Dynamic Work/Life Solutions Blog

Zika Virus

Posted by Blog Tipster on Fri, Dec 30, 2016 @ 03:30 PM


Looking back on 2016, the Zika Virus was certainly a hot, yet troublesome, topic.  Unfortunately, Zika is still a concern and since there are so many questions surrounding the virus, eni’s BalanceCare Guides wanted to provide our members with a few important FAQs.

What is the Zika virus?

Zika is a mosquito borne illness. Its name is derived from the Zika Forest of Uganda where the virus was first isolated in 1947. 

How is it spread?

  • Mosquito bites
  • From a pregnant woman to her fetus
  • Sex
  • Blood transfusions
  • If the virus continues to spread, additional methods may be added to this list

What are the symptoms?

Many people who contract the Zika Virus won’t have any symptoms.  However, the most common symptoms include:

  • Fever
  • Rash
  • Joint pain
  • Conjunctivitis (red eyes)
  • Muscle pain
  • Headache

Symptoms can last for several days up to a week. Once a person is infected with Zika, they are likely to be protected from future infections.

Why is it dangerous?

If you contract the Zika Virus while pregnant, it can cause birth defects such as microcephaly, defects of the eye, hearing and impaired growth.

How can you prevent Zika?

Although there is no vaccine to prevent Zika, there are several things you can do to protect yourself from getting bitten by any type of mosquito:

  • Wear long sleeved shirts, long pants, hats, and socks.
  • Treat clothing and gear with permethrin or buy pre-treated items. Permethrin is a medication and chemical used as an insecticide. Permethrin is a cream or spray which can be purchased over the counter at your local drug or department store.
  • Use insect repellent with one of the following ingredients:
    • DEET
    • Picaridin
    • IR3535
    • Oil of lemon eucalyptus
    • Para-menthane-diol

These are safe for pregnant and breastfeeding women when used as directed.

*DO NOT use insect repellents on babies younger than 2 months old*

*DO NOT use oil of lemon eucalyptus or para-menthane-diol on children younger than 3 years old*

While at home:

  • Stay in air conditioned places.
  • Use screens in windows and doors to keep mosquitoes outside.
  • Use mosquito netting to cover babies under 2 months old in carriers, strollers, and cribs.
  • Sleep under a mosquito bed net if sleeping outdoors.
  • Prevent sexual transmission by using condoms or abstaining from sex.
  • Avoid places where mosquitoes are breeding, such as swamps.
  • Get rid of water containers to eliminate mosquitoes’ breeding sites.

How Zika is diagnosed

  • Diagnosis is based on person’s recent travel history, symptoms, and test results
  • Blood or urine test
  • Tests may be used to rule out other infections

If you have Zika

  • Get plenty of rest
  • Drink lots of fluids to prevent dehydration
  • Take fever and pain reducer
  • DO NOT take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
  • If you’re taking medicine for another condition, talk to your healthcare provider before taking additional medication


Before you travel, check the CDC travel advisory list which is frequently updated. If pregnant or thinking about becoming pregnant, check with your healthcare provider and follow their advice.

Since Zika infections in the United States are relatively new, the implications for the medical insurance community is still a bit of an unknown.  If our members do have any questions, please call BalanceCare and we can get answers for you.



Centers for Disease Control and Prevention


Tags: Health Insurance, Health Advocacy, Zika, Zika Virus


Posted by Blog Tipster on Wed, Feb 17, 2016 @ 03:51 PM


There are a wide variety of vaccines available to help prevent illness.  Some vaccines are required for children to enter school, but others are completely voluntary and it is up to the individual and their doctor to decide if the vaccine is right for them.  In this article, eni’s Health Advocates will review two common vaccines.

Pneumococcal Conjugate Vaccine (PCV13):

Pneumococcal disease is caused by bacteria and is spread from person to person with close contact. It can cause ear infections, and can lead to more serious illnesses such as pneumonia, bacteremia or meningitis.

Approximately 18,000 older adults die of pneumococcal disease each year in the United States alone.  Children under 2 years of age, adults 65 and older, people with certain medical conditions and smokers are at greater risk for pneumococcal  pneumonia.

Pneumococcal meningitis is most common among adults and can cause deafness and brain damage.

The PCV13 vaccine protects against 13 types of pneumococcal bacteria. For children, the vaccine is given at 2, 4, 6, and 12-15 months of age. Older children and adults with certain health conditions are encouraged to get the vaccine as well.

