welcome to the midwest conference on work & cancer! · • as of january 2016, there are more...

© Copyright 2020 Cancer and Careers, Triage Cancer & Julie Larson

Midwest Conference on Work & CancerMarch 27, 2020

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WELCOME TO THE MIDWEST CONFERENCE ON WORK & CANCER!

The Program will begin at 9AM CT

Having technical difficulties? Please contact [email protected] or call 888.799.9666 ext.2

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EVENT COMMUNICATIONS• Q&A: Submit questions to presenters about the content using the Q&A box.

There is an option to submit questions anonymously.• Chat Box: Use to share thoughts & responses publicly with fellow attendees &

CAC staff (if you want).• Audience Poll: Questions will pop up throughout the day. Responses are

anonymous,• Technical Questions/Difficulties?

– Visit https://bit.ly/33Sp7vo for audio or visual questions – OR contact [email protected] or call 888.799.9666, ext.2

CEU/PDC REQUIREMENTSIf you plan on requesting continuing education credits,

you MUST complete all of the following steps:1. You must log on/dial-in individually. Arrival time will be based on the time you logged on/dialed-in for the

virtual conference. *Please note that participants who “listen-in” on another participant’s line will NOT be eligible for credit.

2. Within 2 WEEKS of this event:

Complete the evaluation*

Complete the post-test & earn a passing grade*3. Credits will be determined based on log on and log off times as recorded by our webinar software.

Credits will be prorated for individuals who either log off or are shown by the software to be “inattentive” for a portion of the event.

*An email with links to the evaluation and post-test will be sent

Monday, March 30th.**Certificates will be emailed within 4 weeks**

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The planners and presenters for this program have not disclosed any pertinent financial

relationships or conflicts of interest. The opinions expressed at this event are those of the

participating faculty and do not imply endorsement by the CEU/PDC approvers of any

commercial products discussed. This education program does not include any

information about off-label, investigational, or unproven use of products other than those

approved by the Food and Drug Administration (FDA).

DISCLOSURE STATEMENT

SOCIAL MEDIA

TWITTER: @CancerandCareer|@Triagecancer|@JulieLarsonLCSW

FACEBOOK: Cancer and Careers|Triage Cancer|Julielarson.lcsw

INSTAGRAM: @cancerandcareers|@Triagecancer

#CACMidwest

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PRESENTERS

Rebecca V. Nellis, MPPExecutive Director, Cancer and Careers

Monica Fawzy Bryant, Esq.Chief Operating Officer, Triage Cancer

Julie Larson, LCSW

This presentation is intended to provide general information on the topics presented. It is provided with the understanding that the author is not engaged in rendering any legal, medical, or professional services by its publication or distribution.

Although this content was reviewed by a professional, it should not be used as a substitute for professional services. © Copyright 2020 Cancer and Careers, Triage Cancer & Julie Larson, LCSW

Cancer and Careers, founded in 2001, is a national nonprofit that empowers and educates people with cancer to thrive in their work environment, by

providing expert advice, interactive tools and educational events. All programs and services provided to patients, survivors, healthcare

professionals and caregivers are offered free of charge.

• CancerAndCareers.org

• Publications in English and Spanish

• Job Search Tools and Resume Review

• Professional Development Micro-Grants

• Accredited Programs for Healthcare Professionals

• CancerAndCareers.org/espanol

• Balancing Work & Cancer Webinars

• Community Events

• National and Regional Conferences

• Career Coaching

CANCER AND CAREERS

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UPCOMING WEBINARS

For more information & to register, visit: www.cancerandcareers.org/en/community/events/webinars

Disclosure, Privacy & Online Brand April 8, 2020 (5 PM CT)Working Through Treatment May 6, 2020 (5 PM CT)Occupational Therapy and Vocational RehabJune 3, 2020 (5 PM CT)Enhancing Your Skills: Prepping for SuccessJuly 8, 2020 (12 PM CT)Body-Confidence, Self-Confidence in the WorkplaceAugust 5, 2020 (12 PM CT)

Setting Boundaries September 9, 2020 (12 PM CT)Newly Diagnosed: Getting Started October 7, 2020 (12 PM CT)Health Insurance Options November 4, 2020 (5 PM CT)Communicating Effectively: Tips & Techniques December 9, 2020 (12 PM CT)

SUPPORT SERVICES

Resume Review Service:www.cancerandcareers.org/resume_reviews/new

Online Career Coaching Center:www.cancerandcareers.org/career-coach

Professional Development Micro-Grants:www.cancerandcareers.org/en/resource/micro-grants

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PUBLICATIONS

To Order: https://www.cancerandcareers.org/publication_orders/new

COWORKERS

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MANAGERS• Cancer and Careers Manager’s Kit• Workplace Transitions for People Touched by Cancer

– Online toolkit includes:

