What you may not know about disability insurance

If you got sick or hurt and couldn’t work, how would you pay for everyday living expenses?
While most of us like to think we won’t be affected by a disability, any one of us could be. In fact, common illnesses or health conditions make up 90% of paid disability claims. If you become disabled, you could be out of work for quite some time —several weeks for surgery, months for a serious injury, or a year or more for a chronic illness.

Working without a financial safety net?
More than 1 in 4 of today’s 20-year-olds will become disabled
before age 67. We’re under insured „. More than half (52%) of workers say they know “not very much” or “nothing at all” about disability insurance. Three times as many disabling injuries occur off-the-job as on-the-job and are therefore not covered
by workers’ compensation. The average Social Security Disability Insurance benefit is $1,100 a month and is reserved for eligible disabilities expected to last for at least a year or result in death. The Family and Medical Leave Act provides sick and family leave, but that time may end up not qualifying for payment. Half of all households are “financially fragile,” having a great difficulty raising $2,000 within a month, if needed. More than three-quarters (77%) of workers think that missing work for at least three months because of injury or illness would create a financial hardship, and half think it would cause a “great hardship”.

For More info please contact Info@probityins.com or Call 408-293-9923.

ACA Update: Final Rule Issued on Excepted Health Benefits
Posted on November 7, 2014 by Stacy Madden
On October 1, 2014, the Departments of the Labor, Health and Human Services and Treasury published a final rule regarding excepted health benefits. Excepted benefits are generally exempt from ACA’s market reform, including limits on pre-existing conditions and guaranteed renewability.
The final rule is effective December 1, 2014 and applies to group health plans effective January 1, 2015 and later.
Stand-alone dental and vision plans are already considered excepted benefits. The final rule expands the definition of excepted benefits to include employee assistance plans (EAPs) if the EAP plan meets certain conditions, including:
• The EAP is free to employees, and
• EAP benefits are not coordinated with benefits in a group health plan, and
• The EAP does not provide significant benefits in the nature of medical care or treatment
The final rule also clarified that self-insured plans that offered dental and vision benefits without charging an employee contribution also qualify as excepted benefits. Fully insured vision and dental benefits, and self-insured vision and dental coverage that requires employee contributions, previously qualified as excepted benefits.

Important IRS Updates
Contribution Limits & FSA Compliance
The Internal Revenue Service announced the following new benefit plan limits for 2015. In addition, the IRS just issued an important change to Section 125 Cafeteria Plans. We’re notifying FSA clients about this change now. Health Savings Account (HSA) Limits
• 2015 HSA contribution limits are $3,350 for self-only coverage and $6,650 for family coverage.
• High deductible health plan deductibles are $1,300 for individuals and $2,600 for families. Out-of-pocket expenses cannot exceed $6,450 for individuals and $12,900 for families.

Flexible Spending Account (FSAs) Limits
• Healthcare FSA: The annual maximum for Healthcare FSAs has increased from $2,500 to $2,550 for 2015.
• Dependent Care FSA: At this time, the IRS has not released information on contribution limit changes to these plans.
• Transit & Parking FSA: Contribution limits remain unchanged for 2015. The monthly limits are $250 for parking, $130 for transit and $20 for bicycle commuting.
IRS Issues Notice 2014-55 Allowing Additional Permitted Election Changes to Health Coverage Under Section 125 Cafeteria Plans

The IRS just issued Notice 2014-55 to expand the permitted election rules for health coverage under a Section 125 cafeteria plan. There are now two situations in which a Section 125 cafeteria plan participant is permitted to revoke her/his election during a period of coverage:
• The first situation involves a participating employee whose hours are reduced so that the employee is expected to average less than 30 hours of service per week, but for whom the reduction does not affect the eligibility for coverage under the employer’s group health plan.
• The second situation involves an employee participating in an employer’s group health plan who would like to cease coverage under the group health plan and purchase coverage through a competitive marketplace established by the ACA Exchange or Marketplace.
We are in the process of notifying FSA clients regarding amendment to their plan documents, if they choose. Read more about this change in this release from the IRS.

As always, we hope this information is helpful.

Please contact us at info@probityins.com if you have questions or need more information.

What is the penalty if I don’t buy health insurance?
Major provisions of the Affordable Care Act (ACA) have been in place since the beginning of 2014, however many employees and small business owners still wonder, “Do I have to buy health insurance in 2015?” and “What is the penalty if I don’t buy health insurance?”
This article answers common questions about the requirement to have health insurance and the penalty for not having health insurance.

