Category Archives: Health and wellness

The Biggest Reason People Didn’t Sign Up For Obamacare

The top reason uninsured people didn’t enroll in coverage under Obamacare this year is they still don’t feel like they can afford health insurance, according to a new survey.

The findings in a report published by the Henry J. Kaiser Family Foundation Tuesday highlight the affordability gap facing some U.S. households, especially those with incomes near or above the income cutoff for tax credits that reduce premiums, or those who simply don’t believe health insurance is a good value.

Thirty-six percent of people without health coverage reported they looked for health insurance during the enrollment period that nominally ended March 31, but found the available plans too expensive, according to the Kaiser Family Foundation survey. Just 7 percent said they preferred to pay a tax penalty under the law’s individual mandate, rather than purchase an insurance policy. Others said they believed the mandate doesn’t apply to them, didn’t know about the mandate, or tried and failed to enroll.

obamacare affordable

Health insurance remains a costly product and the Affordable Care Act targets its financial assistance to low-income families. Tax credits to defray the cost of coveragearen’t available to households that earn more than 400 percent of the federal poverty level, which is $45,960 for a single person. The law also provides subsidies to reduce out-of-pocket costs for those who earn up to 250 percent of poverty, or $28,725 for an individual.

The tax credits provided under the Affordable Care Act are pegged to the price of the second-cheapest “silver” level plan in a person’s geographical area, and to household income. The subsidy gets smaller as income increases, so people who earn near 400 percent of poverty receive relatively little help paying for their coverage, and those who make just a little more pay full price.

The average national price for one of these benchmark silver plans is $808 a month for a household of two 40-year-olds with two minor children that earns over 400 percent of poverty, which is $94,200 for a family of four, according to a calculator on the Kaiser Family Foundation website. The same family making exactly 400 percent of poverty would be eligible for a tax credit worth $63 a month.

The vast majority of those enrolling in private insurance under Obamacare are getting help paying for their coverage. As of March 1, 83 percent of enrollees received tax credits for premiums, according to the Department of Health and Human Services.

The Kaiser Family Foundation report includes quotations from some of those surveyed that illustrate the point of view that health insurance is too costly. “What’s out there now is just unaffordable,” one respondent said. “Because I think food on the table is more important,” wrote another. Coloring those views may be a general lack of awareness about the availability of the tax credits, previous surveys have shown.

Although not addressed in the Kaiser Family Foundation poll, the largest affordability gap in health coverage is found in 24 states that didn’t adopt the Affordable Care Act’s expansion of Medicaid to more poor people after the Supreme Court made it optional for states. Those earning up to 133 percent of poverty, or $15,282 for a single person, were supposed to have access to Medicaid, while tax credits are reserved for those who earn at least poverty wages, which amounts to $11,490 for an individual. That meansthe poorest residents of those 24 states aren’t eligible for any help, so millions are expected to remain uninsured.

The Kaiser Foundation Family poll also shows a majority of Americans continue to disapprove of the Affordable Care Act, with 46 percent having an unfavorable view, compared with 38 percent holding a favorable opinion. These attitudes are closely tied to partisan affiliation, with Republicans being much more likely to disapprove and Democrats more likely to approve. A majority, however, wants Congress to improve the law, compared with more than one-third who would prefer it to be repealed and replaced with an alternative.

obamacare affordable

Despite President Barack Obama trumpeting the news this month that private insurance enrollments via the Obamacare exchanges have exceeded 8 million — or 1 million more than the highest projection from the Congressional Budget Office — the public doesn’t see it that way. Even though more than 40 percent were aware that signups had topped 8 million, nearly six out of 10 said enrollment came in below the federal government’s expectation.

obamacare affordable

Story by Jeffrey Young  at Huffington Post

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HSA Limits Will Increase for 2015

HSA Limits Will Increase for 2015

 

On April 23, 2014, the Internal Revenue Service (IRS) issued Revenue Procedure 2014-30, which increases limits for health savings accounts (HSAs) effective for calendar year 2015. The following HSA limits will increase for 2015:

  • Annual contribution limits for single and family coverage;
  • Maximum out-of-pocket expense limits for coverage under a high deductible health plan (HDHP); and
  • Minimum annual deductibles for coverage under an HDHP.

hsA contribution limits

For 2015, the annual HSA contribution limit for an individual with self-only coverage under an HDHP is $3,350 (up from $3,300 for 2014).