Information for frontline managers

Important facts on privacy, disability and medical leave

Downloadable tool for creating transition plan with employee

Practical ideas for workplace accommodations

Suggestions for managing challenges with sensitivity

– Available via www.workplacetransitions.org

GOLD SPONSOR

MIDWEST CONFERENCE ON WORK & CANCER SPONSORS

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SILVER SPONSORS

MIDWEST CONFERENCE ON WORK & CANCER SPONSORS

PATRON SPONSORS

FOUNDING

PLATINUM

GOLD

SILVER

CANCER AND CAREERS SPONSORS

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COMMUNITY PARTNERS

CONTENT PARTNER

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TRIAGE CANCERProvides information and resources on cancer survivorship through:

1. Educational events• Triage Cancer Conferences & Seminars• Cancer Survivorship Webinar Series• Insurance & Finance Intensive

2. TriageCancer.org• Educational blog at TriageCancer.org/blog • International, national & state resources• Chart of state laws• Animated videos • Spanish resources

4. CancerFinances.org

Quick GuidesADAReasonable AccommodationsChemo BrainDisclosureFMLA ExpandedFMLA & How It Works With Other BenefitsDisability InsuranceHealth Insurance COBRAMedicareClinical TrialsBankruptcyEstate Planning Advocacy; Scientific AdvocacyCrowdfundingCaregiving

© Triage Cancer

AGENDA

1. Disclosure, Privacy & Online Brand2. Working Through Treatment3. Returning to Work & Job Search4. Managing Long-Term Stress5. Health Insurance Options

© Cancer and Careers & Triage Cancer

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CANCER FACTS & FIGURES


• As of January 2016, there are more than 15.5 million cancer survivors in the U.S. and will reach 20.3 million by 2026.

• 1.72 million new cancer cases estimated to be diagnosed this year in the United States. Source: ACS Cancer Facts & Figures 2019

• More than 70% of cancer diagnoses are made in adults between the ages of 20 and 74 i.e. “prime employment years.”

Tracy, et al., 2018

SETTING THE STAGE: ERIN


• After college, Erin worked as an assistant at a large company for three years. At the age of 24, she was diagnosed with cancer.

• After talking with her healthcare team, she decided her best course of action was to take some time off work. When she shared her diagnosis with her employer, she was told that she would be let go.

• Erin took COBRA to keep her health insurance coverage, but her 18 months are up and she is concerned about how to get insurance coverage with a pre-existing condition.

• Erin is now 26 and is ready to get back into the workforce, especially since she has student loans to pay back and a pile of outstanding medical bills.

• She isn’t sure how to deal with the gap on her resume and how to address it in an interview — or if she even has to.

• Erin also has monthly medical appointments and has been experiencing chemo brain. She is worried this will keep her from getting a job.

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DISCLOSURE, PRIVACY & ONINE BRAND

Key Topics: • Decisions about whether to work • Americans with Disabilities Act (ADA) • Disclosure and privacy• Online brand and social media use


RESEARCH: WORK & CANCER


• Cancer survivors are 1.4 times more likely to be unemployed than people who have never been diagnosed. (de Boer, et al., 2018)

• 20% of cancer survivors still report work limitations affected by cancer-related problems 1–5 years after diagnosis. (Work & Cancer Survivors)

• In 2018, EEOC received 807 cancer discrimination claims = 3% of overall disability claims. (www.eeoc.gov/eeoc/statistics/enforcement/ada-receipts.cfm)

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DIAGNOSIS / WORK DILEMMA

Diagnosis and

Work

Treatment Choices

Emotional Choices

Practical Choices

Strategic Choices

© Cancer and Careers

TO WORK OR NOT TO WORK


• How will treatment affect work and schedule?

• What are job demands, both physical and mental?

• How flexible is the work environment?

• Can accommodations be made?

• What are the financial and health insurance concerns?

• How is identity connected to work?

• Have career priorities changed?

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INFORMATION NEEDS• Treatment options • Timeline• Potential side effects• Mitigation strategies

Medical and Treatment Info

• Insurance support• Company policies and culture• Workplace flexibilities• Job demands

Work Info

Legal Info• Federal & state laws• Medical leave• Disability insurance • Health insurance


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THE WHOLE PICTUREFederal Law

Finances & Insurance Coverage: Health, Disability, Life, etc.

State Law

Employment Contracts

Workplace Culture & Employer Policies

© Triage Cancer

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EMPLOYMENT RIGHTSLeave Laws

• Federal Family & Medical Leave Act (FMLA)

• State Leave Laws

Federal Fair Employment Laws

• Americans with Disabilities Act (ADA)- Discrimination

protections for patients and caregivers

- Reasonable Accommodations for patients

• Rehabilitation Act of 1973

State Fair Employment Laws

• Discrimination protections for patients and caregivers

• Reasonable Accommodations for patients

Employment Contracts

• Employment Contract

• Union Contract

© Triage Cancer

EMPLOYER POLICIES

Employee Benefits

• Health/dental/vision insurance

• Short-term and/or long-term disability insurance

• Life and/or accidental death insurance

Other Benefits

• Sick time

• Vacation time or paid time off (PTO)

• Pool of donated hours

• Flextime/job sharing/telecommuting

• EAP programs

Medical Leave Process

Reasonable Accommodation

Process

© Triage Cancer

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“At Will” Employment• Most employees in U.S.

