Ten tips: If disability strikes, be ready

Most working adults in the United States would not be capable of paying their bills for very long if they became disabled and lost their ability to earn a living. It's important to know what kinds of financial assistance might - repeat, might - kick in if something bad were to happen during your working years.

1. KNOW YOUR COMPANY'S SICK LEAVE POLICY. How much sick leave do you have at full pay? Can you accumulate sick leave over time? Do so if possible, and also find out whether your employer provides short-term disability insurance, which usually lasts 26 weeks.

2. UNDERSTAND HOW WORKERS' COMPENSATION WORKS. The only way you can be eligible is if your disability is caused by an accident on the job. Workers' comp provides medical benefits and cash, typically two-thirds of your average weekly wage.

3. INVESTIGATE SOCIAL SECURITY DISABILITY INSURANCE. To get this coverage, you have to prove that your disability is so serious that you won't be able to work for at least a year, and also show that you've worked long enough and paid enough Social Security taxes. Two-thirds of first-time applicants get denied. (You can appeal the decision.)

4. ASK ABOUT LONG-TERM GROUP DISABILITY COVERAGE. Your employer may or may not provide this coverage. About 40 percent of workers at medium-sized and large firms have group disability coverage, meaning many employees do not.

5. FIND OUT WHAT YOUR GROUP COVERAGE COVERS. If you have it, this insurance typically provides 60 percent of your former income, maxing out at $5,000 a month; some plans limit the benefit to $3,000 a month. You may have to work at the company for several years before qualifying.

6. GET A CLEAR DEFINITION OF "INCOME.' If you'll be getting 60 percent of your former income, clarify whether that income includes overtime, bonuses, commissions or pretax contributions to a 401(k) plan. (Warning: It might not.) Also, brace yourself for a big tax wallop. You'll owe income taxes on any disability coverage bought by your employer.

7. SUPPLEMENT GROUP COVERAGE WITH INDIVIDUAL COVERAGE. If you buy additional coverage on your own, you can take it with you when you change jobs, and it will be tax-free. Comprehensive coverage can be costly, although you can find accident-only disability policies for $25 a month.

8. OR YOU CAN BUY EXTRA GROUP COVERAGE. Group coverage always costs less than individual coverage, so you could buy additional insurance through your employer to save money. The amount you buy would be tax-free, but you wouldn't be able to keep the coverage if you switch jobs.

9. REDUCE YOUR PREMIUMS. If you're paying for individual or extra group coverage and your insurer knows you have a condition such as diabetes or heart disease, you may be able to lower your premiums by documenting any health improvements. Be sure to let your insurer know if you lose weight, quit smoking or commit to a regular exercise routine.

10. BE PREPARED FOR STAGGERED HELP. Even if you qualify for all of the above-mentioned benefits, you can't tap them at the same time to increase the amount of money you have coming in each month. Workers' comp usually activates first, followed by Social Security disability, then group disability.

Sources: Kiplinger's Personal Finance magazine (www.kiplinger.com) Life and Health Insurance Foundation for Education (www.life-line.org) Florida Division of Workers' Compensation (www.fldfs.com/WC/) Social Security Administration (www.ssa.gov/disability/)

Insurers Expanding Public Access to Medical Cost Information

Shopping for information about the cost and quality of medical care is becoming easier for patients as health insurers compete to become more consumer-friendly.

Insurers are coming up with new ways to provide price and service information to customers who are being called on to take more responsibility for their health insurance.

Aetna Inc. announced last week that as of Aug. 18, it will provide online access to physician costs, clinical quality and efficiency information in Connecticut, six other states and Washington, D.C. Price information will be available in four other states.

The information will be available to all Aetna members. But the new information will be particularly useful to consumers with high-deductible health plans tied to health savings accounts or health reimbursement arrangements.

"While purchasing health care is a much different decision than buying a house or a car, we firmly believe that consumers should ultimately have access to exactly what they're demanding _ the same kind of objective cost and quality information that is readily available when making other significant purchases,'' Ronald Williams, chief executive and president of Aetna, said in a statement.

Aetna launched a price transparency program in August 2005, allowing consumers to research physician pricing before treatment. Between 600 and 1,000 consumers a month have since accessed the information for about 5,000 physicians and physician groups in the Cincinnati area.

With the expansion in August of this year, information on clinical quality and efficiency will be available for nearly 15,000 specialist physicians. Specific pricing will be available for more than 70,000 physicians.

Doctors' pricing would cover 30 procedures by each physician, with a total of 800 procedures when accounting for various physician specialties.

Grace-Marie Turner, president of the Galen Institute, a research organization focusing on health and tax policy in Washington, endorsed the Aetna plan.

"Consumerism is something taking hold not just in this country, but in Europe,'' she said. "They're seeing that more information is out there to help them make decisions. You can't have one-sixth of our economy operate on a different level than the rest of our economy.''

Humana Inc., based in Louisville, Ky., offers Web-based consumer pricing. Minneapolis-based UnitedHealth Group provides information on quality and costs for doctors, hospitals, dental care and pharmacies.

Quality is gauged in consultation with expert groups, said Daryl Richard, a spokesman for UnitedHealth Group.

Philadelphia-based Cigna announced in April that it will provide online health care cost and quality information, including cost data about outpatient surgery procedures and radiology services. The information will be provided initially in New Hampshire and Wichita, Kan.

And Medicare earlier this month published what it pays for 30 common procedures and reported how frequently hospitals perform the procedures.

The release of the information fits with the Bush administration's strategy of moving more people into health savings accounts and high-deductible insurance policies. Such insurance policies require people to bear more of the initial medical expenses.

Bush administration officials say that as more people buy such policies, cost increases would slow because consumers would do more to seek the best deal or decide against a medical service.

Merrill Matthews, director of the Council for Affordable Health Insurance, a research and advocacy group in Alexandria, Va., welcomed Aetna's move.

"The problem we've had in the past is if you had managed care with a $20 copay or traditional HMO, there's really very little incentive to care what the price is,'' he said.

In addition, because the price is negotiated between the insurance company and provider, consumers traditionally have difficulty finding the price for various services, he said.

Aetna adds Jackson Memorial Hospital

Aetna has announced that Jackson Memorial Hospital has joined the Aetna Dade/Broward Florida network effective 07/01/2006. This hospital will be available to employees and their dependents enrolled in the following products:

• HMO
• Aetna Open Access^® (an HMO plan)
• Quality Point-of-Service^® (QPOS^®)
• Aetna Choice^® POS
• Aetna Choice^® POS II
• USAccess^®
• National Advantage™ Program
• Managed Choice^® POS
• Aetna Open Access^® Managed Choice POS
• Elect Choice^® EPO
• Aetna Open Access Elect Choice EPO
• Aetna Select^SM
• Open Access Aetna Select^SM
• Open Choice^® PPO
• Aetna HealthFund^®