For 2015, the annual HSA contribution limit for an individual with family coverage under an HDHP is $6,650 (up from $6,550 for 2014).

hdhp Out-of-pocket expense limits

The maximum out-of-pocket expense (deductibles, copayments and other amounts, but not premiums) limit for self-only HDHP coverage for 2015 is $6,450, which is up from $6,350 for 2014.

For family HDHP coverage, the maximum out-of-pocket expense limit for 2015 is $12,900, which is up from $12,700 for 2014.

hdhp MINIMUM deductibles

For 2015, the deductibles under an HDHP must be at least $1,300 for self-only coverage (up from $1,250 for 2014) and $2,600 for family coverage (up from $2,500 for 2014).

effective date

These new limits are effective for calendar year 2015.

more information

For a copy of IRS Revenue Procedure 2014-30, see www.irs.gov/pub/irs-drop/rp-14-30.pdf.

Higher Health Care Costs for Metabolic Syndrome Risk

metabolic syndromeMetabolic syndrome is not one specific syndrome, but a group of related syndromes which can have a negative effect on your overall health.  Generally, the phrase “metabolic syndrome” includes the conditions:

  • High blood pressure
  • High blood sugar levels
  • Bad cholesterol
  • Excess body fat around the waist (a waist circumference greater than 35” for women and 40” for men)
  • High levels of triglycerides

The presence of one or several of these conditions can greatly increase your risk for diabetes, heart disease, and stroke.

Higher Healthcare Cost

A person with metabolic syndrome will in most cases need to see the doctor more frequently and will likely need more prescriptions and medical assistance than those without the syndrome, costing insurance companies more. Because of the risks associated with metabolic syndrome, people that display some of these symptoms often pay more for insurance in anticipation of them needing more medical care than a healthy person.

The Actual Cost

Studies have shown that people suffering from only one condition of metabolic syndrome pay almost twice as much as those not dealing with this condition. Even suffering from just one facet of metabolic syndrome (such as high blood pressure) renders a person five times more likely to develop diabetes. These increased risks and costs make health care even more difficult – and expensive – to maintain for those that may need it most.

How to Afford it if you Can’t Afford it?

The best way for people with metabolic syndrome to lower the cost of health care is to attack the root of the problem and focus on changing their habits and lifestyle. Most, if not all, of the conditions associated with metabolic syndrome can be made more manageable with increased physical activity and diet change. Some specific lifestyle changes that can decrease your risk for high healthcare costs (and further health problems) include losing weight, exercising, quitting smoking, and increasing fiber intake.

Reducing Employer Healthcare Costs

Employers interested in lowering the cost of their corporate health insurance program can be proactive in creating employee wellness programs geared towards helping employees lose weight and quit smoking. Such programs have a number of benefits:

  • Losing as little as five to ten percent of your body weight can greatly decrease your risk of diabetes, heart disease and stroke. Excess fat can also cause high blood pressure because the heart must work harder and under more pressure to transfer blood to the whole body. This pressure can ultimately prove fatal.
  • Weight loss can be achieved by simply lowering calorie-intake and exercising more. Doctors recommend getting your heart rate above-average for at least 30 minutes a day to stay healthy. Whether it’s a bike ride, aerobic activity, swimming, or just a quick walk; any increase in activity will strengthen your heart and reduce fat over time.
  • In addition to all of the other side-effects of smoking, using tobacco products has been proven to raise blood pressure and increase the risk of heart disease (more so in women than men). Quitting smoking is therefore a crucial step in combating metabolic syndrome risks and inherently combating higher healthcare costs.

A good corporate wellness program will give employees the tools they need to address the underlying lifestyle issues that contribute to poor health and, in many cases, metabolic syndrome. When employees make healthy lifestyle choices, not only does the cost of providing them with healthcare decrease, their productivity also increases, making employee wellness an investment with strong ROI.

Dana Rostro is the Director of Employee Benefits Sales and Operations at Texas Associates Insurors. Dana is ACA certified and has helped clients develop the best strategies for their operations within the new healthcare legislation.

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Is Your Office Gross?

Office GermsThe typical employee’s desk has more bacteria per square inch than an office toilet seat. If that’s not disturbing enough, desks, phones and other private surfaces are also prime habitats for the viruses and bacteria that cause colds, the flu, strep throat, pneumonia and other illnesses.