• Can be fired for almost any reason, as long as not discriminatory

• Protected classes: race, ethnicity, age, gender, religion, disability, etc.

• Unions may have negotiated rights to employment

Independent Contractors• Usually not covered by ADA or state FE laws

Part-Time Employees

Temporary Employees• Under ADA, generally, have 2 employers –

temp agency and placement employer

• www.eeoc.gov/policy/docs/guidance-contingent.html

Undocumented Immigrants• http://las-elc.org/fact-sheets/undocumented-

workers-employment-rights

EMPLOYMENT CONCEPTS

© Triage Cancer

Individuals with Disabilities in Education Act (IDEA)• Ages 3–21 (K–12)• 13 qualifying disabilities:

autism, deaf/blind, deafness, hearing impaired, mental retardation, multiple disabilities, orthopedic impairment, serious emotional disturbance, specific learning disabilities, speech or language impairment, traumatic brain injury, visual impairment including blindness, and other health impairment

• Who require special education services because of the disability in order to receive an appropriate education

Section 504 of Rehabilitation Act of 1973• K–12 and college/grad schools who receive federal funds

• Broader definition of disability

EDUCATION RIGHTS

http://CancerFinances.org© Triage Cancer

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AMERICANS WITH DISABILITIES ACT (ADA)

© Triage Cancer

Title I: Employment

Title II: Public Entities (& Public Transportation)• Covers access to all programs/services

offered by the entity• Applies to all state and local public

housing, housing assistance and housing referrals

Title III: Public Accommodations & Commercial Facilities• Includes most places of lodging,

recreation, transportation, education, and dining, along with stores, care providers and places of public displays

Title IV: Telecommunications

Title V: Misc.

AMERICANS WITH DISABILITIES ACT TITLE I

© Triage Cancer

Eligibility• Private employers with 15 or more employees & state/local

governments- Note: Federal employees covered by Rehabilitation Act of 1973 (similar to ADA)

- ADA does not apply to tribal employers

• Be a “qualified individual”- “Can perform essential functions of the job with or without a reasonable accommodation”

• Have a disability under the ADA’s definition

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AMERICANS WITH DISABILITIES ACT

© Triage Cancer

Definitions• Disability:

- “A physical or mental impairment that substantially limits one or more major life activities”

• Major life activity:- Eating, breathing, speaking, walking

- ADA Amendments: concentrating, thinking, sleeping, operation of major bodily functions

• Predictable assessments: cell growth

AMERICANS WITH DISABILITIES ACT

© Triage Cancer

4 ways to use the ADA:1. Currently 2. History 3. Regarded4. Association

Applies to all phases of the employment process

Benefits:• Protection from discrimination

(1–4)- Employers can’t make

employment-related decisions based on medical information

• Reasonable accommodations (1 & 2)

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STATE FAIR EMPLOYMENT LAWS

*Triage Cancer Chart of State Lawshttp://TriageCancer.org/StateLaws

© Triage Cancer

• Similar to ADA• But, can be more protective in three ways:

1. Broader definition of disability• e.g., CA, IA, IL, NY, WA, WI

2. Specifically list cancer as a potential disability• e.g., CA, ME, OH, VT

3. Cover employers with fewer than 15 employees

STATE FAIR EMPLOYMENT LAWSEMPLOYER SIZE

1 2 3 4 5 6 8 9 12

AKHIIL

MEMIMNMTNJNDSDVTVAWI

COWY

CT IAKSNMNYOHPARI

CAID

MAMONHOR

KYTNWA

AR (but 15 for RA’s)

WV

*If state is not listed, it requires 15 employees © Triage Cancer

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DISCLOSURE RIGHTSGenerally, not required, but may need to disclose someinformation to use . . .

• ADA’s discrimination protections

• Reasonable accommodations

• Medical leave

*Triage Cancer Quick Guide to Disclosure, Privacy, & Medical Certification https://triagecancer.org/QuickGuide-Disclosure

*Triage Cancer Quick Guide to Helping Navigate Patients Through Disclosure Decisions https://triagecancer.org/QuickGuide-DisclosureHCP

© Triage Cancer

DISCLOSURE RIGHTS

© Triage Cancer

Employers or prospective employers can ask:• Pre-offer

– Can you perform essential functions of the job?– How will you perform essential functions of the job?

• Post-offer– Disability-related inquiries or medical exams, regardless of whether related to

job, but only if same for all employees entering same job category

• Employed– Any disability-related inquiry or medical exam, ONLY if job-related and

consistent with business necessity

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MEDICAL CERTIFICATION

© Triage Cancer

• Employers entitled to medical certification for RA’s & FMLA- But diagnosis may not be required

- Patients should talk to their healthcare team

• Be careful of- Employer forms and state laws

• DOL Model Form is an option

- FMLA requirement of healthcare provider’s type of practice/specialization

• FMLA healthcare professional =

- MDs, DOs, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, nurse practitioners, nurse-midwives, clinical social workers, Christian Science practitioners, or any HCP recognized by the employer or the employer’s group health plan’s benefits manager

• Employers CANNOT:- Ask for copies of medical records- Put medical information in regular employee file- Contact the healthcare provider for additional info

• FMLA: Only to “authenticate” and “clarify”

• ADA: Maybe not w/o employee’s permission

MEDICAL CERTIFICATION

© Triage Cancer

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FOR EXAMPLE: MEET DANIELA• Daniela is 38 and was diagnosed with cancer earlier this week. She has worked at a large

department store for three years. She is using sick time to take time off work for her surgery next week and to recover. She is waiting to hear if she will also need chemotherapy.