Do I Have to Buy Health Insurance If I’m Uninsured?
Most Americans are required to have health insurance, or pay a tax penalty if they don’t. This ACA rule is called the “Individual Mandate” or “Individual Shared Responsibility Fee” and started in 2014. Coverage can include job-based health insurance, individual health insurance, or insurance through a government program such as Medicaid or Medicare.

What Is the Penalty If I Don’t Buy Health Insurance?
The penalty for not having “minimum essential coverage” is called the “Individual Shared Responsibility Fee.” This fee is either a flat fee or a percentage of household income, whichever is greater. The penalty increases over the first three years.

Year Flat Fee or Percentage of Income
2014 $95 per adult, $47.50 per child, up to $285 per family or 1% of family income minus federal filling threshold
2015 $325 per adult, 162.50 per child, up to $975 per family or 2% of family income minus federal filling threshold
2016 $695 per adult, 347.50 per child, up to $2,085 per family or 2.5% of family income minus federal filling threshold
2017 Adjusted Annually or Adjusted Annually
Source: Affordable Care Act 101

Example of the Individual Shared Responsibility Fee:
Nancy is single and earns an annual income of $40,000/year. Nancy went uninsured in 2014. At tax time, Nancy is required to pay an Individual Shared Responsibility Fee. Nancy will pay either 1% of income (minus the federal tax filing threshold) or $95, whichever is greater.
Nancy’s annual income ($40,000) minus the federal tax filing threshold ($10,000) is $30,000. One percent (1%) of $30,000 is $300.
Since this amount is greater than $95, Nancy will pay a $300 fee.
See more Individual Shared Responsibility Fee examples here.

Does Everyone Who Is Uninsured Have to Pay the Fee?
You may not have to pay the Individual Shared Responsibility Fee if you are uninsured, and:
• Are required to pay more than 8% of your household income for the lowest cost bronze plan.
• Are not a U.S. citizen, a U.S. national, or a resident alien lawfully present in the U.S.
• Had one gap in coverage for less than three consecutive months during the year.
• Won’t file a tax return because your income is below the tax filing threshold. In 2013, the tax filing threshold was $10,000 for individuals and $20,000 for a couple.
• Are unable to qualify for Medicaid because your state has chosen not to expand the program.
• Participate in a healthcare sharing ministry or are a member of a recognized religious sect with objections to health insurance.
• Are a member of a federally recognized Indian tribe.
• Are incarcerated.
• Qualify for a hardship exemption.
If I Owe a Fee for 2014, How Do I Pay It?
If you go uninsured in 2014 and don’t qualify for an exemption, you will have to pay the Individual Shared Responsibility Fee to the IRS on your 2014 tax return. You will most likely need to submit your tax return for 2014 by April 15, 2015.
How Do I Prove I Had Coverage to Avoid Paying the Fee?
If you obtained insurance in 2014, you should receive a notice from your insurance provider by January 31, 2015 that describes your coverage status during the year to use with your tax return.

Financial protection that fits your needs

Sometimes called “supplemental insurance,” voluntary benefits are policies you buy to add to the health and life insurance your employer may already provide. These benefits can help you pay for things your other insurance won’t, such as lost wages, out-of-pocket expenses and household bills. Everyone’s benefit needs are different. That’s why it’s important to choose the benefits that are right for your personal situation.

Disability insurance — Helps replace a portion of your income to help make ends meet if you become disabled from a covered accident or covered sickness.

Accident insurance — Helps offset unexpected medical expenses, such as emergency room fees, deductibles and co-payments that can result from a fracture, dislocation or other covered accidental injury.

Life insurance — Enables you to tailor coverage for your individual needs and helps provide financial security for your family members.

Cancer insurance — Helps offset the out-of-pocket medical and indirect, non-medical expenses related to cancer that most medical plans don’t cover. This coverage also provides a benefit for specified cancer-screening tests.

Critical illness insurance — Supplements your major medical coverage by providing a lump-sum benefit you can use to pay the direct and indirect costs related to a covered critical illness, which can often be expensive and lengthy.

Hospital confinement indemnity insurance — Provides a lump-sum benefit for a covered hospital confinement or a covered outpatient surgery to help with co-payments and deductibles that are not covered by most major medical plans.

For more information contact info@probityins.com or call 408-293-9923

What you may not know about disability insurance

If you got sick or hurt and couldn’t work, how would you pay for everyday living expenses?
While most of us like to think we won’t be affected by a disability, any one of us could be. In fact, common illnesses or health conditions make up 90% of paid disability claims. If you become disabled, you could be out of work for quite some time several weeks for surgery, months for a serious injury, or a year or more for a chronic illness. Working without a financial safety net?

