No minor under 12 years of age may be employed. Minors under 16 years of age who have not graduated from high school must have a work certificate (or work permit) from the child's school. In addition, there are also numerous hourly restrictions: Minors under 16 may not be employed between the hours of 9:00 p.m. and 6:00 a.m., more than 4 hours a day during the school year, more than 8 hours a day during vacations and not more than 40 hours a week. (The rules may be different for employers in agricultural industries.) Also, minors under 16 may not be employed in a "dangerous occupation."

Under COBRA, businesses that employ 20 or more employees and offer a healthcare plan must offer employees and former employees the option of continuing their healthcare coverage if the employee's healthcare coverage is lost or reduced because his or her employment has been terminated, his or her hours have been reduced, or the employee has become eligible for Medicare.

Your share of the cost when you receive medical services. It's shown as a percentage - for example, 80 percent for a doctor's office visit or 70 percent for outpatient surgery. If you have 80 percent coinsurance for a certain service, that means your plan pays 80 percent of covered costs, and you pay the remaining 20 percent.

You may pay coinsurance when you:

• Have an inpatient hospital stay


• Use an emergency room, urgent care center, or outpatient facility


• Need medical services like lab tests or outpatient surgery


• Go to the doctor or dentist (not applicable to all plans)


• Fill a prescription for a drug (depending on your pharmacy benefits)

Coinsurance can vary depending on the service and the type of provider you use. With most types of plans, you pay less when you use participating providers. And when you use participating providers, your percentage is calculated based on the negotiated rate - the discounted amount the provider has agreed to charge for health plan members.

A flat amount you pay when you receive health care services. A copayment can range from a few dollars to a few hundred dollars, depending on the services you need.

You may have to pay a copayment when you:

• Go to a doctor


• Fill a prescription


• Use an emergency room, urgent care center, or outpatient facility


• Receive a CAT scan or MRI


• Have an inpatient hospital stay

Copayments generally do not reduce the annual deductible or out-of-pocket maximums.

The amount of covered expenses you have to pay before the health plan pays for any services. A plan's deductible can apply to one person, all covered family members, or some combination. It's shown as an annual number, meaning your expenses accumulate during a plan year. When the new plan year starts, you start fresh with a new deductible to meet.

You may have to pay toward a deductible when you:

• Go to a doctor


• Go to a dentist


• Fill a prescription


• Use an emergency room, urgent care center, or outpatient facility


• Have an inpatient hospital stay

With some types of plans, you have a spending account to help you pay for health care before you meet the deductible.

Age: The Age Discrimination in Employment Act prohibits discrimination against workers who are 40 years of age or older. The law applies to all private employers with 20 or more employees, employment agencies and certain labor unions.

Bankruptcy: Generally, federal law prohibits discrimination in employment decisions against people who have declared bankruptcy.

Disability: Employers are prohibited from engaging in discrimination against qualified individuals with a disability by The Rehabilitation Act of 1973 and the Americans With Disabilities Act of 1990. A "qualified individual with a disability" is an individual who possesses the requisite skills, experience, education, and other job-related requirements of the position and who can perform the essential functions of the job with or without reasonable accommodation. An "individual with a disability" is a person with a physical or mental impairment which substantially limits one or more major life activities, has a record of such impairment or is regarded by the employer as having such an impairment. The determinatin of whether a person is “disabled” should be made with reference to measures that might mitigate that individual’s impairment, including medicine or eye glasses. Typical "major life activities" are caring for oneself, performing manual tasks, walking, hearing, speaking, breathing, learning and working. "Reasonable accommodation" might include making existing facilities accessible to the disabled, restructuring jobs, reassigning work or otherwise modifying schedules, or revising employment tests. An employer is not required to create a job that does not already exist. An accommodation is not reasonable where it would cause the employer undue hardship (significant difficulty or expense).

Equal Pay: The Equal Pay Act forbids employers to pay different wages to men and women who are performing equal jobs.

Pregnancy: The Pregnancy Discrimination Act prohibits discrimination because of or on the basis of pregnancy, childbirth, or related medical conditions. Women affected by pregnancy, childbirth or related medical conditions shall be treated the same for all employment-related purposes, including receipt of benefits, as other persons not so affected but similar in their ability or inability to work.

Race, Color, Religion, Sex or National Origin: Title VII of the Civil Rights Act of 1964 prohibits discrimination (any adverse employment action) by employers of 15 or more employees, employment agencies, and labor organizations on the basis of race, color, religion, sex or national origin.

Section 1981 prohibits discrimination against employees based on their race.

Retaliation: The law prohibits employers from retaliating against their employees for asserting their rights to be free of discrimination.