• She is concerned about sharing her diagnosis at work. Her supervisor is not very supportive and a coworker was let go shortly after her husband had a heart attack. She is worried that she might be treated differently or even fired if they find out she has cancer.

• While Daniela is a private person, her mother is addicted to Facebook. Daniela shared her diagnosis with her mother, and soon after her mother posted on Facebook that Daniela has been diagnosed with cancer. Within a few hours, Daniela started receiving phone calls and had to explain her diagnosis to each caller, which left Daniela feeling exhausted.

• What should Daniela be thinking about?


RESEARCH: SOCIAL MEDIA & HEALTH


• More than 75% of Americans use social media to research their symptoms.

• 90% of people ages 18 to 24 stated they trust medical info shared on their social feeds.

• 45% of 45- to 64-year-olds would be likely to share via social media, while 56% would be likely to engage in health activities.

PWC Health Research Institute Survey – April 2012

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RESEARCH: SOCIAL MEDIA & DISCLOSURE

(Cancer and Careers/Harris Poll 2019)


• 26% disclosed cancer diagnosis on social media

• 11% said disclosing diagnosis on social media had a negative impact on my career

• 17% regret posting information about cancer diagnosis on social media sites

• 28% expressed concern about their employer discovering cancer diagnosis through social media

Source: http://press.careerbuilder.com/2018-08-09-More-Than-Half-of-Employers-Have-Found-Content-on-Social-Media-That-Caused-Them-NOT-to-Hire-a-Candidate-According-to-Recent-CareerBuilder-Survey

In 2018:

• 47% are less likely to interview a candidate they can't find online

• 57% have decided not to hire a candidate based on their social media profiles

• Half of employers check current employees' social media profiles, over a third have reprimanded or fired an employee for inappropriate content

• 70% of employers use social media to screen candidates

EMPLOYERS GOOGLE


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ONLINE PRIVACY


ONLINE PRIVACY

*CAC Maintaining Online Privacy


• MyLifeline or CaringBridge– Opt into highest level of privacy– Consider who you want to be part of this community– Think before you share posts from these sites on other social

media

• In general, review privacy policies for any website where you are sharing personal info

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• Make conscious disclosure decisions– Then communicate those decisions– What are other people saying about you?

• Long-term impact• Relationships & dating

ONLINE DISCLOSURE


Be prepared to deal with:

• Volunteer gigs & jobs in the cancer community (and what they might say about you)

• Fundraising sites

• Background & credit checks

• Employer access to voicemail, email, etc.

• Google-searching at work

• Social media password laws

OTHER DIGITAL DIRT

*Triage Cancer Chart of State Laws http://TriageCancer.org/StateLaws


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• Google yourself• Use popular social media websites to

strategically increase your online presence– LinkedIn – Instagram

– Twitter – Pinterest

• Set up a professional webpage or blog• Delete old posts that no longer represent your

interests– Though they may still exist somewhere in the online space, they

become harder to find

BUILDING A PROFESSIONALONLINE BRAND

• Think deliberately about what you post– Would I want a boss —

current or future — or coworkers to know this?

– Would I want this on the front page of a newspaper (or the homepage of my favorite news site)?

– Would I want my grandmother or mother to see this?


10 MINUTE STRETCH BREAK

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WORKING THROUGH TREATMENT

Key Topics: • What and whom to tell • ADA, including reasonable accommodations • On-the-job strategies• Family and Medical Leave Act


RESEARCH: WORKING THROUGH TREATMENT• Top five reasons to continue working after a diagnosis:

Want things to feel normal (65%) Feel productive (60%) Work provides a routine (59%) Kept/keeps mind off cancer (55%) Feel less isolated (38%)

• 75% of surveyed patients and survivors agrees that working during treatment helps or helped them cope.

• 74% of surveyed patients and survivors said work aids or aided in their treatment and recovery.

(Cancer and Careers/Harris Poll 2019) © Cancer and Careers

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RESEARCH: DISCLOSURE AT WORK

(Cancer and Careers/Harris Poll 2019)

• 17% of employed respondents felt that disclosing their diagnosis limited their ability to find a better job

• 18% of employed respondents felt that disclosing their diagnosis has negatively affected their long-term career goals

71%

61%

28%

10%

Supervisor/manager

Co-workers/colleagues

Human resources

No one

Disclosed tosomeone

90%


FOR EXAMPLE: JARED• Jared has worked as an office manager for a doctor’s office for seven years. The doctor’s office

has five employees, including Jared.

• Jared has been a valued employee and trusted with significant responsibilities. He has always had stellar employee evaluations. His employer was considering giving him a promotion and a raise at the beginning of next year.