People who have ever had an allergic reaction to earlier versions of this vaccine (PCV7), or DTaP, or any of its components should not get the PCV13 vaccine.

If you’re scheduled for the vaccine and aren’t feeling well on that day, you and your provider may want to reschedule it for when you’re feeling better.

For children, reactions range from mild fever to drowsiness.  Adults may experience site pain, redness and swelling. Any serious reactions should be reported to your provider.

Shingles Vaccine:

Shingles occurs when the virus that causes chickenpox starts up again in your body. After you get better from chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus "wakes up" when disease, stress, or aging weakens the immune system. Some medicines may trigger the virus to wake up and cause a shingles rash. It is not clear why this happens. After the virus becomes active again, it can only cause shingles, not chickenpox.

You can't catch shingles from someone else who has shingles. However, there is a small chance that a person with a shingles rash can spread the virus to another person who hasn't had chickenpox and who hasn't gotten the chickenpox vaccine.

Shingles may start as unusual pain or tingling in one location on one side of the body. This area may be sensitive to touch.  A red rash then leads to fluid-filled blisters that wrap around either the left or right side of the torso. It can also appear around one eye or one side of the face or neck.

The shingles vaccine is almost 70% effective for those 50-59 years of age and 51% effective for those 60-69 years of age.  The current shingles vaccine offers protection for about 8 years.  A new vaccine which may be effective longer is currently being tested.

As always, check with your provider to see if he recommends either vaccine.

Some vaccines have age requirements and some insurance companies won’t pay for certain vaccines without a prescription.  BalanceCare is available to assist our members with determining if your insurance will pay for these vaccines and help you navigate the complexities of your healthcare.



US Department of Health and Human Services, Centers for Disease Control and Prevention


AARP Bulletin, November 2015


Tags: Health Insurance, Health Care, Health Advocacy, vaccines

The Affordable Care Act - What You Need To Know

Posted by Melissa Mayfield on Wed, Jan 28, 2015 @ 04:51 PM

doctor stethoscope resized 600

The Affordable Care Act (ACA) requires that everyone has insurance coverage.  eni’s health advocates discusses the parameters surrounding the ACA. To avoid future tax penalties everyone must have insurance that qualifies as minimum essential coverage (MEC). Tax penalties can affect both employer and employee.

The following types of plans qualify for this coverage:

  • Any Marketplace plan

  • Any individual plan you already have

  • Any employer plan with or without “grandfathered” plan status

  • COBRA 

  • Medicare

  • Medicaid

  • Children’s Health Insurance Program (CHIP)

  • Tricare

  • Veteran’s health care programs [including Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA) and Spina Bifida Health Care Benefits Program]

  • Peace Corp Volunteer plans

  • Self-funded health coverage offered to students by universities for plan or policy years that began on/or after December 31, 2014

 Types of plans that DON’T qualify as coverage:

  • Coverage for vision or dental care only

  • Worker’s Compensation

  • Coverage only for a specific disease or condition

  • Plans that offer only discounts on medical services

 MEC offered through the marketplace must cover the following at minimum:

  • Outpatient care – the kind you get without being admitted to the hospital

  • Trips to the emergency room

  • Treatment in the hospital for inpatient care

  • Care before and after your baby is born

  • Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy

  • Prescription drugs

  • Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.

  • Lab tests

  • Preventive services including counseling, screenings, and vaccines to keep you healthy

  • Care for managing a chronic disease.

  • Pediatric services: This includes dental care and vision care for kids

Commercial insurance policies have different minimum standards than Marketplace policies.  However, they must cover Essential Health Benefits (EHB), which include:

  • Outpatient hospital care (doctor’s visits)

  • Prescription drugs

  • Emergency Care

  • Mental Health Services including substance use disorder services and behavioral health treatment

  • Hospitalization

  • Rehabilitative and Habilitative Services

  • Preventive and Wellness Services

  • Laboratory services

  • Pediatric Care including oral and vision care

  • Maternity and Newborn Care

When comparing out-of-pocket expenses, look at benefits being offered to ensure you are getting the best value for your premium expenses.

BalanceCare, Health Advocacy is a comprehensive, time-saving benefit that assists your employees in maximizing their healthcare benefits. Our Health Advocacy Services will work with you to fully customize a health advocacy program that will drive the most change for your employees.




Tags: medical plan, Health Insurance, Benefits, Affordable Care Act, Health Care Reform, Health Advocacy

Choosing the Right Health Insurance for You!

