It is characterized by the breakdown of cartilage in the part of the joint that cushions the ends of bones. When cartilage breaks down, bones rub together causing pain and loss of movement. Osteoarthritis most often affects middle-aged and older adults. It can range from very mild to very severe, and most often occurs in the hands and weight-bearing joints such as the knees, hips, feet and back.

What Causes Osteoarthritis?

• Age: Your risk of developing arthritis increases as you age.
• Gender: In general, arthritis occurs more frequently in women than in men.
• Obesity: Obesity increases your chances of getting osteoarthritis, particularly for women, where a link has been found connecting obesity and the development of arthritis of the knee. However, with diet and exercise you can help reduce your weight and minimize the stress on weight-bearing joints such as the knees.
• Work factors: Repetitive injuries and physical traumas at work can contribute to the development of arthritis.

Symptoms of Osteoarthritis

Osteoarthritis usually develops slowly. In its early stage, joints may ache after physical work or exercise. However, about a third of those actually report pain or other symptoms. For those that do experience symptoms, the most common warning signs include:

• Steady or intermittent pain in a joint.
• Stiffness that tends to follow periods of inactivity, such as sleeping or sitting.
• Swelling or tenderness in one or more joints.
• Crunching feeling or the sound of bones rubbing together when the joint is used.

Treating Osteoarthritis

Generally, osteoarthritis is treated by focusing on decreasing pain and improving joint movement and may include the following:

• Exercise to keep joints flexible and improve muscle strength.
• Medications to control pain. Acetaminophen is used for mild pain while steroid injections in the joints can relieve more severe pain.
• Heat and cold therapy for temporary pain relief.
• Joint protection to prevent strain or stress on painful joints.
• Surgery, to relieve chronic pain in damaged joints.
• Weight control to prevent extra stress on weight-bearing joints.

As a result of these physiological changes, older adults are more susceptible to various cardiovascular diseases. In spite of this, there are many things people can do to live long after their hearts have exhibited the signs of age.

Hypertension

High blood pressure is an extremely common condition, especially in the elderly. This disease is linked to stroke, kidney disease, heart attack and heart failure. Those whose blood pressure measures above 160/90 mm Hg, should seek treatment including:

• Diet modification
• Moderate exercise
• Giving up smoking
• Weight loss
• Medication

Coronary Heart Disease

Half of all heart attack victims are over 65, and women are most at risk for a heart attack after menopause.

Treatment varies for heart attack sufferers depending on physical limitations, history of heart disease and other factors. However, some form of medication is traditionally prescribed.

Heart Valve Disorders

There are several common heart valve disorders present in older adults, the most common being aortic valve disease. Valve disorders cause heart failure, chest pain and fainting in most patients as valves thicken and stiffen. Many patients are treated successfully through a valve replacement surgery.

Rhythm Disorders

People of any age but predominantly older adults may experience problems with rhythm abnormalities. They may experience slow or missed beats, dizziness and fainting. However, at times, sufferers may not experience an indication of any rhythmic problem at all. Doctors often prescribe pace makers to resolve this problem.

Overall, lifestyle changes make a large difference in the prevention of cardiovascular disease. To minimize your risks, follow a regular exercise regime, eat a low-fat diet and do not smoke. Also, visit your doctor on a regular basis to check your heart health.

Make the Right Health Benefit Decisions When You Get Married

The Health Insurance Portability and Accountability Act (HIPAA) offers special enrollment rights for employees and spouses that allow them to enroll in a group health plan upon marriage, and provides protections for individuals who have preexisting conditions or might suffer discrimination on the basis of health status when they switch plans.

ERISA Disclosure Provisions provide individuals with rights to important information concerning benefits under their own or spouse’s group health plan.

Protect Your Rights When You Have or Adopt a Baby

HIPAA prohibits preexisting condition exclusions from being applied to pregnancy, regardless of whether the mother had previous health coverage. In addition, HIPAA does not permit preexisting condition exclusions to be applied to newborns and adopted children who enroll within 30 days of birth or adoption.

HIPAA also offers special enrollment rights for employees, spouses and new dependents allowing them to enroll in a group health plan upon birth, adoption or placement for adoption.

ERISA Claims Procedures help ensure timely and fair review of maternity and other claims under group health plans. The Newborns’ and Mothers’ Health Protection Act includes important new protections for mothers and their newborn children with regard to the lengths of hospital stays following the birth of a child.

Keep Health Coverage After a Job Change

HIPAA protects individuals who have preexisting conditions, helping them keep coverage for those conditions or get coverage for them in no more than 12 or 18 months through limits on the length of preexisting condition exclusions. HIPAA also helps individuals who might suffer discrimination in health coverage on the basis of health status when they change jobs.