Sexual Orientation: There is currently no Federal law prohibiting discrimination against employees based on their sexual orientation.

If an employer implements a drug-free work place program, the employer may qualify for certification for a premium discount under its workers’ compensation insurance policy. To qualify, an employer must have a written policy regarding its drug-free and drug testing policies, use a testing facility which meets certain criteria, provide an employee assistance program, provide a semi-annual education program on substance abuse, and conduct supervisor training.

Employment at will means that in the absence of a written contract of employment for a defined duration, an employer can terminate an employee for good cause, bad cause or no cause at all, so long as it is not an illegal cause.

Employers have specific duties when using a consumer credit report for hiring or employment purposes. An applicant or employee must give written consent to the employer before the employer obtains a credit report. Additionally, the employer must provide the employee or applicant with a copy of the report and a summary of their rights before the employer can take any adverse action based on the credit report.

The FMLA requires that employers with 50 or more employees, who are employed within a 75 mile radius, provide eligible employees with up to 12 weeks of unpaid, job-protected leave each year to care for a newborn or newly adopted or foster child; to care for a seriously ill child, spouse or parent; or because of the employee’s own illness. Employers may, under certain circumstances, require employees to take unpaid FMLA leave rather than accrued paid leave. It is, however, always the employer’s responsibility to designate whether an employee’s use of paid leave counts as FMLA leave, based on infromation provided by the employee and it is the employer’s responsibility to notify the employee of this designation.

A doctor who is trained to give basic care, such as a general practitioner, family practitioner, internist, or pediatrician. Another name for a family doctor is Primary Care Physician, or "PCP." Your insurance company determines who's considered a PCP according to your plan.

FSAs allow you to set aside part of your paycheck before federal taxes are taken out.* Then you can use the money to pay for either dependent care or health care, depending on which type of account your FSA is.

A health care FSA can be used for your expenses or another family member's - even if he or she isn't covered by your health plan. You can spend health care FSA money on expenses not covered by your health plan, like deductibles, copayments, and coinsurance. You may be able to use the FSA for dental and vision care expenses, also. Your employer chooses which items are eligible for FSA payment, within Internal Revenue Service regulations. If you don't use all your FSA money by the end of the plan year, you have to forfeit what's left.

* Some states require you to pay taxes on FSA contributions.

Garnishment is a court-ordered collection method available to creditors. Once the creditor files the garnishment papers, an employee can challenge the validity of the garnishment and the amount. Employers can also challenge the garnishment but they must file an answer within 45 days of the date of the garnishment notice. If an employer fails to file the required answer, the creditor can seek a judgment against the employer for the full amount of the employee’s debt. An employer may not discharge an employee on the basis that the creditor is garnishing the employee’s wages.

A generic drug is the same as its brand-name counterpart in dosage, safety, strength, quality, performance, intended use, and how it's taken. According to the Food and Drug Administration:

• Generics work the same way and in the same amount of time as brand-name drugs.


• The differences between brand-name and generic drugs are appearance, flavor, and certain inactive ingredients.


• Both brand-name and generic drug manufacturers must meet the same government standards and good manufacturing practices.

Generics usually cost less because their prices don't include the cost of new product research, development, and advertising.

It is advisable for private employers to provide their employees with an employee handbook. A handbook will generally not affect employee's "employment at will" status. Any handbook should contain a disclaimer setting forth an express provision that the at will relationship is not affected by the handbook and that the policies set forth in the handbook are subject to change at any time.

An HMO plan usually covers only services you receive from participating providers - unless your health care need is urgent or an emergency. With most HMO plans, you select a primary care physician (PCP) who tends to the majority of your health needs and refers you to a specialist if necessary.

Another name for health insurance or health benefits. A health plan provides certain benefits, as spelled out in a "Certificate of Coverage" or similar document. You and/or your employer pay a premium that entitles you to the benefits. Then, when you have a health care expense, you share the cost with your health plan as specified in your Certificate. A health plan pays benefits only for the covered services listed in your Certificate.

An employer-funded account you can use for health expenses not covered by your plan, like deductibles, copayments, and coinsurance. Your employer chooses which items are eligible, within Internal Revenue Service regulations. If you don't use all of your HRA funds during the plan year, you may be able to carry them over to the next year. This account is sometimes called a Personal Care Account (PCA).

A special kind of account that allows you to set aside money for health care expenses before federal taxes are taken out.* An employee, employer, or both can put money in the account. You can spend HSA money for your health care expenses or another family member's - even if he or she isn't covered by your health plan.

Money you don't use during the plan year stays in your account. Like a savings account at your bank, money in your account can earn interest - and you don't have to pay taxes on your earnings. HSAs are subject to several Internal Revenue Service regulations; for instance, you can only put money in an HSA if your only health insurance coverage is with a special kind of plan called a High Deductible Health Plan.

