Are You Covered for Health Insurance?
Save Up to 70% on Generic Drugs Through Rx Savings
Higher Drug Prices May Offset Card Savings
Medicare Urges Comparison Shopping
Older and Wiser
Jim Richardson Honored as a Pro Bono Attorney of the Year
Factoids on Low-Wage Work
Some Low-Wage Workers May Receive Overtime Pay
Equal Pay for Women
Regular Payday
No "Willful Misconduct" Unemployment Comp if...
What Working Women Want
Some "Voluntary Quits" May Be Eligible for UC
Eat Better for Less
Free Speaker for Your Next Meeting

Are You Covered for Health Insurance?

If not, do not despair. There are at least seven ways by which you can find health insurance coverage, according to Families USA, 1334 G Street NW, 3rd Floor, Washington DC 20005, which is campaigning to “Get America Covered.”

1. If you recently lost your job from a company that employs at least 20 workers, and you had health insurance at that job, you can retain your health insurance coverage by signing for COBRA within 60 days from the time you lost your job. But you have to pay the expensive premium yourself. For more information, visit www.dol.gov/ebsa/faqs/faq_consumer_cobra.html  or call the Pennsylvania Insurance Department at 1-877-881-6388, or the U.S. Department of Labor at 1-866-275-7922

2. If you were laid off because the products your company manufactures are being replaced by products made by workers in other countries, 65% of the cost of your health insurance may be paid through the Trade Adjustment Assistance Reform Act for up to 3 years. Call the Health Coverage Tax Credit (HCTC) Customer Contact Center at 1-866-628-HCTC or go to www.irs.gov/pub/irs-utl/hctc_program _kit.pdf .

3. If you retired early at age 55 or older and you receive your pension benefit from the federal Pension Benefits Guaranty Corporation, instead of your former company, HCTC can help you pay 65% of the cost of health insurance until you qualify for Medicare when you turn 65.

4. If you cannot afford to buy health insurance on your own, you can apply for Medicaid or adultBasic. You may qualify even if you work. But there are income and asset limits.

You can also apply for Pennsylvania’s Children’s Health Insurance Program (CHIP) for your uninsured children at 1-877-KIDSNOW or visit www.insurekidsnow.gov . The income limits for CHIP are higher. You can also contact the County Assistance Office, the office of Northwestern Legal Services that covers your area, or the Pennsylvania Health Law Project at 1-800-426-2090.

5. If you worked and have a disability or serious medical condition, you can apply for Social Security Disability Insurance (SSDI) at your local Social Security Administration office. Call them at 1-800-772-1213 or TTY 1-800-325-0778. After receiving SSDI for 24 months, you can enroll in Medicare, even if you are under age 65. To qualify for Medicare if you are not 65 years old yet, you must have a disability that is expected to last at least a year or is expected to cause your death. To learn more about Medicare, call 1-800-MEDICARE (633-4227) or go to www.medicare.gov .

6. If you have low income and are blind or have a disability, you can apply for Supplemental Security Income (SSI). While waiting for your SSI, you may be able to get Medicaid. Even if you do not qualify for SSI, you may still be able to get Medicaid. Contact the Pennsylvania Medicaid at 1-800-692-7462 or the AdultBasic program at 1-800-GO-BASIC. If you are denied Medicare or Medicaid, you can ask for help from the Northwestern Legal Services office nearest you. You can also seek information, counseling, and assistance on Medicare from the State Health Insurance Assistance Program (SHIP) by calling APPRISE at 1-800-783-7067. The Pennsylvania Protection and Advocacy program (P&A) provides legal representation and other advocacy services to all people with disabilities. Contact them at 1-800-692-7443 (TTY 1-877-375-7139) or visit www.ppainc.org .

7. If you can’t get health insurance through your job, you can shop carefully for an individual health insurance policy through a health insurance agent who is licensed to operate in your state.

When shopping for an individual health insurance policy, be sure you know what medical services are covered, what deductible you must pay before the insurance starts to pay for services, how much your co-payment is for services, what pre-existing conditions will it cover and not cover, and how extensive the provider network is.