Posted by Melissa Mayfield on Wed, Nov 12, 2014 @ 04:36 PM

health guide woman and daughter in hospital resized 600

Purchasing health insurance has become increasingly more confusing with the multitude of choices available. Whether choosing plans offered by your employer or individual plans through the health marketplace under the Affordable Care Act, there are several factors to consider. eni’s BalanceCare Guides review these important factors and how their services are available to assist members.

Are you healthy? One annual routine physical/office visit is covered 100% under all policies due to the Affordable Care Act. Routine visits include pap smears, mammograms, and colonoscopies as long as there are no health issues. Keep this in mind when computing your healthcare costs.

Do you take a lot of medications? Check the co-pays for the medications you are currently taking. Are the costs applied to the deductible before the co-pays?  What “tier” are your medications? Insurance companies can change their formularies up to 2 times every year. Changes also occur when medications have a generic equivalent. BalanceCare Guides are available to assist with the drug formularies to determine the coverage. They can also determine if there is a cost savings for ordering through the mail.

Are your doctors covered under the plan? Doctors that are in-network save you money. Some insurance plans have limited coverage areas and your doctor may not accept that plan.  Once a plan is selected, BalanceCare Guides can furnish you a list of in-network providers.

Do you see a chiropractor or a mental health provider? Are your costs subject to the deductible or do you have a traditional co-pay? Are the number of visits limited? These factors should be taken into consideration when comparing plans.

Are you eligible for Medicare? Some group plans will penalize you if you don’t sign up for Medicare when you turn 65. BalanceCare can offer information to assist you with your decision to keep your group plan with or without Medicare. 

What are the premiums? Compare the approximate costs of your annual healthcare (prescriptions, office visits, etc) with the premium you’ll be paying. If you are healthy, you may want to choose a plan with a higher deductible and lower premium payment. If you take a lot of medication and frequently visit the doctor, a lower deductible and higher premiums payment may be more cost effective in the long run.

eni’s BalanceCare Guides are available to assist our members navigate the complexities of choosing health insurance!

Tags: Health Care Exchanges, Health Insurance, Affordable Care Act, Health Care Reform, Health Advocacy

Understanding HIPAA and Your Privacy

Posted by Cindy Mccall on Wed, Aug 20, 2014 @ 03:02 PM


health insurance file resized 600

Since HIPAA (Health Insurance Portability and Accountability Act) is misunderstood by many people, eni’s BalanceCare Guides have prepared and provided information on many of the guidelines and regulations associated with the act.  The most important thing to remember about HIPAA is that it is in place to protect your privacy.

Doctors, nurses and other healthcare professionals cannot discuss your medical condition or treatment to other people without your permission.  It is within your rights to authorize who may have access to your medical information and you can change who gets this information at any time. 

In order to protect your privacy all billing and medical information must be stored on secure computer systems and medical information which identifies you cannot be shared unless necessary.

You have the right to see your own medical records but you may be charged a fee for copies.  You are required to be given a notice of how your information will be protected, used, or shared.  You also have the right to file a complaint with your insurance company, healthcare provider, or with the U.S. Government, if you feel your rights have been violated.

Your healthcare provider cannot share your medical information with your employer without your consent.  Nor can your information be shared for advertising or marketing purposes without your permission.

HIPAA does not protect information held by life insurance companies, employers, schools, or workers compensation carriers.  HIPAA also exempts state agencies, municipal offices and law enforcement agencies.

It is important to remember that if you are in the hospital or other healthcare facility and would like your clergyperson, rabbi, or spiritual advisor to know you are there, you must list them as a representative.

Due to HIPAA regulations, in order for eni’s BalanceCare Guides to assist you with benefit or claims questions, they may need you to sign an authorization form giving them permission to speak to insurance companies or provider’s offices on your behalf.  Also, parents calling on behalf of dependents 18 and older must get the dependent’s permission to discuss any medical related information.  Members must also obtain benefit administrators and/or spouse’s permission to speak on their behalf.  These regulations may delay the time frame in which you receive your requested information but it does protect your privacy.

HealthCare providers, insurance companies and healthcare advocates (i.e. BalanceCare Guides) are covered under HIPAA regulations.

BalanceCare, eni’s health advocacy is a comprehensive, time-saving benefit that assists your employees in maximizing their healthcare benefits.  eni’s program is designed to:
  • Create more efficient utilization of employee benefits

  • Save HR professionals’ time by answering benefits questions

  • Boost employee productivity by acting as liaison or ombudsman with billing or authorization issues

  • Help companies give employees better coverage at a lower cost

  • Assist with FMLA, Worker’s Comp and disability issues and concerns

For more information contact eni today!