• In March, Jared was diagnosed with cancer. He chose not to tell his employer, because he didn’t want anyone to treat him differently as a result of his diagnosis. He took vacation days for surgery and has been able to schedule his medical appointments around his work schedule.

• But, he has been experiencing some side effects that affected his work, such as fatigue and an inability to focus. Jared has tried to struggle through these side effects to do his job, but his work performance has suffered over the past six months. His employer let him know today that they will have to let him go.

• What could Jared have done differently?• Would it matter if he worked for a larger employer?


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Control the Message• Should you tell?• Whom should you tell?• When should you tell?

– Timing is everything

• How much should you share?– #itsfluid

• How should you share it?

*CAC Manager’s Kit & Workplace Transitions

SHARING A DIAGNOSIS AT WORK


• “I know this is a lot for you as well, but I think if we collaborate we can come up with a plan that works for both of us. It’s very important to me that everything continue running as smoothly as possible.”

• “I know you have many things to consider in terms of how we manage this, but I want you to know how important it is to me to continue doing the best work I possibly can. To make the process easier, I found a resource from an organization called Cancer and Careers. It’s a Manager’s Kit that offers ideas for how we can work through the situation together, and help ensure that we’re covering all the bases.”

STARTING THE CONVERSATION WITH YOUR EMPLOYER

*CAC Manager’s Kit© Cancer and Careers

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SIDE EFFECTS & IMPACT ON SHARING THE NEWS AT WORK

Visible Manifestations “Hidden” Manifestations

Hair Loss Pain

Weight Changes Fatigue

Skin Changes Mental Health

Surgery Scars Ostomy Bags


“CHEMO BRAIN”• What is “chemo brain”?

– Cognitive problems: memory & concentration, executive function, ability to learn new material, ability to work with numbers

• Studies show cognitive challenges aren’t just a result of chemo

– e.g., radiation, endocrine therapy

• Causes of chemo brain

• Predictors of cognitive decline: age, cognitive reserve (IQ, education, occupation, hobbies, etc.), genetics

Triage Cancer Quick Guide to “Chemo Brain” http://TriageCancer.org/QuickGuide-ChemoBrain

© Triage Cancer

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“CHEMO BRAIN” FACTORSWhat other factors affect cognitive function? • Sleep disorders (insomnia, sleep apnea)• Inadequate hydration, nutrition and exercise• Stress, depression, anxiety• Pain and pain medications• Other physical illnesses/comorbidities

Practical strategies to improve cognitive function:• Sleep• Hydration, nutrition, and exercise• Mindfulness meditation, yoga, etc.• Medication (e.g., depression, anxiety, pain, etc.)

© Triage Cancer

MANAGING “CHEMO BRAIN”ON THE JOB — BACK TO BASICS

• Don’t multi-task• Write down a list of priorities• Do one thing at a time• Take notes• Rehearse everything• Build breaks into your day


*CAC “Chemo Brain” Info sheet

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ON-THE-JOB STRATEGIES• Identify a point person• Communication is key

– Ask for priorities• Create a written plan

– Know your limits and set boundaries• “I appreciate that you thought of me for this project, but I’m a bit swamped this week

and am concerned about my ability to get this back to you in a timely manner.”• “Thank you for offering me these additional shifts. Unfortunately, I’m short on time at

the moment as I have some family obligations to attend to. But I’d love to talk about this possibility again in a few months, once the situation at home has settled down.”


COMMUNICATION STRATEGIES:ADDRESSING WELL-INTENDED COMMENTS

Your boss says: “You’ve been looking so exhausted recently, I didn’t want to overwhelm you by adding more to your plate.”

• Response: “I appreciate your concern, but work is a key part of my overall wellbeing. In fact, last night I had some ideas about our new project, which I’d love to share with you.”


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COMMUNICATION STRATEGIES:ADDRESSING INSENSITIVE COMMENTSAfter disclosing your diagnosis, your supervisor says: “Did you smoke?” (Or “Did you drink?” or “Did you tan?”)

• Response: “There is a lot of confusion, complexity and fear around cancer, so I can understand that you’d be curious about whether I somehow brought this on myself. However, what is important now is how we can work together to make sure that all our goals are still being met while I balance both work and treatment. My job is incredibly important to me, so I hope we can collaborate to come up with the best plan of attack.”


“Any change in the work environment or in the way things are customarily done that enables an individual with a disability

to enjoy equal employment opportunities”

WHAT ARE REASONABLE ACCOMMODATIONS?