COBRA generally requires that most group health plans of employers with at least 20 employees offer employees and their dependents the opportunity to continue their health plan coverage for limited periods of time when the employee loses his or her job or has a reduction in hours that would result in a loss of coverage.

Make Sure Your Loved Ones Have Good Health Care

ERISA permits a parent to obtain a court order to provide coverage for children under the noncustodial parent’s health plan (called a qualified medical child support order).

ERISA Disclosure Provisions help to ensure that individuals covered by group health plans receive clear information about their rights, benefits and obligations under the plan, including information about COBRA continuation coverage, access to urgent or specialized care, and composition of physician and other provider networks.

HIPAA includes protections for newborns and adopted children with preexisting conditions. Specifically, HIPAA does not permit a preexisting condition exclusion to be applied to a newborn or adopted child who enrolls within 30 days of birth or adoption.

ERISA Claims Procedures help ensure timely and fair review of plan denials of claims.

Keep Coverage When a Marriage Ends

HIPAA offers special enrollment rights, generally allowing employees and dependents who were covered under a spouse’s plan to obtain coverage under the employee’s plan upon divorce or legal separation, if they are otherwise eligible.

COBRA generally requires that group health plans of employers with at least 20 employees offer spouses and dependent children the opportunity to continue their health care coverage for limited periods of time in the event of the spouse’s legal separation or divorce from the employee covered by the plan.

Secure the Right Care in Your Later Years

HIPAA offers protections for individuals who have preexisting conditions, helping them to keep coverage for those conditions or get coverage in no more than 12 or 18 months through limits on preexisting condition exclusions.

HIPAA includes protections to help ensure individuals are not excluded from coverage under their group health plan or charged a higher premium based on health status.

COBRA generally requires that group health plans of employers with at least 20 employees offer employees and their dependents the opportunity to continue their health plan coverage for limited periods of time when the employee loses his or her job due to retirement.

ERISA Claims Procedures help ensure fair and timely appeals process for covered individuals.

ERISA Disclosure Provisions require that group health plan disclosure material furnished to plan participants and beneficiaries must contain information about specialists in the plan network and the plan’s rules for accessing specialty care.

ERISA Disclosure Provisions also require that plan disclosure material must describe the ability of the employer to reduce plan benefits or terminate the plan.

Source: Department of Labor

Under the Patient Protection and Affordable Care Act (PPACA), annual limits for health plans are being eliminated. Annual limits on essential health benefits will be prohibited in 2014, but “restricted annual limits” are permitted for plan years beginning before Jan. 1, 2014.

The Department of Health and Human Services (HHS) implemented a waiver program for plans that would experience a significant decrease in access to benefits or a significant increase in premiums due to the restricted annual limits requirements. The annual limit waivers may apply until plan years beginning on or after Jan. 1, 2014, when all annual limits on essential health benefits will be prohibited.

HHS is no longer accepting annual limit waiver applications. The annual limit waiver program closed to applications on Sept. 22, 2011. Plans that did not receive a waiver must fully comply with PPACA’s restricted annual limits on essential health benefits. Plan that received a waiver must provide a notice informing current and eligible participants that the plan does not meet the minimum annual limits and has received a waiver of the requirement.

This GSM Insurors Legislative Brief summarizes the notice requirement for recipients of annual limit waivers and contains HHS’s updated model notice.

PROVIDING THE NOTICE

According to HHS, communicating the information required in the notice is necessary in order for consumers to understand the value and quality of the coverage they have, and to ensure that they do not have expectations that PPACA’s annual limits apply to their policies.

Each recipient of an annual limit waiver must distribute an annual notice to participants. The annual notice must be provided to participants as part of plan or policy materials that describe the terms of coverage (for example, summary plan descriptions) for each plan year for which the waiver applies.

When HHS announced the close of the annual limit waiver application process, it also released an updated model notice that group health plans and insurance issuers must use to meet the notice requirement. Waiver recipients must obtain written permission from HHS to use different notice language to satisfy the annual notice requirement.

Plans that received a waiver for a plan year beginning before Sept. 23, 2011 and already distributed the annual notice will need to distribute the updated annual notice beginning with the plan year starting on or after Sept. 23, 2011.

MODEL NOTICE

The following model language, which must be prominently displayed in clear, conspicuous 14 point bold type on the front of the materials, must be used to satisfy the notice requirement:

The Affordable Care Act prohibits health plans from applying dollar limits below a specific amount on coverage for certain benefits. This year, if a plan applies a dollar limit on the coverage it provides for certain benefits in a year, that limit must be at least [$750,000/$1.25 million/$2 million, as applicable].

This regulation now goes to the Federal Office of Management and Budget (OMB) for review and approval.