Source: http://www.ehow.com/about_6307239_hipaa-explained-simple-terms.html




Tags: HIPAA, Health Insurance, Health Advocacy

Special Enrollment Periods For The Marketplace

Posted by Melissa Mayfield on Wed, Jul 02, 2014 @ 10:03 AM

Open enrollment for 2014 coverage is over, however, you may still have options to get health coverage through a special enrollment period for qualified health plans on the Marketplace.  Special enrollment periods are available only if you meet certain requirements.  Although, if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can enroll in those programs at any time of the year.

What you need to know before you apply:

If you have experienced a qualifying life event, you are eligible to enroll during the special enrollment period.  Here are some examples of qualifying life events:

  • Marriage or divorce.

  • Having a baby, adopting a child, or placing a child for adoption or foster care.

  • Moving your residence, gaining citizenship, leaving incarceration.

  • Losing other health coverage – due to losing job based coverage, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP.

  • Gaining status as a member of an American Indian tribe – members of federally recognized American Indian tribes can sign up for or change plans once a month throughout the year.

  • For people already enrolled in Marketplace coverage:  Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions.

If you think you qualify for a special enrollment period based on the above criteria, you can go to HealthCare.gov and start a Marketplace application.

If none of these options work for you, the Open Enrollment period for 2015 coverage begins on November 15, 2014.

Important:  If you don’t have minimum essential coverage, you must either pay a fee or have an exemption from paying the fee.  To find out more information on exemptions from the penalty, visit www.healthcare.gov/exemptions.

HR BLog Graphic resized 600

To learn more about special enrollment periods go to www.healthcare.gov.

This article is designed to provide general information and is not a substitute for legal advice 

Tags: Health Care Exchanges, enrollment services, Human Resource Management, Health Insurance, Health Care, Health Care Reform, Human Resources

BalanceCare Health Advocacy Services

Posted by Melissa Mayfield on Thu, Jun 05, 2014 @ 01:00 PM

call center PA resized 600Requesting assistance with navigating your health insurance can be as simple as picking up the phone.  eni’s BalanceCare Guides are here to assist our valued health advocacy clients with many aspects of their health insurance questions.

Some examples of how BalanceCare can assist your employees include:

  • Do you need a list of in-network providers that participate in your plan, if so, call us!  Using in-network providers can significantly decrease out of pocket expenses.

  • Are you unsure as to why you have received a bill for the services you thought would be covered in full?  BalanceCare can research and investigate that claim with the insurance carrier to be sure it was processed correctly.

  • Haven’t received your ID cards but you have an appointment coming up?  We can either obtain the ID information for you or connect you with the carrier so they can provide that to you directly.  We can also request cards be sent to you and provide the carrier website for the printing of a temporary card.

  • Do you need information on whether or not a service is covered?  With the information that you supply us, we can research if a service or medication is included in your plan.

  • Are you confused about how deductibles and co-insurance work?  We can review and go over these areas of the plan with you.  These two specifics areas can be very different from plan to plan.

If assistance is needed with general questions on plans prior to enrolling, BalanceCare may be able to help with this as well.

For example, when choosing between multiple plans it is important to consider:

  • The overall health of family members.

  • The number of medications a family requires.  Compare the prescription costs for the plans.  Do pharmacy benefits go towards the deductible or is there a separate deductible for medications?  Is mail order available and less expensive for a 90 day supply?

  • Do the deductibles and co insurance fit with your budget for the out of pocket expenses they create?

BalanceCare, Health Advocacy is a comprehensive, time-saving benefit that assists your employees in maximizing their healthcare benefits. Our Health Advocacy Services will work with you to fully customize a health advocacy program that will drive the most change for your employees.  Contact eni today to learn more!

Tags: enrollment services, employee satisfaction, employee engagement, Health Insurance, Health Care, Health Advocacy

Insurance Tips While Traveling

Posted by Melissa Mayfield on Wed, Mar 19, 2014 @ 06:32 PM

Freinds in London resized 600

With summer on the way, many people are scheduling their vacations. What do you do if you get sick or injured while out of town?  eni's BalanceCare Guides have some suggestions for you.

Within the USA:

  • Always have your medical identification card with you while traveling.

  • Prior to traveling, check with your BalanceCare Guide who can provide you with a list of area in-network providers, walk-in clinics, or urgent care facilities.