Germs are bacteria, viruses, fungi and parasites. Not all will cause disease, but many are bad news in the workplace, as some can live from 2 to 72 hours or more on hard surfaces. Germs are then spread in a few of ways:

  • Infectious droplets from coughs or sneezes move through the air and land on nearby surfaces or are inhaled by others.
  • Physical contact is made with infected droplets on a hard surface (e.g., a desk) and is transferred by touching the mouth, eyes or nose prior to hand washing.

Germ Hot Spots

  • Telephones
  • Keyboard and mouse
  • Desktops
  • Doorknobs, elevator buttons and light switches
  • Vending machine buttons
  • Fax, printer and copy machines
  • Water fountain handles and water cooler spigots
  • Microwave door handles
  • Bathroom door handles and faucets
  • Chair armrests
  • Pens and other shared office items
  • Escalator and elevator handrails

Tidy vs. Clean

Even if you keep your desk tidy, it may not be “clean.” Unlike toilets, which tend to be cleaned regularly; keyboards, phone receivers and desks rarely receive a wipe-down. Consider this: crumbs and coffee spills are capable of supporting mini eco-systems. Without a cleaning, even a small area on your desk or phone can sustain millions of bacteria that could potentially cause illness.

Getting Rid of Germs

The good news: heightened awareness and hygiene efforts can go a long way in helping keep your office safer. Keep the following points in mind and share them with your co-workers:

  • Germ-busting at the office is a team effort! It only takes one person to infect healthy co-workers.
  • Regular cleaning of personal workspaces (desk, phone, keyboard, etc.) kills bacteria, stopping the spread of germs.
  • Frequent cleaning of shared workspaces (door handles, coffee pots, light switches, faucets, office equipment, etc.) is essential in maintaining sanitary safety. Disinfection is the goal, so be sure to use a true disinfectant, not simply an antibacterial product. Daily disinfection reduces bacteria levels by 99 percent, drastically lowering the risk of illness.
  • Be considerate of others and cough or sneeze into tissues, your sleeve or the crook of your arm. Wash your hands often and sanitize using alcohol-based disposable hand wipes or gel. Consider having these on-hand at your desk and in any common areas, including kitchens and restrooms.

Dana Rostro is the Director of Employee Benefits Sales and Operations at Texas Associates Insurors. Dana is ACA certified and has helped clients develop the best strategies for their operations within the new healthcare legislation.

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Workplace Wellness Programs – Are They For You?

wellnessOne of the many provisions buried in the Affordable Care Act is the ability for employers to set up workplace wellness programs that incentivize employees to take better care of themselves. A healthier workforce doesn’t just reduce insurance premiums. It’s also a workforce that is more productive when it’s at work and that takes fewer days off when ill.

There are two different types of workplace wellness programs. A participatory wellness program is a program that provides a reward to employees that perform an action. Some examples of participatory programs include when a company provides access to a fitness center for anyone who chooses to use it, provides a bonus for taking a diagnostic test or incentivizes employees to attend health-related educational programs.

A workplace wellness plan can also be structured as a health-contingent program. These programs are more specifically based on employees’ individual health issues and can also come in two types:

  1. Activity-Based Health-Contingent Programs
  2. Outcome-Based Health-Contingent Programs

If a company chooses to implement a health-contingent program, it can offer a reward equivalent to up to 30 percent of an employee’s cost of health coverage. A program that is tied to stopping smoking can have a reward of up to 50 percent of a worker’s insurance coverage cost.

Activity-Based Workplace Wellness

An activity-based program is a program that focuses on getting an employee to take a certain activity towards improving their health. While a participatory program might include company support towards the cost of a gym membership, an activity-based program would require that worker to go to the gym on a predefined basis to earn the reward. Another example would be a reward tied to successfully completing a dieting program or committing to walk a certain number of times per week for a certain number of minutes per session.

Outcome-Based Workplace Wellness

Outcome-based programs focus on what a worker achieves rather than on what he does. An outcome-based plan starts with measuring a worker’s health. It can then set a goal for the measured standard. These programs can be tied to lowering cholesterol, lowering blood pressure or to reducing body-mass index. In these programs, the result is more important than the inputs that go into achieving it.