© Triage Cancer

*Quick Guide to Reasonable Accommodationshttp://TriageCancer.org/QuickGuide-ReasonableAccommodations

*Checklist: Reasonable Accommodationshttp://TriageCancer.org/Checklist-ReasonableAccommodations

*Video: How to Deal with Side Effectshttps://TriageCancer.org/Video-SideEffectsatWork

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• Identify Challenges• Manipulate Work Space- Phone, files within easy reach- Switching offices- Special furniture requests- Hand controls on cars

MODIFYING WORK SPACE


Manipulate Work Schedule• Working from home• Part-time or full-time• Flexible schedule• Schedule breaks• Extended leave

Source: Wrike Survey 2012

MODIFYING SCHEDULE


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OTHER OPTIONS

•Smartphone/tablet•Speak/type softwareUse of Technology

•Valet•Head coveringChange in Policy

•Water cooler•Occupational/vocational therapy/rehabilitation

Shift Job Responsibilities

•ER nurse•School teacher

Change Job (Move to an open position)

© Triage Cancer

RESEARCH: ACCOMMODATIONSWorkplace Accommodations: Low Cost, High Impact• Cost of accommodations:

- 59% cost $0- 36% onetime cost, typically $500

• Accommodation benefits for employers include: - Retaining a valued employee (89%)- Increasing the employee’s productivity (72%) - Avoiding the costs of training a new employee (61%)- Increased the employee’s attendance (56%)

(Job Accommodation Network Study, 9/30/18)

83% of employers who called JAN for info or help were doing so to retain or promote a current employee

© Triage Cancer

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• Do employers have to accommodate you?

– Yes, unless undue hardship or direct threat

• Has to be “reasonable”

• Can get more than one!

• Caregivers not entitled to accommodations, but could still ask

REASONABLE ACCOMMODATION TIPS

© Triage Cancer

• When do you ask?– As soon as you realize you need one

• How do you ask?– Job Accommodation Network: www.AskJan.org– Check employer’s policies

• Whom do you ask?– Supervisors vs. HR– Requests must be confidential, but limitations– Check employer’s policies

• Can change over time/needs

REASONABLE ACCOMMODATION TIPS

© Triage Cancer

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Define the situation(Essential functions of the job?)

Perform needs assessment(Modify job, policy, facility,

equipment?)

Explore alternative placements

(Reassignment to vacant position?)

Redefine the situation

Monitor accommodations

RA INTERACTIVE PROCESS

© Triage Cancer

REASONABLE ACCOMMODATIONS:ADDRESSING QUESTIONS

Why is Phillip getting to…work from home? Work different hours? Move to an office? Have a printer at his desk?• Possible Manager’s Response

– “I realize that it may seem like Phillip is getting special treatment, but please know that we treat each employee as an individual and sometimes need to make accommodations to best support that person. We also highly value each person’s privacy. Now, I have been meaning to talk to you about that presentation that is coming up. . .”

• Possible Employee’s Response– “Our manager thought this might be a good way for me to deal with some personal matters

as well as benefit the company. I appreciate your concern! And since I have you, I would love to talk about the new territory I have been assigned; do you have any suggestions?”


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• Genevieve has been diagnosed with cancer and she has been receiving chemotherapy treatment.

• She has worked through her treatment, but has been experiencing chemo brain, including loss of focus and short-term memory challenges. She is concerned it is affecting her ability to work.

• Genevieve works for an Internet company and her desk is on a floor of the building where all the desks are in an open floor plan with offices circling the open floor plan. There are 2 desks per cubicle and low partitions between the cubicles, but Genevieve finds it difficult to concentrate at work.

FOR DISCUSSION: GENEVIEVE

• What types of reasonable accommodations could help Genevieve continue to do her job effectively?


• John has been a cruise ship director for the last six years. He was recently diagnosed with cancer, had surgery and is now receiving chemotherapy treatment.

• John has been working through treatment, but has started to experience side effects including nausea. He is concerned it may affect his ability to work.

• What types of reasonable accommodations could help John continue to work?

FOR DISCUSSION: JOHN


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FOR DISCUSSION: GRACE

• Grace is a firefighter. She has been diagnosed with cancer and recently had surgery and is now receiving chemotherapy treatment.

• Grace is experiencing respiratory difficulties but wants to work through her treatment.

• What types of reasonable accommodations could help Grace continue to work?


REASONABLE ACCOMMODATIONS SUMMARY

1. Be careful of assumptions

2. Get the details

3. Be creative

4. Get it in writing


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FAMILY & MEDICAL LEAVE ACT (FMLA)

© Triage Cancer

Federal law for:• Employees with a serious medical condition

• Employees with a spouse, parent or child with a serious medical condition

– Parents

– Spouses (common law spouses & same-sex spouses as of 3/27/15)

– Children (biological, foster, adopted, step, or in loco parentis)

» 18+ only if “incapable of self-care because of a mental or physical disability”

Employer: Private employers with 50+ employees (75-mile radius) and all government employers (federal, state, local)

• 75-mile radius

– “As the car drives, not as the crow flies”

• No fixed work site

– e.g., sales rep, truck driver, flight attendant

Employee: 1,250 hours; 12 months

• 12 months = total of 12 months in 7 years

• 1,250 hours =

– 24 hours in each of the 52 weeks/year; or

– 104+ hours in each of the 12 months/year; or

– 40 hours/week for more than 31 weeks of the year

FMLA ELIGIBILITY

© Triage Cancer

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What hours of work count toward FMLA?• 1,250-hour requirement:

- Only hours that were physically worked count- Not breaks, vacation or travel time- Except: those who were on military leave during the 12 months

preceding the leave, and airline flight crew

• 12-month requirement:- Paid vacation or sick leave counts

• Exempt employees:- Burden on employer to show you didn’t meet the hour requirement