When Traveling Outside of the Country:

Most insurance companies will not cover the recommended immunizations for traveling to certain areas of the world. However, your BalanceCare Guide is available to double check this for you. If these immunizations are not covered, your local health department may be a low cost alternative to your doctor’s office.

It’s important to be aware that only medical emergencies are covered when traveling abroad. If you do need medical services abroad, be prepared to pay in advance.  Always make sure any medical bills are presented to you in English with the charges in American dollars.  Once you return to the USA, these charges can be submitted to the insurance company for reimbursement and eni’s BalanceCare Guides can assist with claim submissions.

BalanceCare Health Advocacy is a comprehensive, time-saving benefit that assists your employees in maximizing their healthcare benefits. Our Health Advocacy Services will work with you to fully customize a health advocacy program that will drive the most change for your employees.  Learn more about eni’s BalanceCare health advocacy program today!

Tags: Health Insurance, Health Care, Health Advocacy, Insurance while traveling

eni’s Health Advocates Provide Information on Medicare

Posted by Melissa Mayfield on Thu, Jan 02, 2014 @ 04:50 PM

You may have questions when you become eligible for Medicare. While BalanceCare Guides can give you general information, there are also resources that can help you with specific questions.  “Medicare for Dummies” was recently published by AARP.  “Medicare and You” and “Who Pays First” are published by the government and are available on Medicare’s website.

Being on Medicare does not mean inferior care.  The doctors you choose are not government employees. They are independent and can choose whether or not to participate in the Medicare program.  Your doctors, laboratories and radiology facilities as well as hospitals may already participate with Medicare so there’s no need to change providers of service.

Medicare offers more choices than many group policies offered through employers.  Traditional Medicare and a variety of Medicare Advantage Plans (HMO and PPO) will begin offering different plans through the mail.  The number of plans offered varies depending on where you live.  Plans should be reviewed so an educated choice can be made depending on your specific medical needs.  Deductibles, co-pays, and out-of-pocket limits should be noted.  HMOs restrict the doctors you see so it’s best to check with your doctor before changing to that kind of plan.  Choosing a doctor outside of any plan will mean additional expenses to you.

Pre-existing conditions or past medical history will not affect your premium.  Tobacco use, alcohol use, or obesity will also not affect your premium.

You won’t lose Medicare coverage once you reach a certain age.  As long as the treatment you seek is medically necessary and you can physically tolerate the procedure, Medicare will pay for it. 

eni’s Health Advocates are available to help our BalanceCare members navigate their health insurance.  BalanceCare, Health Advocacy is a comprehensive, time-saving benefit that assists your employees in maximizing their healthcare benefits. Our Health Advocacy Services will work with you to fully customize a health advocacy program that will drive the most change for your employees.

Tags: Health Insurance, Health Care Reform, Health Advocacy, Medicare

Healthcare Reform Update

Posted by Melissa Mayfield on Wed, Nov 13, 2013 @ 04:10 PM

Individual Mandate Penalty Deadline Has Been Extended.

The Obama Administration recently announced that it has extended until March 31, 2014, the “individual mandate” deadline to purchase health insurance through the new state exchanges to avoid paying tax penalties.

The current ACA law requires that by January 1, 2014 individuals must enroll in “minimum essential coverage” or pay a shared responsibility tax, the so-called “individual mandate” unless they fit within one of the exemptions established by the ACA.  One of the exemptions that excuses individuals from this penalty is having a gap in coverage for “a continuous period of less than 3 months”.  Under this short coverage gap a person would still be compliant with the individual mandate as long as they obtain minimum essential coverage by March 31, 2014 and remain in continuous coverage for the balance of 2014.  However, in order to guarantee coverage by March 31st, consumers would have to choose a policy by February 15 of 2014. 

Due to continuous problems plaguing the website, many individuals have been unable to sign up for coverage and are concerned they will not meet the deadline to avoid the individual mandate penalty.

In a recent release, the department of Health and Human Services recognized a hardship exemption for individuals who purchase coverage through the exchange between February 15 and March 31, 2014 and extended until March 31 (the last day of the open enrollment period) the date that individuals can purchase insurance and still avoid paying tax penalties.

For more information on “individual mandate penalties” visit the Health and Human Services website at www.hhs.gov

To provide enrollment support, eni is proud to announce that we recently expanded our capabilities and cut the ribbon on our benefit enrollment call center!  We encourage you to contact eni for information on enrollment services.

**This article is designed to provide general information and is not a substitute for legal advice**

Tags: Health Care Exchanges, enrollment services, Health Insurance, eni, Health Care, Health Care Reform, enrollment