Calculating Rewards

Whether a company chooses an activity- or an outcome-based program, the rewards are calculated the same way. Rewards are based on the total cost of coverage, spanning both the employer’s and the employee’s payment .For instance, if an employee’s coverage costs $4,800 per year and the employer offers a 30 percent rebate, the employee would receive a bonus of $1,440. She would receive the bonus regardless of whether she pays $1,200, $2,400 or more of her total healthcare cost.

Alternate Routes to Rewards

Workplace wellness programs must comply with other federal laws, including the Americans with Disabilities Act. This means that they must have an alternate path for employees to earn a reward if they are unable to comply with the initial terms of a reward. For instance, an employee in a wheelchair won’t be able to participate in a program that incentivizes walking, so some other type of incentive must be put in place for them.

The rules underlying both activity- and outcome-based workplace wellness programs are complicated. Adding in the additional risks of legal exposure that come with creating incentives that are meaningful but also available to every employee makes the process even more challenging. However, the benefits to be reaped from a healthier workforce are also well worth it in the long run.

Dana Rostro is the Director of Employee Benefits Sales and Operations at Texas Associates Insurors. Dana is ACA certified and has helped clients develop the best strategies for their operations within the new healthcare legislation.

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Mistakes to Avoid With Employee Wellness Programs

Workplace wellness programs are an increasingly important part of the employee benefits program, designed to encourage employees to take steps to prevent the onset of worsening health conditions and eliminate unhealthy behaviours, through nutrition seminars and physical activity. While they are often touted a costly venture for employers, such investments can pay off handsomely for employers, by improving relationships, building work ethic and of course, cutting down financial costs long term.key person insurance

Whether you are thinking about Workplace Wellness for the first time, or indeed considering a revamp of your current initiative, understanding the common mistakes and misconceptions associated with Wellness programs can help you and your employees deliver the results.

No plan at all

It may seem like a no brainer, but having no wellness program is probably the biggest mistake you should avoid making. Workplace Wellness programs are something of a fresh fad and were not always considered a requirement for Businesses. While there is not currently any legislation binding companies to promote workplace wellness, it is something that Businesses consider to be an important part of their overall benefits plan, heading into the future.

Businesses that decide against the promotion of a preventative scheme will run the risk of missing out on building relationships within the workplace by making employees feel valued. At the end of the day, wellness programs are something you implement FOR the workforce, not something you do to them. Neglecting the growing demand for wellness in the workplace can leave businesses standing still when they could just as easily be moving forward.

Insufficient budget

There is no point in ignoring the fact that a successful wellness program will cost you. In order to see results, employers must be committed to their workforce and prepared to meet the financial requirements of Wellness initiatives. If you fail to provide adequate funding, your wellness initiative will automatically be doomed to failure.

Failing to sit down and assess the budgetary requirements of introducing a workplace wellness scheme is a common mistake that companies make when first approaching a workplace initiative. It is important to understand that a wellness initiative can be a major undertaking and will require adequate funding, staffing and resources to provide meaningful results. It is important for employers to persist and provide consistent funding, if required, so that the long-term future of your employees and employee benefit costs are manageable and guaranteed.

One size fits all approach

One of the most important considerations to make when assessing the requirements of your workplace wellness initiative and deciding what it should entail, is that no two workers are the same and therefore, adopting a ‘one size fits all approach’ is something worth avoiding. Some employees may be in a different condition of health than others. Some may smoke while some may not. It is important to tailor your plan to fit each individual employee and if that involves individual profiling, BMI and fitness testing, then so be it.

Many companies that introduce general wellness plans that hold the physical condition of each and every employee in the same regard will see participation levels drop. Considering participation is key to the success of the wellness program, low participation levels mean it’s time to rethink your initiative.

Wellness programs should also account for issues such as stress management as well as emotional and mental wellness in order to fully acknowledge the diverse needs of the workforce. By understanding those needs and the obstacles to watch out for, you can introduce an effective, cost-efficient – in the long run – wellness program that can help boost morale, working relationships, reputation and ultimately, productivity.

Need advice on how your Employee Benefits Program? Ask an expert for free.

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Will Healthcare Reform Actually Work?

After 3 long years, the countdown to the Health Care exchanges is coming to an end. While a lot of the confusion and uncertainty brought on by the heavily-debated 2010 Affordable Care Act remains, the October 1 deadline beckons, as we approach a new age of ‘Health Care for All’ here in the US.