The Health Insurance Portability and Accountability Act prohibits insurance companies from refusing to cover pre-existing conditions or health problems you already have. To determine the reliability of an insurance company and insurance agent, contact the Pennsylvania Insurance Department at 1-877-881-6388.

8. If you can’t still find health insurance, you may be able to get low-cost primary health care from a local community health clinic. Call the Forum for Primary Health Care at 1-717-761-6443 or search www.bphc.hrsa.gov . You may also be able to get free or low cost health care from some non-profit hospitals. You may get financial assistance for your hospital bills.

Save Up to 70% on Generic Drugs Through Rx Savings

You may save up to 70% on generic drugs everyday by using the Rx Savings Access card, which costs only $24.95 per year. Savings on brand name drugs may be up to 38%.

To qualify for this Medicare-Approved Prescription Drug Discount Card, you must have Medicare Part A and/or Medicare Part B, and you do not have outpatient prescription drug benefits under the State Medicaid Program.

Call 1-888-CARD4RX (1-888-227-3479) or TTY 1-800-279-0571 to apply. Or visit www.RxSavingsAccess.com .

You may qualify for the free Transition Assistance Program if your annual income is no more than $12,569 if single or no more than $16,862 if married. Medicare will provide you a $600 credit for prescription drugs if you do not have other health insurance with prescription drug coverage (except a Medicare Managed Care Plan or a Medigap policy).

Higher Drug Prices May Offset Card Savings

If you frequently take brand-name prescription drugs for any ailment that you have, their increased cost may offset the savings that you get from using the Medicare-approved drug discount card.

According to a Families USA report, “the prices of the 30 brand-name drugs most frequently used by the elderly rose by 4.3 times the rate of inflation in 2003.” While the rate of inflation was 1.5 percent, the average cost of these heavily prescribed drugs increased by 6.5 from January 2003 to January 2004.

The following are fourteen of the 30 brand-name drugs that increased in price by more than five times the rate of inflation: Comvibent (used for treating chronic asthma and other respiratory conditions), Alphagan P (for glaucoma), Evista (for osteoporosis), Diovan (for high blood pressure), Detrol LA (for overactive bladder), Xalatan (for glaucoma), Lipitor (to lower cholesterol), Plavix (to prevent blood clot), Norvasc (for high blood pressure), Celebrex (for arthritis and joint pain), Protonix (for gastric reflux), Zoloft (for depression), Cozaar (for high blood pressure), and Celexa (for depression). Other drugs which prices increased significantly are Pravachol (for high cholesterol) and Toprol XL (a beta blocker).

Medicare Urges Comparison Shopping

Medicare will provide information that will let people compare the prices they would have to pay for their prescription drugs by accessing http://www.medicare.gov  or calling 1-800-MEDICARE. Elderly and disabled Americans will be able to choose from 73 discount cards which can be used to purchase over 60,000 drug products from more than 50,000 pharmacies around the country. They can also monitor the weekly changes in the prices of their medicines.

Aside from the Rx Savings Access card described on page 1, AARP is also selling drug discount cards. Prime Therapeutics manages drug services for seven Blue Cross and Blue Shield plans offering cards. UnitedHealth Group manages three cards. Pharmacy Care Alliance, a joint venture of Express Scripts and chain drugstores, is selling cards. Other companies that are also marketing drug cards are Caremark, Medco and WellPoint.

People enrolled in Medicare health maintenance organizations (HMOs) will receive cards automatically without filing applications. People in the traditional fee-for-service Medicare program will have to sign up for their discount cards.

Hopefully, competition among the 40 national and 33 regional drug card sponsors will drive down prices of prescription drugs. Some companies are offering their cards at no cost at all. While drug users have a wide selection of cards, they can switch cards only once a year.

Individuals with annual income of $12,569 or less, and married couples with income of $16,862 or less, will be eligible for a credit of $600 a year on their cards in 2004 and 2005. Additionally, they may use senior-discount cards and drug manufacturers’ assistance programs.

Older and Wiser

As baby boomers begin to reach retirement age, they need to take some important information with them.