More than 1 in 4 of today’s 20-year-olds will become disabled before age 67. We’re under insured. More than half (52%) of workers say they know “not very much” or “nothing at all” about disability insurance. Three times as many disabling injuries occur off-the-job as on-the-job and are therefore not covered by workers’ compensation. The average Social Security Disability Insurance benefit is $1,100 a month and is reserved for eligible disabilities expected to last for at least a year or result in death. The Family and Medical Leave Act provides sick and family leave, but that time may end up not qualifying for payment.

Half of all households are “financially fragile ,”having a great difficulty raising $2,000 within a month, if needed. More than three-quarters (77%) of workers think that missing work for at least three months because of injury or illness would create a financial hardship ,and half think it would cause a “great hardship.”
Common illnesses or health conditions make up 90% of paid disability claims.

For more information please contact info@probityins.com or 408-293-9923

What are voluntary benefits?
Sometimes called “supplemental insurance,” voluntary benefits are policies you buy to add to the health and life insurance your employer may already provide. These benefits can help you pay for things your other insurance won’t, such as lost wages, out-of-pocket expenses and household bills.

Disability insurance: Helps replace part of your regular income if you are unable to work because of a covered injury or illness.
Accident insurance: Helps cover out-of-pocket expenses in the event of a covered accident.
Cancer and critical illness insurance: Helps with the high cost of cancer or critical illness screenings, diagnosis and treatment.
Life insurance: Helps pay for final expenses and helps provide financial security for your family members.
Hospital confinement: Helps pay for covered hospital-related expenses, including co-payments and deductibles.

Advantages Voluntary Benefits:

 Flexibility: Use claim payments however you like – pay deductibles, co-payments and other expenses not covered by your health or life insurance.
Portability: Take coverage with you if you leave your job or retire.
Stability: Maintain coverage whether or not you’re employed.
Convenience:Pay premiums using your choice of payroll deduction, bank draft or direct billing.

For more information please contact info@probityins.com or 408-293-9923

The annual open enrollment period for individuals is coming soon. If you are looking for new coverage, to review your options, or make a plan change the window for this is November 15, 2014 thru December 15, 2014 for an effective date of January 1, 2015. The open enrollment period to make any changes ends February 15, 2015. If you do not make changes during this time you will need to wait until the next open enrollment period unless you have a qualifying event during the year. A qualifying event includes different life changes which allow one to make a change outside of open enrollment. Here are a couple of the most common qualifying events: marriage, divorce, birth/moving of a child, moving inside/outside of a service area or loss of coverage.
You have a couple of options to obtain coverage which Probity Insurance Services can assist you with. You may qualify for assistance in paying your monthly premiums thru the Federal Healthcare Exchange Covered CA, if you meet the income guidelines. Or you may decide to go with a Carrier outside of Covered California. Covered California is a part of the state of California and was created to help you get health coverage to protect yourself and your loved ones. Having insurance can ensure your access to medical care if you get sick or are injured, so that you can keep your body healthy, but it also protects your peace of mind, because you can rest assured that you will have help when you need it most.
For more information contact probity insurance service at 408-293-9923 or info@probityins.com

