get the virus, but it often goes unnoticed because their symptoms are mild. Older adults usually do not get mono, because they have immunity to the virus.

Mono can be spread through contact with saliva, mucus from the nose and throat, and sometimes tears. If you have mono, you can avoid passing the virus to others by not kissing anyone and by not sharing things like drinking glasses, eating utensils, or toothbrushes. As soon as you get over mono, your symptoms will go away for good, but you will always carry the virus that caused it. The virus may become active from time to time without causing any symptoms. When the virus is active, it can be spread to others.

According to the NIH, mono may begin slowly with fatigue, a general ill feeling, headache, and sore throat. The sore throat slowly gets worse. Your tonsils become swollen and develop a whitish-yellow covering. The lymph nodes in the neck are frequently swollen and painful. A pink, measles-like rash can occur and is more likely if you take the medicines ampicillin or amoxicillin for a throat infection. (Antibiotics should NOT be given without a positive Strep test.) Symptoms of mononucleosis include:

• Drowsiness
• Fever
• General discomfort, uneasiness, or ill feeling
• Loss of appetite
• Muscle aches or stiffness
• Rash
• Sore throat
• Swollen lymph nodes, especially in the neck and armpit
• Swollen spleen

Less frequently occurring symptoms include:

• Chest pain
• Cough
• Fatigue
• Headache
• Hives
• Jaundice (yellow color to the skin)
• Neck stiffness
• Nosebleed
• Rapid heart rate
• Sensitivity to light
• Shortness of breath

Much more detail about mono and how to deal with it can be found at this website: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001617/ .

Symptoms usually start 4 to 6 weeks after you are exposed to the virus, according to WebMD. Mono can cause the spleen to swell. Severe pain in the upper left part of your belly may mean that your spleen has burst. This is an emergency. Your doctor will ask you questions about your symptoms and examine you. You may also need blood tests to check for signs of mono (monospot test) and the Epstein-Barr virus. Blood tests can also help rule out other causes of your symptoms. Usually only self-care is needed for mono:

• Get plenty of rest. You may need bed rest, which could keep you away from school or work for a little while.
• Gargle with salt water or use throat lozenges to soothe your sore throat.
• Take acetaminophen (such as Tylenol) or ibuprofen (such as Advil) to reduce fever and relieve a sore throat and headaches.
• Avoid contact sports and heavy lifting. Your spleen may be enlarged, and impact or straining could cause it to burst.

In severe cases, medicines called corticosteroids may be used to reduce swelling of the throat, tonsils, or spleen. More material on Mono can be found at this site: http://www.webmd.com/a-to-z-guides/infectious-mononucleosis-topic-overview .

According to MedicineNet.com, research has shown that, depending on the method used to detect the virus, anywhere from 20%-80% of people who have had mononucleosis and have recovered will continue to secrete the EBV (Epstein-Barr virus) in their saliva for years due to periodic "reactivations" of the viral infection. Since healthy people without symptoms also secrete the virus during reactivation episodes throughout their lifetime, isolation of people infected with EBV is not necessary.

It is currently believed that these healthy people, who nevertheless secrete EBV particles, are the primary reservoir for transmission of EBV among humans. Patients can continue to have virus particles present in their saliva for as long as 18 months after the initial infection. When symptoms persist for more than six months, the condition is frequently called "chronic" EBV infection. However, laboratory tests generally cannot confirm continued active EBV infection in people with "chronic" EBV infection.

There can be rare complications due to contracting mono, which is typically not seen in healthy people, according to MedicineNet. Fortunately, the more severe complications of mono are quite rare, and mono is very rarely fatal in healthy people. The rare severe complications include destruction of red blood cells (hemolytic anemia) and inflammation of the sac surrounding the heart (pericarditis), the heart muscle itself (myocarditis), and the brain (encephalitis). Mono tends to be more aggressive in patients with abnormal immune systems, such as people with AIDS or those who are taking medications that suppress immune function.