Northwestern Legal Services is partnering with state legislators in our region to present a series of seminars titled “Older & Wiser.” These seminars present important information about legal issues that affect elderly adults, their families and/or caretakers. Local attorneys with expertise in elder law volunteer their time to lead each session that includes a PowerPoint presentation, referral information, and legal education materials. Questions are welcome from audience members. Each seminar is free of charge and open to the public.

NWLS and State Representative Tom Scrimenti presented the first seminar in this series on Friday, May 14, at the Union City Senior Citizens Center. Erie attorney Colleen McCarthy led a session on the topic of “Powers of Attorney and Living Wills.” These are written legal documents, prepared in advance of the time you need them, that instruct or authorize others to act in your behalf if you should experience a medical emergency, become incapacitated or when, in certain situations, you simply prefer not to handle your own affairs.

We are in discussion with other state legislators in northwestern Pennsylvania to sponsor events in communities throughout our service region.

The concept for the “Older & Wiser” seminar was developed by Neighborhood Legal Services in Pittsburgh.

(Contributed by Vince Brocki, NWLS Resource Developer)

Jim Richardson Honored as a Pro Bono Attorney of the Year

Northwestern Legal Services and the Erie County Bar Association honored Erie attorney Jim Richardson as this year’s Pro Bono Attorney of the Year for his dedicated service to the Legal Aid Volunteer Attorney (LAVA) Program. Richardson received the award as part of Law Day festivities at the Erie Shrine Club on April 30.

In 2003, Attorney Richardson contributed 46 hours of pro bono representation to low-income clients as part of LAVA. He has been very active in the program since it began in 1982, taking 28 pro bono cases and donating 144 hours of pro bono representation and counsel during that time. Richardson also served on the Board of Directors of Northwestern Legal Services from 1982 to 1992, and as president of that board from 1988 through 1991, helping to create the LAVA program as we know it today.

In addition to his many years of service to NWLS, Richardson has been very active with the Shriner’s Hospital for Children, and with the Boy Scouts of America French Creek Council.

(Contributed by Vince Brocki, NWLS Resource Developer)

Factoids on Low-Wage Work

At the current minimum wage of $5.15 an hour, a full-time, full year worker would make just $10,712 annually. That, according to most surveys, is too low to support a family. Only households with two full-time working adults earning minimum wages with basic benefits and no children could meet their living needs, according to Douglas Gould & Co. ( www.economythatworks.org/facts )

The average CEO makes as much as the combined incomes of 1,223 minimum wage workers. The congressional pay is nearly 14 times that of minimum-wage workers.

While most employees working at minimum-wage are teenagers living with the support of their families, two out of every three minimum-wage workers are adults. Two out of every three minimum-wage workers are women.

While the child tax credit may help families with a refund of up to 10 percent of the amount by which their earnings exceed $10,000, a single parent earning the full-time minimum wage of $10,712 a year would receive only a $71 tax credit. A family earning $9,999 would receive no credit at all.

Education and job training can improve the minimum-wage worker’s opportunity for a better job and higher pay. But with the 43.5 hours average work week for the working adult, this time constraint, along with family obligations, limits the amount of time available for workers to further their education. There is therefore a preference for short, intensive education programs over the traditional 15-week semester programs.

Twenty-eight percent of working parents enrolled in adult education programs were poor. Only 7.7 percent of all working parents received federal, state, or institutional financial assistance.

Job training increases low-income family earnings anywhere from 10 to 156 percent beyond what other job seekers receive without job training. Low-income workers who receive job training are more likely to attain jobs with benefits (such as health care, retirement plans, and paid leave) than those who do not seek job training. People with more education tend to work more and earn more.

Some Low-Wage Workers May Receive Overtime Pay

Effective Aug. 23, 2004, some workers, including police officers, fire fighters, paramedics, emergency medical technicians, and licensed practical nurses, will be entitled to overtime protection under the Fair Labor Standards Act. To see the FairPay rule, visit www.dol.gov/fairpay .

For the past 50 years, only workers earning less than $8,060 annually were guaranteed overtime pay. Under the new rules, some workers earning $23,660 or less will be guaranteed overtime pay. This strengthens overtime protection for 6.7 million low-wage salaried workers, including 1.3 million salaried white-collar workers who were not entitled to overtime pay under the existing regulations, according to the U.S. Department of Labor.