FMLA ELIGIBILITY

© Triage Cancer

FMLA BENEFITS

© Triage Cancer

Quick Guides ~ https://triagecancer.org/QuickGuide-FMLA andhttp://triagecancer.org/QuickGuide-FMLAExtended

Protections• Up to 12 weeks of leave, per year• Unpaid leave• FMLA Bubble:

– Job protected FMLA protects job where sick leave/STD/LTD don’t

– Health insurance protected

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FMLA TIPS

© Triage Cancer

• Can be used in segments or intermittently

• Deciding the year period

• Asking for FMLA & giving notice- Foreseeable vs. unforeseeable

• Employers can’t make employees use/exhaust PTO, vacation, & sick leave before using FMLA

• Employers can require use of PTO, vacation, & sick leave concurrently

• Employees can request use of PTO, vacation, & sick leave concurrently

• ADA can work with FMLA or instead of FMLA!

https://TriageCancer.org/Blog

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• Private insurance (Short or long-term)• Employer plan

• Individual plan

• State disability insurance (Short-term)o CA, NY, NJ, RI, HI, and PR

• Federal disability insurance• Social Security Disability Insurance (SSDI)

• Supplemental Security Income (SSI)

DISABILITY INSURANCE

© Triage Cancer

Resources:

Quick Guide: https://triagecancer.org/QuickGuide-DisabilityInsurance

CancerFinances.org Disability Insurance

Taking Time Off & Paying For It Webinar: https://triagecancer.org/TakingTimeOffWebinar

True or False1. The most effective way to manage “chemo brain at work is to

eliminate multitasking and go back-to-basics.

2. The law is just one place to look for figuring out how to balance cancer in the workplace.

3. When identifying reasonable accommodations, it is key to be creative, reasonable, and avoid making assumptions.


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TOP TAKEAWAYS

1. Gather information about needs in the workplace and legal protections that might help.

2. Think about whom to tell and how to share the news at work.

3. Reasonable accommodations can help make working through treatment easier.

4. FMLA provides job protections that sick and disability leave do not.


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30 MINUTE LUNCH BREAK

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RETURNING TO WORK


Key Topics: • Re-entry into a job• ADA & FMLA return-to-work requirements• Job search (resumes, interviews, networking, LinkedIn)

DECIDING TO RETURN TO WORK


• Are you still in treatment? If so, for how long and how often?

• What are your financial needs?

• What is your psychological mindset?

• Does it make sense to go back to your former job?

• If not your former job, should you try to stay at your employer?

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RETURNING TO AN EXISTING JOB


• What kind of flexibility exists in your former job?

• Can you still do the work?

• Do you still want to do the work?

• What if they always see you as a person with cancer?

COMMUNICATIONS STRATEGIES:THE SWIVEL


My uncle had cancer . . .

• “I’m sorry to hear that, it must have been quite hard . . . [AND] . . . What did you think about the meeting that we had yesterday?”

How are you feeling?• “Really excited to be back! In fact, I have a few questions about the new

time-card system. Do you have a few minutes to answer them?”

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LEGAL PROTECTIONS WHEN RETURNING TO YOUR FORMER JOB

© Triage Cancer

• Similar issues to “Working Through Treatment”• Disclosure

- If, when, and how

- Some info required for use of ADA/FMLA protections

• ADA Reasonable Accommodation requests- If, when, and how

- Medical certification – how much to share

• Intermittent FMLA leave• Medical certification – how much to share

• Return-to-work rights under ADA/FMLA

• Prompt return to equivalent or same employment • Equivalent position =

- virtually identical to employee’s former position in terms of pay, benefits, working conditions, including privileges, perquisites and status; AND

- same or substantially similar duties and responsibilities

• Employer not required to reinstate employee who takes leave beyond 12 weeks of FMLA

• But, must comply with company policies, state leave laws (which may be better than FMLA), and federal and state pregnancy and disability protections

FMLA RETURN-TO-WORK RIGHTS

© Triage Cancer

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ADA RETURN-TO-WORK RIGHTS

© Triage Cancer

• Reinstatement to the same job!

• If reinstatement to same job is an undue hardship for the employer, employer may have to reinstate employee to any available vacant position the employee is qualified to perform.

RESEARCH: JOB SEARCH• Among cancer patients and survivors looking for work: − 49% feel prospective employers would treat them differently if they disclosed their

cancer.− 31% feel their diagnosis has limited their job prospects and ability to get hired.− 49% express at least some concern about getting hired if a potential employer finds out

about their diagnosis. (Cancer and Careers/Harris Poll 2019)

• In a study with fake cover letters, researchers found employers expressed 26% less interest in candidates who disclosed a disability than in candidates who did not. (Source: www.nber.org/papers/w21560)

• Applicants who disclosed a cancer history received fewer callbacks from managers (21%) than the applicants who did not disclose a cancer history (37%). (Source: HR and Employment Law News 11/17/15)


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*CAC Job Search Toolkit

JOB SEARCH

• Things to think about:− Emotional highs/lows− Being strategic− Holding yourself to a higher standard

• The steps of a job search are the same as the steps to build any relationship — consider what you reveal, and when.