Influenza is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different, and influenza infection can affect people differently. Even healthy people can get very sick from the flu and spread it to others. Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. During a regular flu season, about 90 percent of deaths occur in people 65 years and older. “Flu season” in the United States can begin as early as October and last as late as May.
During this time, flu viruses are circulating at higher levels in the U.S. population. An annual seasonal flu vaccine (either the flu shot or the nasal spray flu vaccine) is the best way to reduce the chances that you will get seasonal flu and spread it to others. When more people get vaccinated against the flu, less flu can spread through that community.
What kinds of flu vaccines are available?
There are several flu vaccine options for the 2014-2015 flu season.
Traditional flu vaccines made to protect against three different flu viruses (called “trivalent” vaccines) are available. In addition, flu vaccines made to protect against four different flu viruses (called “quadrivalent” vaccines) also are available.
Trivalent flu vaccine protects against two influenza A viruses (an H1N1 and an H3N2) and an influenza B virus. The following trivalent flu vaccines are available:
• Standard-dose trivalent shots (IIV3) that are manufactured using virus grown in eggs. Different flu shots are approved for people of different ages, but there are flu shots that are approved for use in people as young as 6 months of age and up.
• An intradermal trivalent shot, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot. It is approved for people 18 through 64 years of age.
• A high-dose trivalent shot, approved for people 65 and older.
• A trivalent shot containing virus grown in cell culture, which is approved for people 18 and older.
• A recombinant trivalent shot that is egg-free, approved for people 18 through 49 years of age.
The quadrivalent flu vaccine protects against two influenza A viruses and two influenza B viruses. The following quadrivalent flu vaccines are available:
• A quadrivalent flu shot.
• A quadrivalent nasal spray vaccine, approved for people 2 through 49 years of age (recommended preferentially for healthy* children 2 years through 8 years old when immediately available and there are no contraindications or precautions).
(*“Healthy” in this instance refers to children 2 years through 8 years old who do not have an underlying medical condition that predisposes them to influenza complications.)
Who should get vaccinated this season?
Everyone 6 months of age and older should get a flu vaccine every season. This recommendation has been in place since February 24, 2010 when CDC’s Advisory Committee on Immunization Practices (ACIP) voted for “universal” flu vaccination in the United States to expand protection against the flu to more people.
Vaccination to prevent influenza is particularly important for people who are at high risk of serious complications from influenza. See People at High Risk of Developing Flu-Related Complications for a full list of age and health factors that confer increased risk.
Who Should Not Be Vaccinated?
Different flu vaccines are approved for use in different groups of people. Factors that can determine a person’s suitability for vaccination, or vaccination with a particular vaccine, include a person’s age, health (current and past) and any relevant allergies, including an egg allergy.
Flu Shot:
• People who cannot get a flu shot
• People who should talk to their doctor before getting the flu shot
Nasal Spray Vaccine:
• People who cannot get a nasal spray vaccine
• People who should talk to their doctor before getting the nasal spray vaccine
When should I get vaccinated?
Flu vaccination should begin soon after vaccine becomes available, ideally by October. However, as long as flu viruses are circulating, vaccination should continue to be offered throughout the flu season, even in January or later. While seasonal influenza outbreaks can happen as early as October, during most seasons influenza activity peaks in January or later. Since it takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza virus infection, it is best that people get vaccinated so they are protected before influenza begins spreading in their community.
Flu vaccine is produced by private manufacturers, so availability depends on when production is completed. Shipments began in late July and August and will continue throughout September and October until all vaccine is distributed.
Why do I need a flu vaccine every year?
A flu vaccine is needed every season for two reasons. First, the body’s immune response from vaccination declines over time, so an annual vaccine is needed for optimal protection. Second, because flu viruses are constantly changing, the formulation of the flu vaccine is reviewed each year and sometimes updated to keep up with changing flu viruses. For the best protection, everyone 6 months and older should get vaccinated annually.
Does flu vaccine work right away?
No. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection. That’s why it’s better to get vaccinated early in the fall, before the flu season really gets under way.
Can I get seasonal flu even though I got a flu vaccine this year?
Yes. There is still a possibility you could get the flu even if you got vaccinated. The ability of flu vaccine to protect a person depends on various factors, including the age and health status of the person being vaccinated, and also the similarity or “match” between the viruses used to make the vaccine and those circulating in the community. If the viruses in the vaccine and the influenza viruses circulating in the community are closely matched, vaccine effectiveness is higher. If they are not closely matched, vaccine effectiveness can be reduced. However, it’s important to remember that even when the viruses are not closely matched, the vaccine can still protect many people and prevent flu-related complications. Such protection is possible because antibodies made in response to the vaccine can provide some protection (called cross-protection) against different but related influenza viruses. For more information about vaccine effectiveness, visit How Well Does the Seasonal Flu Vaccine Work?
Vaccine Effectiveness
Influenza vaccine effectiveness (VE) can vary from year to year and among different age and risk groups. For more information about vaccine effectiveness, visit
Vaccine Benefits
What are the benefits of flu vaccination?
While how well the flu vaccine works can vary, there are a lot of reasons to get a flu vaccine each year.
• Flu vaccination can keep you from getting sick from flu. Protecting yourself from flu also protects the people around you who are more vulnerable to serious flu illness.
• Flu vaccination can help protect people who are at greater risk of getting seriously ill from flu, like older adults, people with chronic health conditions and young children (especially infants younger than 6 months old who are too young to get vaccinated).
• Flu vaccination also may make your illness milder if you do get sick.
• Flu vaccination can reduce the risk of more serious flu outcomes, like hospitalizations and deaths.
o A recent study* showed that flu vaccine reduced children’s risk of flu-related pediatric intensive care unit (PICU) admission by 74% during flu seasons from 2010-2012.
o One study showed that flu vaccination was associated with a 71% reduction in flu-related hospitalizations among adults of all ages and a 77% reduction among adults 50 years of age and older during the 2011-2012 flu season.
o Flu vaccination is an important preventive tool for people with chronic health conditions. Vaccination was associated with lower rates of some cardiac events among people with heart disease, especially among those who had had a cardiac event in the past year. Flu vaccination also has been shown to be associated with reduced hospitalizations among people with diabetes (79%) and chronic lung disease (52%).
o Vaccination helps protect women during pregnancy and their babies for up to 6 months after they are born. One study showed that giving flu vaccine to pregnant women was 92% effective in preventing hospitalization of infants for flu.
o Other studies have shown that vaccination can reduce the risk of flu-related hospitalizations in older adults. A study that looked at flu vaccine effectiveness over the course of three flu seasons estimated that flu vaccination lowered the risk of hospitalizations by 61% in people 50 years of age and older.
References for the studies listed above can be found at Publications on Influenza Vaccine Benefits.
Flu viruses are constantly changing (called “antigenic drift”) – they can change from one season to the next or they can even change within the course of one flu season. Experts must pick which viruses to include in the vaccine many months in advance in order for vaccine to be produced and delivered on time. (For more information about the vaccine virus selection process visit Selecting the Viruses in the Influenza (Flu) Vaccine.) Because of these factors, there is always the possibility of a less than optimal match between circulating viruses and the viruses in the vaccine.
Vaccine Side Effects (What to Expect)
Can the flu vaccine give me the flu?
No, a flu vaccine cannot cause flu illness. Flu vaccines that are administered with a needle are currently made in two ways: the vaccine is made either with a) flu vaccine viruses that have been ‘inactivated’ and are therefore not infectious, or b) with no flu vaccine viruses at all (which is the case for recombinant influenza vaccine). The nasal spray flu vaccine does contain live viruses. However, the viruses are attenuated (weakened), and therefore cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist.
While a flu vaccine cannot give you flu illness, there are different side effects that may be associated with getting a flu shot or a nasal spray flu vaccine. These side effects are mild and short-lasting, especially when compared to symptoms of bad case of flu.
The flu shot: The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that may occur are:
• Soreness, redness, or swelling where the shot was given
• Fever (low grade)
• Aches
The nasal spray: The viruses in the nasal spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. In children, side effects from the nasal spray may include:
• Runny nose
• Wheezing
• Headache
• Vomiting
• Muscle aches
• Fever
In adults, side effects from the nasal spray vaccine may include:
• Runny nose
• Headache
• Sore throat
• Cough
Vaccine Supply and Distribution
Information about vaccine supply is available on the CDC influenza web site.