If approved, the regulation will place more burdens on employers regarding older workers and the Age Discrimination in Employment Act. The regulation would make it more difficult for employers to justify that a practice is based on a reasonable factor other than age, potentially putting them at risk for more lawsuits.

The EEOC will release more details if the regulation is approved by OMB.

Employers want to win back employee morale, but it may not be in the budget to reverse these recent trends. Some employers are instead turning to unique benefits and perks to appeal to current and prospective employees.

Many of the following options cost the company little or nothing, but are perceived as valuable by employees:

• Voluntary benefits (including unusual options like pet insurance)
• Group-buying discounts—on items like computers, gym memberships and cell phone plans—often cost the company nothing but offer cost savings to employees

• Free tickets to theme parks or other entertainment venues
• At-work chair massages
• Online stress-relief or exercise how-to videos
• Adoption assistance
• Concierge services
• Offer free or subsidized soda, coffee and/or snacks during the workday
• Additional PTO or personal days, such as an extra bonus day or two
• Paid hours for volunteer work each year
• Flexible scheduling options
• Telecommuting options

These may not all appeal to every employee, but offering a variety of perks and benefits can help satisfy a diverse employee population.

Voluntary employer extensions may apply.

Under a tax provision in the Patient Protection and Affordable Care Act (PPACA or the Affordable Care Act), the value of any employer-provided health coverage for an employee’s child is excluded from the employee’s income through the end of the taxable year in which the child turns 26.

This tax benefit applies regardless of whether the plan is required by law to extend health care coverage to the adult child or the plan voluntarily extends the coverage.

Tax Benefit Continues Beyond Extended Coverage Requirement

While the Affordable Care Act requires health care plans to cover enrollees’ children up to age 26, some employers may decide to continue coverage beyond the child’s 26th birthday. In such cases, the Affordable Care Act provides that the value of the employer-provided health coverage is excluded from the employee’s income for the entire taxable year in which the child turns 26. Because of this, if a child turns 26 in March but stays on the plan through Dec. 31 (the end of most people’s taxable year), all health benefits provided that year are excluded for income tax purposes.

When is it Available?

These tax benefits are effective March 30, 2010. The exclusion applies to any coverage that is provided to an adult child from that date through the end of the taxable year in which the child turns 26.

What are the Eligibility Requirements?

This expanded health care tax benefit applies to various workplace and retiree health plans. It also applies to self-employed individuals who qualify for the self-employed health insurance deduction on their federal income tax return.

Both Employer and Employee Shares of Premiums are Excluded from Income

In addition to the exclusion from income of any employer contribution toward qualifying adult child coverage, employees can receive the same tax benefit if they contribute toward the cost of coverage through a cafeteria plan.

If you belong to a health maintenance organization (HMO) or your employer offers its own health insurance plan, chances are it uses a prescription drug formulary to maximize the effectiveness of its pharmacy benefits program.

A formulary is essentially a preferred drug list for a particular health

plan. The drugs on the formulary have been evaluated and researched for safety and effectiveness, and are often the most cost-effective versions of commonly prescribed medications. By using a single set of prescribed medications for most routine

treatments, health plans are able to provide high quality care and keep costs as low as possible.

Formularies are not static lists; they change as new drugs and research become available. Usually, doctors and pharmacists review medical and pharmaceutical literature when deciding which drugs to place on a formulary. Some insurers allow variation from their formulary in specific instances, while others charge members a much higher copayment for medications that do not appear on the formulary.

Here is some basic information about a drug formulary:

• It is a comprehensive list of drugs expected to meet the needs of most patients.
• It is used as a way to provide cost-effective prescription drugs to members.
• It consists of both brand and generic drugs that have been approved by the health plan’s panel of physicians and pharmacists.
• It enhances the quality of medical care by identifying the best medicines from among the thousands available. It is also a tool to address skyrocketing prescription drug costs.
• Formulary drugs are chosen for their safety, effectiveness, quality and cost.

To find out about your health plan’s formulary, talk to your company’s human resources representative.

Generic vs. Brand Name

Some people think that generic versions of their prescription drugs are inferior, but the FDA requires that generic drugs meet the same standards as their brand name counterparts.

The difference between the two involves the research, development and marketing investment that went into the original brand name product. When “generic equivalents” become available, they have the same active ingredients and chemical purity as the brand-name drugs they imitate. Other ingredients such as tablet fillers, binders, coatings or flavors may differ. Because their development costs are less, generic drugs are often priced substantially lower.

When you receive a prescription from your doctor, ask if a generic equivalent is available. Many health plans charge a lower copay for patients who choose generics.

2010

Employers: Small businesses can receive tax credits if purchasing insurance for employees.