Equal Pay for Women

The Equal Pay Law of 1959, P.L. 1913, No. 694 prohibits discrimination in rate of pay because of sex.

The law provides that no employer shall discriminate “between employees on the basis of sex by paying wages to employees...at a rate less than the rate at which he pays wages to employees of the opposite sex...for equal work on jobs, the performance of which, requires equal skill, effort, and responsibility, and which are performed under similar working conditions, except where such payment is made pursuant to (1) a seniority system; (2) a merit system; (3)a system which measures earnings by quantity or quality of production; or (4) a differential based on any other factor other than sex.”

Regular Payday

Every employer shall pay all wages due on his/her employees on regularly scheduled paydays designated in advance by the employer, according to the Wage Payment and Collection Law (PA Act No. 329 of July 14, 1961).

No "Willful Misconduct" Unemployment Comp if...

The courts of Pennsylvania have provided guidance in determining an individual’s eligibility for unemployment compensation (UC) in specific situations involving a discharge for “willful misconduct.”

Section 402(e) provides that an individual who is discharged from employment for reasons that are considered to be “willful misconduct” connected with his/her work, is not eligible to receive UC benefits.

“Willful misconduct” is defined as an act of “wanton or willful disregard of the employer’s interests, the deliberate violation of rules, the disregard of standards of behavior which an employer can rightfully expect from an employee, or negligence which manifests culpability, wrongful intent, evil design, or intentional and substantial disregard of the employer’s interests or of the employee’s duties and obligations.”

An employee is eligible to collect unemployment compensation if the discharge is not due to “willful misconduct.”

Some of the common discharge situations are (1) absenteeism/tardiness; (2) rule violation; (3) attitude toward employer or disruptive influence; (4) damage to equipment or property; (5) unsatisfactory work performance; and (6) drug and alcohol testing.

Absenteeism alone may justify a discharge, if proven as “wanton and willful disregard of the employer's interests.” If an employee has a good reason for being tardy or absent, such as being ill or have an ill child, and reports off according to the employer’s policy, that individual’s conduct does not rise to the level of willful misconduct and the employee is eligible for unemployment compensation

Deliberate violation of an employer’s rule which is known to the employee constitutes willful misconduct if the employer’s rule is reasonable and the employee’s conduct, in violating the rule, was not motivated by good cause. If the employee can prove that the rule was not reasonable, or that he/she had good cause for violating the rule, he/she cannot be denied unemployment compensation benefits.

If an employee is being discharged due to his/her attitude toward the employer or due to being a disruptive influence, the employer must show specific conduct adverse to the employer’s interests. Employees are expected to respect standards of behavior set by the employer.

An employer can discharge an employee who damages equipment or property if the employer can show that the action which caused the damage was willful or due to willful carelessness. Negligence resulting in property or equipment damage can be prevented by reasonable care.

An employer can discharge an employee for unsatisfactory work performance as willful misconduct if the employee was capable of doing the work, but was not performing up to standards despite warnings and admonitions. To stay on the job, an employee must work to the best of his/her ability.

An employee can be discharged and denied unemployment compensation for failure to submit to and/or pass a drug or alcohol test, provided that the test is lawful and not in disagreement with an existing labor agreement. If the test is proven to be unlawful, inaccurate, and in violation of an existing labor agreement, the discharged employee is eligible for unemployment compensation.

What Working Women Want

Working women want to protect their family time, according to Andrew J. Cherlin, the author of “Public and Private Families” and a professor of public policy and sociology at Johns Hopkins University.

Employed mothers spend less time with their children than do other mothers. And they get less sleep, watch less TV, and generally have less free time than mothers who don’t work outside the home.

The lack of leisure time takes its toll on working mothers, but they compensate this by doing less housework. They feel rushed. But they feel that a busy life that combines employment and child rearing is a fulfilling and satisfactory life.

What working women want is that their husbands should do somewhat more housework and child care. Working mothers could use more help from their husbands and partners to reduce the leisure gap.