Open Enrollment for 2015 coverage starts November 15, 2014. Until then, you can get ready by learning about the Marketplace, seeing if you may qualify for savings, downloading an application checklist, and more. Plans and estimated prices for 2015 coverage will be available in early November.
Applying for coverage Important. Before November 15, 2014, you can enroll in a Marketplace health plan only if you qualify for a Special Enrollment Period. Any plan you enroll in before November 15, 2014 ends December 31, 2014. Find out if you qualify for a Special Enrollment Period or view plans and prices for coverage ending December 31, 2014.
If you know you qualify for a Special Enrollment period, you can create an account and apply right now.
You can apply for Medicaid and the Children’s Health Insurance Program (CHIP) any time. Learn how to apply through your state agency by visiting our Medicaid page and choosing your state. You can also apply by filling out a Marketplace application. If you want to do that, find out if you may qualify and start an application.
To apply for 2015 coverage, come back on or after November 15, 2014. The deadline for enrolling in 2015 coverage is February 15, 2015.
• Need a general overview of the Marketplace? Start with our quick guide to the Marketplace and we’ll lay out your next steps.
• Wondering if you qualify for savings on a Marketplace health insurance plan or Medicaid? Check out the quick chart, which shows income ranges that qualify for savings in 2015.
• Want to get timely email and text message reminders and important Marketplace information? We’ll let you know as soon as 2015 plans and prices are available. Sign up for Marketplace emails.
• Want to get ready to fill out your application starting November 15? Use this checklist to gather the documents you’ll need to apply (PDF).
• Have questions about 2015 coverage? Plans and prices will be available soon. If you have questions in the meantime, contact the Marketplace Call Center 24 hours a day, 7 days a week.