The EBV has been associated with some types of cancers, most commonly lymphomas. This occurs most frequently in people whose immune systems have been compromised due to disease or immune suppressive drugs. EBV infection has also been found to be associated with two types of cancer found in other cultures -- nasopharyngeal carcinoma (cancer of the pharynx and nose) in southern China and Burkitt's lymphoma of the jaw among children in equatorial Africa. Further, numerous studies have also found that EBV infection is associated with the development of at least one subtype of Hodgkin's disease. However, since the vast majority of people have been infected with EBV and never develop these types of tumors, EBV infection cannot be the sole cause of these cancers. The overwhelming majority of people who have had mono recover completely without any serious complications. Much more detail can be found at this website: http://www.medicinenet.com/infectious_mononucleosis/article.htm .

According to the Mayo Clinic, mononucleosis can be a prolonged condition, keeping you at home for weeks as you recover. But be patient with your body as it fights the infection. For young people, having mononucleosis will mean some missed activities — classes, team practices and parties. Without doubt, you'll need to take it easy for a while. Students need to let their schools know they are recovering from mononucleosis and may need special considerations to keep up with their work. If you have mononucleosis, you don't necessarily need to be quarantined. Many people are already immune to the Epstein-Barr virus because of exposure as children. But plan on staying home from school and other activities until you're feeling better. Seek the help of friends and family as you recover from mononucleosis. College students should also contact the campus student health center staff for assistance or treatment, if necessary. More info can be found at this website: http://www.mayoclinic.com/health/mononucleosis/DS00352 .

If you suspect that you or a family member may be coming down with mononucleosis, consult a physician or health care provider as soon as possible. Containing the contagious disease as early as you can helps to prevent the spread of mono to others. Be careful not to over exert yourself, and follow the advice of your doctor. Although not fatal in most cases, there are some lingering issues that can cause more problems if you don’t treat it as prescribed.

Until next time.

Health Care and Menopause

Menopause is a universal and irreversible part of the overall aging process involving a woman's reproductive system, after which she no longer menstruates, according to MedScape. The menopausal transition (MT) is characterized by hormonal changes and clinical symptoms that occur over a period leading up to and immediately post menopause. This period is frequently termed the climacteric, and/or perimenopause, but mostly recently is coined the menopausal transition.

Menopause is the permanent end of menstruation and fertility, defined as occurring 12 months after your last menstrual period, according to the Mayo Clinic. Menopause is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss. Even though menopause is not a disease, women shouldn't hesitate to seek treatment for severe symptoms. Many effective treatments are available, from lifestyle adjustments to hormone therapy.

Technically, women don't actually "hit" menopause until it's been one year since their final menstrual period, according to the Mayo Clinic. In the United States, that happens at about age 51, on average. But in the months or years leading up to that point, women might experience these signs and symptoms:

• Irregular periods
• Decreased fertility
• Vaginal dryness
• Hot flashes
• Sleep disturbances
• Mood swings
• Increased abdominal fat
• Thinning hair
• Loss of breast fullness

The Mayo Clinic has lots of additional information about menopause, located at this site: http://www.mayoclinic.com/health/menopause/DS00119.

According to the North American Menopause Society (NAMS), physical signs of menopause begin many years before the final menstrual period. Perimenopause (literally meaning “around menopause”), can last 6 years or more, and by definition, ends 1 year after the final menstrual period. Perimenopausal changes are brought on by changing levels of ovarian hormones such as estrogen. During this transition time, estrogen levels gradually decline, but they do so in an erratic fashion. Sometimes they can even be higher than during the reproductive years. During perimenopause, a woman may be able to conceive, although fertility is very low. If pregnancy is not desired, contraception is necessary until menopause is reached.

When a woman suspects she is experiencing perimenopause, it is an excellent time to have a complete medical examination by a qualified health professional. According to NAMS, the diagnosis of perimenopause can usually be made by reviewing a woman’s medical history, her menstrual history, and her signs and symptoms. In most cases, testing hormonal blood levels is not recommended because in menstruating women hormone levels are changing all the time. However, in younger women (below 40) menstrual irregularity is infrequently a sign of menopause, so hormone testing may be a useful tool to test whether menopause has occurred.Testing blood hormone levels can also be helpful in assessing a woman’s fertility and potential for pregnancy. Results can help women make decisions about beginning or adjusting medications and help them understand their personal biological clock. For some women, it may make sense to test for other causes of symptoms that can mimic perimenopause, such as thyroid disease.