* Some states require you to pay taxes on HSA contributions.

An IRS term to describe a kind of medical plan. Key features of a High Deductible Health Plan: * Its annual deductible is higher than typical health plans. In 2005, the minimum deductible is $1,000 for an individual plan and $2,000 for a family plan. These amounts may be adjusted for inflation every year.

• It has one deductible for both medical and prescription expenses. That means money you spend on prescriptions helps you meet the deductible - but it also means your pharmacy benefits begin only after you've met the deductible. However, you may still get a discount price because insurance companies negotiate rates with pharmacies.


• Preventive care coverage may differ from other coverage. For example, you may have preventive care benefits before you meet the deductible.


• The plan has an out-of-pocket maximum. The maximum is a pre-set "cap" on how much you pay for covered services from participating providers during a plan year.

The federal immigration laws require employers to complete the Dept. of Homeland Security Form I-9 to verify each employee’s authorization to work in the U.S. The laws establish fines and criminal penalties for employers that knowingly hire unauthorized aliens. The laws also establish procedures for hiring on a temporary or permanent basis certain aliens, including skilled workers and professionals in occupations with shortages of qualified U.S. workers.

It is illegal to discharge or in any way penalize an employee because the employee is absent for the purposes of attending a judicial proceeding in response to a subpoena, summons for jury duty, or other court order.

The IRS limit on how much can be deposited in your Health Savings Account within a calendar year. Generally, total contributions to the HSA from any source - you, your employer, or anyone else - can't exceed your health plan deductible. If the deductible is higher than the IRS maximum, the IRS maximum is the limit.

Your coverage level (single or family) affects your limit. So does your age, since people over age 55 may be eligible for additional catch-up contributions. Your previous health plan can also affect your limit; if you had another High Deductible Health Plan in the same calendar year as the one you're enrolling for, you also have to take into consideration:

• Previous contributions


• Previous deductible


• Number of months covered by a High Deductible Health Plan
  Network

A group of doctors, hospitals, dentists, and other health care professionals who have agreed to charge a set rate for members of a health benefits plan. Network providers are also called participating providers. With most plan types - including Preferred Provider Organization (PPO) plans - your plan pays higher benefits when you use providers in the plan's network. Some plan types - including Health Maintenance Organizations (HMOs) - pay benefits ONLY when you use network providers (unless the care is for urgent or emergency health issues).

Under federal law, an employee who leaves a position to perform state or federal military service must generally be restored to his or her previous position or a like position.

A nonparticipating provider is a health care professional or facility that is not under contract with a health plan or insurer to provide care to its members. If you use a nonparticipating provider:

• You may pay a much larger share of the total cost of your care.


• You pay toward a separate deductible.


• The provider can bill you for any balance not covered by your insurance plan.

The amounts you pay when you receive health care services. Out-of-pocket costs include copayments for doctor's office visits and prescriptions, your deductible, and the coinsurance percentage you're responsible for. Your premium (the amount you pay for coverage) isn't considered an out-of-pocket cost.

The limit, or ceiling, on your costs for medical care within the plan year. As you use health care services, much of what you pay counts toward your maximum out-of-pocket amount. Once you meet the maximum out-of-pocket amount, your plan provides 100 percent coverage. (You may still need to pay copayments when you receive care.) Your plan might have a separate out-of-pocket maximum for certain benefits (such as transplant services or prescription drugs) in addition to the medical plan’s maximum.

Over-the-counter drugs per year: For this step in Build a Budget, enter the number of over-the-counter medications you, your spouse, and your dependents purchase in a typical 12-month period. This category includes drugs available without a prescription like cold medicines, heartburn relief, and pain relievers. Do not include vitamins or supplements – you’ll enter your spending for those items later.

Participating provider
A participating provider is a health care professional or facility that is under contract with a health plan or insurer to provide care to its members. Participating providers are members of your plan's network.

Using participating providers saves you money three ways:

• Generally, you pay a smaller percentage of the costs (coinsurance) when you stay in the network. Say, for example, you choose a plan with 100 percent coinsurance for participating providers and 70 percent coinsurance for nonparticipating providers. When you go to participating providers, the plan pays 100 percent of charges, and you pay nothing; if you use nonparticipating providers, the plan pays only 70 percent of the costs, and you pay the remainder.


• Your percentage is calculated based on the negotiated rate - the discounted amount the provider has agreed to charge for health plan members.


• The provider can't bill you for charges above the negotiated rate.

Typically the 12-month period that an insurance policy is in effect (for example: January 2005 - December 2005 or July 2005 - June 2006). If you happen to be choosing your benefits at a time other than the beginning of your enrollment period, your benefits will be in effect until the end of the current plan year.