Insurers: Cannot impose pre-existing condition exclusions on coverage for children. Must cover preventive services without copays. Cannot remove coverage when a person becomes ill. Cannot impose lifetime coverage limits.

Uninsured: Individuals with pre-existing conditions receive immediate access to coverage through a high-risk pool. Dependent children can remain on parents’ plans until age 26.

Early retirees: Employers will be able to participate in a reinsurance program to help provide coverage for retirees and their spouses, surviving spouses and dependents over age 55 and not eligible for Medicare.

Medicare Part D enrollees: A $250 rebate check received for those entering the “doughnut hole” gap in coverage in 2010. Rebate payable by April 1, 2011.

2011

Insurers: Required to spend at least 80 percent of premiums on medical services.

Medicare Part D enrollees: Receive a 50 percent discount on brand-name prescription drugs when in doughnut hole coverage gap.

Those with health care savings accounts: Federal tax on those who spend health care savings account money on ineligible medical expenses increases to 20 percent.

Over-the-counter drugs: Except for insulin, OTC drugs without a prescription are not reimbursable from an FSA or HRA, and are not a tax-free reimbursement from an HSA.

W-2: The value of your health coverage must be disclosed on your W-2 form (optional for 2011).

2012-2013

Taxpayers: Medicare payroll taxes increase to 2.35 percent for individuals earning more than $200,000 and families earning more than $250,000.
Those with flexible savings accounts: A federal limit of $2,500 for individual pretax contributions per year.

2014

Employers: Companies with 50 or more employees must provide affordable coverage or pay a penalty.

Insurers: Prohibited from refusing to sell or renew policies. Cannot deny coverage for adults with pre-existing conditions. Limits ability to set prices on the basis of sex, health status or other factors. Prohibited from imposing annual limits.

Uninsured: Most Americans required to buy health insurance or pay fines of $95 per individual and up to $285 per family. Families will pay half the amount for children. Families can receive subsidies to buy insurance if they earn no greater than four times the federal poverty level (about $88,000 per year for a family of four). Individuals and small businesses can buy packages through state exchanges.

2015

Uninsured: Penalties for not carrying insurance increase to $325 per individual and up to $975 per family. Families will pay half the amount for children.

2016

Uninsured: Penalties for not carrying insurance increase to $695 per individual and up to $2,250 per family or 2.5 percent of taxable family income – whichever is greater. Families will pay half the amount for children.

2018

Taxpayers: A 40 percent excise tax imposed on high-cost employer-provided policies ($10,200 for individual coverage or $27,500 for family coverage).

2020

Medicare Part D Enrollees: Prescription drug coverage gap eliminated.

The Cleveland Clinic Department of Patient Education and Health Information defines posture as the position when one holds his/her body upright against gravity. Good posture involves training the body to stand, walk, sit and lie in ways to place the least amount of strain on muscles and ligaments.

There are many physical benefits to having good posture, such as:

• Keeping your bones and joints in the correct alignment to ensure that muscles work properly
• Decreasing abnormal wear on joint surfaces (may result in arthritis)
• Decreasing the stress on ligaments which hold the spine together
• Preventing the spine from fixing in an abnormal position
• Lessening fatigue
• Preventing strains, backaches and muscular pain

Contributions to Bad Posture

Though it is not a conscious decision most of the time, many workers have bad posture which can result in injuries. Here are some common behaviors that contribute to bad posture:

• Shoulders hunched forward while slouching
• Forming a “swayback” (also known as lordosis) in which there is an inward curve in the lower back
• Carrying a heavy load on one side of the body
• Cradling a phone receiver between the neck and shoulder
• Wearing high-heeled shoes without arch support or clothes that are too tight
• Excessively looking up or down
• Slumping or sliding in a forward position in a desk chair

Helpful Solutions

Want to ease strains and prevent back and neck injuries? Here are some recommendations for standing, sitting and lying down:

Standing Properly:

• Put your chin in and keep your head up
• Keep your earlobes in line with the middle of your shoulders
• Keep shoulder blades back and chest forward
• Keep your knees straight and tuck in your stomach
• Extend your head towards the ceiling

Sitting Properly:

• Place your shoulders back and your back straight
• Evenly distribute your body weight on both hips
• Bend your knees at a right angle and keep your feet rested flat on the floor
• Adjust chair height to sit close to your workstation
• Do not twist at the waist to grab something, turn your entire body
• Avoid sitting in the same position for more than 30 minutes

Lying Down Properly:

• Lie in such a way to maintain the curve in your back such as on your back with a pillow under your knees
• Place a lumbar pillow under your lower back or on your side with the knees bent
• Sleep on a firm mattress with a box spring that does not sag