There is no doubt that the Affordable Care Act was seen as a huge political victory for the Obama Administration. But the question of whether or not it will prove a historic one, also lingers.  As employers and citizens seek consultation on the best possible Health Insurance plan, a number of hiccups, including the recent postponement of the employer’s mandate, not to mention the 17 states who have opted out of ‘Obamacare’, have left many US citizens wondering whether or not Health Care Reform will actually work.

What exactly are we working towards?

‘Obamacare’ legislates that all US citizens must have some form of Health Care coverage come January 2014. Those who fail to buy Health Insurance by the turn of the year will be subject to hefty fines. The scheme also calls on large employers to provide Health Care coverage to employees, provided they have over 50 working staff. Making it a legal obligation for people to have Health Insurance is seen as the most effective way to achieve nationwide coverage come 2018, and while some states have opted out of a federal health insurance exchange, they have devised their own initiatives to roll out state-wide Health Care by January 2014.

Convincing the people

Up until now, the Obama Administration’s Health Care Reform initiative has received heavy criticism from various bodies and media figures from different backgrounds. But the White House ensures, job-growth, new and improved health care facilities as well as practitioners, and increased localisation of Health Care services are at the heart of the initiative which thus far, hasn’t resulted in job losses. Convincing doubters is arguably the biggest challenge President Obama has had to face during his tenure, which ultimately will be defined by the success of Health Care Reform.

Nurturing before and after 2014

Legislation will count for very little come the end of 2014 unless the initiative is nurtured into existence, enforced and invested in. Investment from the Government is as important as investment from the people, who are the main beneficiaries of Health Care Reform. While January 2014 is seen as a new dawn, people must go out, consult their insurance brokers and find the best possible health insurance package for them and their loved ones. The future of US Health Care depends on people making that step, regardless of their current state of health or financial situation. The ‘Health Care for All’ initiative must be supported by all so it can benefit all.

The role of employers

Large employers are responsible for providing Health Care coverage for employees and in many ways, they are the backbone of the Obamacare initiative. Critics claim some employers may let go of staff to lower their books and avoid having to provide health insurance, but this puts the sustainability of the company in doubt and also puts a business in an impossible position where they can be held subject to fines and penalties. Health Care reform depends on employers, both large and small, learning about the provisions of the Affordable Care Act and working to accommodate employees in a way that both ensures their health and the long term health of the company itself.

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Healthcare Reform and the Youth of America

The October 1 deadline for US Health Care Reform is fast approaching as president Obama continues to work on multiple strategies aiming to enroll 7 million US citizens to the news scheme by January 1 2014. The new scheme legislates that US citizens must have health insurance by 2014 or else face heavy fines.

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At present, 17 States will offer insurance through their own exchanges, while the rest will offer health insurance through the federally managed programme dubbed ‘Obamacare’. Deputy White House advisor David Simas spoke to PBS recently about the challenges that remain in the Obama Administration’s implementation of the new Healthcare regime. “In order for the marketplace to be successful, a smaller subset needs to be at the centre of our focus for outreach, and that’s about 2-2.5 million, young and healthy, 18-35 year olds,” Simas said, confirming public opinion that the biggest challenge facing the Obama Administration is convincing young people who are healthy and active, to buy health insurance.

As the debate of whether or not Obamacare is good or bad for young Americans rages on, we look at the considerations of young people in the run up to the Oct 1 Healthcare exchange opening.

Cost

The number one reason that almost 20 million young adults in the US lack basic Healthcare coverage is the cost of Healthcare. Many between the ages of 18-35 are still in education be it school, part-time schooling or community college or else they are recent graduates, looking to secure full-time employment. For many of these people, particularly in the current climate, it is difficult to find that full-time job with benefits. With low disposable income, it is very difficult for young people to commit to health insurance, particularly when they have a clean bill of health and no urgent need for medical treatment.

While Obamacare provides that large companies must offer healthcare coverage for their employees, many young people who are recent graduates or are still in education, find themselves out of this loop.

Risk

While many young people may refrain from buying health insurance due to their state of health, there is no guarantee that someone between the ages of 18-35 will have a clean bill of health throughout those years. Those who are uninsured run the risk of paying huge fees if they end up having to seek medical care, something that happens quite regularly across the States. According to Aaron Smith, Executive Director of Young People advocacy agency ‘Young Invincibles,’ more young people than elderly are admitted to A&E during an average year and are therefore fully aware of the risk they run without health insurance.