With a PPO plan, you can choose any health care provider. However, when you go to a participating provider, the plan covers more of the cost. For example, the plan may pay 80 percent of charges when you go to participating providers and only 50 percent when you go to nonparticipating providers.

Payment that entitles you to insurance benefits. You pay the premium whether or not you use health care services. If you receive coverage through an employer, money may be taken out of your regular paycheck to cover your share of the premium. (Your employer pays the rest of the premium, if any.) For some retirees, COBRA participants, and other eligible employees, you pay the premium by check or some other means.

Prescriptions per year: For this step in Build a Budget, enter the number of prescription medications you, your spouse, and your dependents purchase in a typical 12-month period. For example, if you have one prescription that’s refilled monthly, enter “12.” For two fills of three different medications, enter “6.” If you get prescriptions by mail order, think about how often you would fill the prescription if you went to the pharmacy instead; with most prescription-by-mail services, you receive a three-month supply each time, so this would count as three fills/refills.

Employers should have both an anti?discrimination and a non-harassment policy. The anti-discrimination policy should include language which declares that the employer will not discriminate against any qualified individuals on the basis of race, religion, national origin, color, gender, age, disability, or veteran status. The harassment policy should include not only sexual harassment, but also other forms of harassment, specifically including religious, gender and racial harassment. Additionally, the harassment policy should have a clearly defined procedure for reporting harassment, including a mechanism whereby the employee can bypass his or her immediate supervisor. The harassment policy should also include a provision which states that the company will not tolerate retaliation against individuals who complain about harassment. The harassment policy should be posted and disseminated to all employees, who sign a receipt acknowledging that they received the policy. Companies who do not have anti-harassment policies could be left without any defenses in the event of a harassment lawsuit.

Health care, such as tests and examinations, to keep you healthy or to prevent illness. Examples include annual physical exams, Pap tests, pelvic exams, yearly mammograms, and flu shots.

A doctor who is trained to give basic care, like a general practitioner, family doctor, or pediatrician. Your insurance company determines who's considered a PCP according to your plan. In many managed care plans, like HMO plans, the primary care physician is a participating provider who coordinates your care - which means you have to see your primary care physician before you see a specialist.

Under the Occupational Safety and Health Act, employers have a specific duty to comply with all applicable safety and health regulations and a general duty to maintain a place of employment that is free from recognized hazards that can cause death or serious physical harm to employees.

Any doctor whose practice is in areas other than general medicine, family medicine, or pediatrics is considered a specialist. Specialists usually have advanced training and education related to a specific condition or part of the body. For example, a cardiologist specializes in heart and blood vessel care. Surgeons are also considered specialists.

Specialists usually charge higher fees than doctors who provide primary care - so your health benefits plan may require you to pick up more of the cost. For example, your plan might specify a $30 copayment for a family doctor and $45 for a specialist.

An "expense account" you can use to pay for certain health care items and services. The key benefit of these accounts is that you don't pay federal taxes on money you set aside. However, you may have to pay state taxes, depending on where you live.

The Internal Revenue Service (IRS) sets rules about how these accounts work, and expenses eligible for payment must be on an IRS-approved list. The following expenses are usually eligible for payment from a spending account:

• Health care costs like doctor's office visits, lab tests, and hospital charges


• Dental services like cleanings and orthodontics


• Vision care like glasses, contacts, and laser surgery


• Prescription drugs and some over-the-counter items

Three common account types:

• Flexible Spending Account - you put money in the account; unused money is lost at the end of the year


• Health Reimbursement Arrangement - your employer puts money in the account; unused money can carry over if you meet certain requirements


• Health Savings Account - anyone can contribute to your account; unused money carries over automatically at the end of the year

See the "Compare Accounts" page in the Health Insurance Basics section to find out more.

A facility equipped to provide medical care for minor illnesses or injuries. Most are walk-in clinics that don't require an appointment. They're usually open longer hours than doctors' offices and have shorter wait times than hospital emergency rooms. For health situations that aren't life-threatening, you can save money by choosing an urgent care center instead of an emergency room.

The Fair Labor Standards Act sets out minimum wage and overtime requirements that apply to any employer who engages in interstate commerce (which is deemed to include any business with revenues of $500,000.00 per year.) Under the law, non-exempt (hourly) employees must be paid a minimum wage which is $5.15 per hour. When a non-exempt (hourly) employee works more than forty hours in a week, the employer must pay the employee one and one half times their regular rate of pay for every hour over forty worked that week. Employees engaged in executive, administrative or professional capacities and paid on a salary basis are exempt from this act. (That is, these employees do not have to be paid overtime).