(Source: The New York Times, May 9, 2004)

Some "Voluntary Quits" May Be Eligible for UC

Section 402(b) of the Pennsylvania Unemployment Compensation Law provides that if an employee voluntarily leaves work without cause of a “necessitous and compelling nature,” he/she shall be ineligible for unemployment compensation (UC) benefits. The employee must make every reasonable effort to maintain the employer-employee relationship, and if the cause for voluntary quit is “real and substantial” and there is no other alternative, then the claimant may be eligible for UC.

Some common examples of voluntary quit situations are: (1) health reasons; (2) transportation problems; (3) spouse following spouse; (4) leaving work due to personal reasons; (5) to attend school; (6) due to unsuitable work; and (7) job not the same as what was anticipated.

If the employer fails to offer suitable work to a claimant who informed the employer of his/her health limitations and his/her ability and availability for suggested accommodations, then the claimant may be eligible for UC when he/she quits.

If the employee loses his/her transportation through no fault of his/her own, and places himself/herself available for suitable work in the local labor market, but quits due to an insurmountable problem of securing alternate transportation, he/she may be eligible for UC.

If the employee quits in order to follow his/her spouse who has been relocated beyond his/her control, and such relocation created economic circumstances which could not be overcome, or maintaining two residences is economically impossible, the claimant may be eligible for UC.

Personal circumstances that leave an employee no reasonable alternative but to voluntarily quit may qualify him/her for UC. However, he/she must be available for suitable work and must show that he/she reasonably maintained the employer-employee relationship.

To quit a job to attend school or training provided under the Trade Readjustment Act (TRA) may qualify an employee to receive UC. But the job he/she quits must not be suitable work or is not substantially of a higher skill level than the claimant’s past “adversely affected employment.”

A claimant who quits a job for unsuitable work must show that there were changes in the conditions of employment, or there was deception on the part of the employer regarding pay or work duties.

Eat Better for Less

Nutrition educators from the Expanded Food and Nutrition Education Program (EFNEP) in Pennsylvania will instruct low-income homemakers, including pregnant or breast-feeding teens and low-income youth from rural and urban communities, on food preparation skills, food buying, food safety, meal planning, stretching food dollars and using food stamps and other resources effectively.

Administered through Penn State University’s College of Agricultural Sciences Cooperative Extension, EFNEP is federally funded through the U.S. Department of Agriculture Cooperative Research Education and Extension Service. Staff members of local County Cooperative Extension Service implement the EFNEP program.

Only women and youth with incomes 125% of the 2004 Poverty Guidelines are eligible for the program, i.e., $970 monthly income for a single individual, $1,301 a month for a single mother with one child, $1,632 a month for a family of three, and $331.25 for each additional family member.

Participants must complete at least six hours of instruction in order to receive a certificate of completion from Penn State University.

Adults and families will learn about planning tasty meals, preparing simple snacks and healthful meals, feeding babies and children, keeping food safe and healthy, stretching food dollars, and using Food Stamps wisely.

Pregnant women will learn about their baby’s growth, eating right during pregnancy, gaining a healthy amount of weight, choosing breast or formula feeding, starting infants on solid foods, and the baby’s health risk from drug or alcohol abuse.

For more information, call your local Cooperative Extension Service or 1-888-PSU-3535. Also visit http://nutrlinks.cas.psu.edu .

Free Speaker for Your Next Meeting

If you need a speaker for your next meeting, conference, or in-service training, our Community Educator is available as a presenter on civil legal issues pertaining to the family, health, education, employment, housing, public benefits, and consumer rights.

Call him at (814) 452-6949, Ext. 105, or e-mail him at sparco@nwls.org or use our on-line registration form.  Please indicate which of the following topics you would want him to discuss:

[ ] Free legal aid for low-income clients, Pro Bono, District Justice Court
[ ] Protection from abuse, divorce, child support, child custody
[ ] Medicaid, Medicare, Medigap, Managed Health Care
[ ] Rights of children with special needs
[ ] Unemployment compensation
[ ] Tenants’ rights
[ ] Social Security, Supplemental Security Income
[ ] Temporary Assistance for Needy Families, Food Stamps
[ ] Consumers’ rights
[ ] Consumer credit; Consumer frauds
[ ] Identity theft      [ ] Other__________________________________
 

For more information, visit our website: www.nwls.org  

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