While health insurance costs are generally avoided by young people who may not have the disposable income to avail of coverage, Obamacare will offer those young Americans who earn less than $44,000 dollars per year a tax credit that will help them to fund healthcare coverage. In addition, many young people may have been refused medicaid in the past unless they had children. 2014 will see Medacaid offered to people with incomes lower than $15,000, encompassing roughly 8 million US citizens. This will ensure that young Americans who fall into that low earners bracket can still avail of the care available to wealthier citizens.

Future

While study, travel and securing full-time work are the things that most occupy the minds of 18-35 year olds, it is important for young Americans to think ahead with regards the Healthcare reform act. 2014 marks the beginning of this new era in US Healthcare, and young people must make sure to consider their future, economically, domestically and in terms of family planning in run up to the October 1 deadline.

Healthcare reform will give young Americans that safety blanket of health insurance coverage as they exit their leaner years. Financially, while many young people are convinced contributing funds towards healthcare is just a way of benefitting the older generation, they are contributing to US Healthcare as a whole, something they will certainly avail of in years to come, especially when they begin families of their own.

So whether they’re covered by Obamacare or state provided exchanges,Healthcare Reform is something everyone needs to prepare for, no matter what age they are or State they come from. Personal health is something everyone needs to manage and invest in and it is worth investigating the possibilities instead of accepting a hefty fine come 2014.

If you have a question about Healthcare Reform, ask it for free and get answers from an expert.

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Safe Walking & Cycling

The weather outside has finally turned from frightful to delightful (if you like it hot!), and for millions of Americans that means it’s time to head outdoors for some fun in the sun. If you are hiking or biking on or near roads and sidewalks, keep these safety tips in mind.

When walking:

  • Always do so at marked crosswalks so cars are aware of your presence.
  • Make sure drivers know you are about to cross by making eye contact with them.
  • Don’t just look left and right—pay attention to cars that may be turning at intersections.
  • If you’re walking at night, wear bright or reflective clothing.

When riding a bike:

  • Always make sure you have enough room to avoid being sideswiped by nearby vehicles.
  • Use hand signals when turning or stopping so that drivers know what you are about to do.
  • Wear bright or reflective clothing so that you catch drivers’ attention and they know you are there.
  • Be attentive and slow down slightly when nearing intersections.

And as usual, when doing any kind of physical activity out of doors – DRINK LOTS OF WATER!

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3 Steps to Avoiding HIPAA Breaches

The Department of Health & Human Services has begun to come down hard on Healthcare Providers for HIPAA Breaches. The Department of Health & Human Services has fined the Hospice of North Idaho for failing to encrypt a stolen laptop. The Hospice Organization has agreed to pay a $50,000 HIPAA Penalty for this single violation.

An important note here is that the $50,000 penalty does not include or cover the expenses the Hospice Organization will incur to notify affected patients. That additional cost could be as much as $83,000. All in all that’s a huge impact for a single HIPAA breach. The message for healthcare organizations is clear, it’s time to check on your HIPAA compliance and breach procedure.

Review Policies & Best Practice

HIPAA breaches should never happen. Organizations that properly manage their data and monitor tier procedures won’t suffer breaches. You need to review your security policy and procedure and perform a risk analysis. Cyber security is a vital issue for all organizations that carry personal information. For the healthcare industry that information is more comprehensive and more sensitive, you need to ensure that your data is secure on every level.

Insurance

Once you have preformed a risk analysis and ensured that you are following best practice, you need to think about insurance. HIPAA breaches don’t happen to organizations that properly manage their data, but that relies on people following procedure. People make mistakes, so you need to ensure you are covered. The cost that the Hospice of North Idaho have incurred will be huge, insurance coverage could really soften that blow.

Create an Internal Plan

When HIPAA breaches do occur, the organization will suffer a variety of setbacks. Alongside the financial cost, there is also the practical issue of informing patients. You will need to create in internal plan for dealing with a breach. That means your organization should have a clear strategy for informing those affected and a contingency plan to ensure that normal service is not affected.

HIPAA breaches can be avoided with effective risk management, but you need to prepare for them anyway. Few medical organizations could deal with the cost incurred in Idaho.

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