What about testing for follicle-stimulating hormone (FSH)? Sometimes, elevated FSH levels are used to confirm menopause. FSH is a hormone produced by the pituitary gland that triggers the ovaries to secrete estrogen. As the ovaries’ production of estrogen declines around menopause, the pituitary gland releases more FSH into the blood to try to stimulate estrogen production. So, when a woman’s FSH blood level is consistently elevated, and she is no longer having menstrual periods, it is generally accepted that she has reached menopause. However, a single FSH level can be misleading in perimenopause because estrogen production doesn’t fall at a steady rate from day to day. Instead, both estrogen and FSH levels fluctuate from fairly high to fairly low during perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid. Some healthcare practitioners recommend testing a woman’s saliva for estrogen levels, but there is no conclusive evidence that this test provides useful information around menopause. Much more information can be found at their website: http://www.menopause.org/.

What are the complications and effects of menopause on chronic medical conditions? According to MedicineNet.com, one of them is the increased risk of osteoporosis. Osteoporosis is the deterioration of the quantity and quality of bone that causes an increased risk of fracture. The density of the bone (bone mineral density) normally begins to decrease in women during the fourth decade of life. However, that normal decline in bone density is accelerated during the menopausal transition. As a consequence, both age and the hormonal changes due to the menopause transition act together to cause osteoporosis. The process leading to osteoporosis can operate silently for decades. Women may not be aware of their osteoporosis until suffering a painful fracture. The symptoms are then related to the location and severity of the fractures.

The second health risk is cardiovascular disease, according to MedicineNet. Prior to menopause, women have a decreased risk of heart disease and stroke when compared with men. Around the time of menopause, however, a women's risk of cardiovascular disease increases. Heart disease is the leading cause of death in both men and women in the U.S. Coronary heart disease rates in postmenopausal women are two to three times higher than in women of the same age who have not reached menopause. This increased risk for cardiovascular disease may be related to declining estrogen levels, but in light of other factors, postmenopausal women are not advised to take hormone therapy simply as a preventive measure to decrease their risk of heart attack or stroke. A significant amount of material on this health care topic concerning menopause can be found at this site: http://www.medicinenet.com/menopause/article.htm .

According to the National Institute on Aging (NIA), as a woman, staying healthy after menopause may mean making some changes in the way you live:

• Don't smoke. If you do use any type of tobacco, stop—it's never too late to benefit from quitting smoking.
• Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals.
• Make sure you get enough calcium and vitamin D—in your diet or with vitamin/mineral supplements.
• Learn what your healthy weight is, and try to stay there.
• Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health.

Here are some other things to remember, according to the NIA:

• Take medicine if your doctor prescribes it for you, especially if it is for health problems you cannot see or feel—for example, high blood pressure, high cholesterol, or osteoporosis.
• Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort.
• Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed.

Menopause is not a disease that has to be treated, according to the NIA. But you might need help if symptoms like hot flashes bother you. Here are some ideas that have helped some women:

• Try to keep track of when hot flashes happen—a diary can help. You might be able to use this information to find out what triggers your flashes and then avoid those triggers.
• When a hot flash starts, try to go somewhere cool.
• If night sweats wake you, sleep in a cool room or with a fan on.
• Dress in layers that you can take off if you get too warm.
• Use sheets and clothing that let your skin "breathe."
• Have a cold drink (water or juice) when a flash is starting.

You could also talk to your doctor about whether there are any medicines to manage hot flashes. A few drugs that are approved for other uses, for example, certain anti-depressants, seem to be helpful to some women. Much more info can be located at this website: http://www.nia.nih.gov/health/publication/menopause .

Menopause can be treated, and it makes sense to see a primary care doctor if the symptoms appear to be troublesome. The condition can get worse in some women. Find out about available information and resources to deal with this health care issue. What you learn can help you through the emotional and physical trauma.

Until next time.