CONSIDERING CAREER SHIFT


• How do you define meaning?• What makes you feel satisfied at work?• What skills do you possess?

– Make an exhaustive list– Ask other people in your life

• What skills do you want to use at work?• What kinds of positions exist that need your skills?

– Have informational meetings to learn more about interesting jobs

• Is it the job or the company that is more important to you?

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• Only a small percentage of job-seekers find employment on job boards

• Great articles and surveys

• Useful for researching job descriptions & companies

• Possible exceptions include industry-specific or function-specific job websites (e.g. www.idealist.org or www.flexjobs.com)

JOB BOARDS


NETWORKING

• Approximately 85% of jobs are found through networking

• Networking sources:- Online social networking websites — LinkedIn

- Previous colleagues and vendors

- Friends, neighbors, fellow members of faith community

- Professional associations

- Doctors, lawyers, dentists, accountants, dog walkers

- Neighborhood associations or community groups


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NETWORKING


• Reciprocity is key

• Network with everyone

• Be specific about what you need

• Exhibit appropriate etiquette

• Keep your contacts organized digitally, if possible

• Make networking a habit

• Follow up

LINKEDIN


• Write a compelling profile• Do put your photo here • Ask for substantive recommendations

- #BeSpecific

• Post status updates regularly• Join a few groups and participate actively

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*CAC free Resume Review service

CREATING AN EFFECTIVE RESUME


• Written with the audience in mind• A succinct summary of capabilities

80% of your content should be accomplishments

• Easy to read and understand Should be visually appealing, have white space, and use a readable font such as

Arial, Times New Roman or Helvetica

• Future focused and targeted toward career goal

ELEMENTS OF AN EFFECTIVE RESUME


• Two pages; one page for a recent college grad• Must have a profile or summary at the top• Must have keywords for scanning software to pick up• Putting volunteer/community service on your resume is fine; putting

personal information is not• Job titles don’t have universal meaning, so explain in terms of

responsibility• Avoid using phrases such as “effective communicator” or “detail oriented”

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ELEMENTS OF AN EFFECTIVE RESUME: WRITING ACCOMPLISHMENTS


• What was the pre-existing problem, need or situation?• What did you do about it? (Be specific.)• What obstacle or barrier did you overcome?• What results did you produce? (Quantify as much as possible.)• What skills, abilities or qualities did you demonstrate?

Questions developed by Julie Jansen, Career Coach and Author (www.juliejansen.net)

SAMPLE PROFILE


Marketing professional with comprehensive experience in brand development, product marketing, internal communications, social media strategy and trade-show management. Demonstrated agility at managing projects and collaborating with and influencing multiple stakeholders, including senior management, colleagues, clients and vendors.Characterized as dynamic, creative, passionate about learning and undertaking new projects, with a great facility for excelling under tight deadlines. Recently earned MBA in marketing.

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SAMPLE KEYWORDS

• Project management • Social media strategy • Trade-show/event planning

• Client service • Budget management • Billing and invoicing

• Strategic planning • Graphic design • Annual report design

• Internal communications • Product marketing • Vendor supervision


STRENGTHS & EXPERTISE

COVER LETTERS/EMAILS


More resources:

https://www.cancerandcareers.org/en/looking-for-work/resume-cover-letter

• Make it personal• Don’t waste reader’s time• Highlight one or two professional experiences that are

relevant to the job you are applying for• Sell yourself• Proof your letter• Follow-up

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• Should you disclose your cancer history…

– on your resume?

– in your cover letter?

– during an interview?

DISCLOSURE & JOB SEARCH


THE SWIVEL


I see you have a gap on your resume, can you tell me what you were doing?

• “I was dealing with a family issue that is resolved now, and I am thrilled to discuss how my management skills can build the team and grow your business.”

• “I realized that what I was doing didn’t fulfill me, so I took a step back to think about what would make me happy, and I think my tech background would really be an asset — not just for this role but for the company as a whole.”

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INTERVIEWING EFFECTIVELY


• Research the company and the interviewer• Prepare and practice answers to potential questions • Tell stories and use examples• Don’t be afraid to make it conversational• Ask clarifying questions to help you provide the best response• Be strategic about when you ask about benefits• Remember your cancer experience may be front and center in

your mind, but it is unlikely to be in the interviewer’s

More resources: https://www.cancerandcareers.org/en/looking-for-work/interviewing

APPLICANTS CAN GOOGLE, TOO


• Company size: Will the ADA apply? Will the FMLA?

• Benefits

• How have they treated employees in the past?

• Discrimination lawsuits

• Do they have employee programs?- EAP, affinity programs, etc.

• Other info that can help identify their workplace culture

• Sites such as www.glassdoor.com and www.LinkedIn.com

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LEGAL PROTECTIONS WHEN LOOKING FOR A NEW JOB

• Disclosure- If, when, and how- Required for use of ADA protections- Pre-offer, post-offer, employed

• Medical Exams- If, when, and how

• Reasonable Accommodation Requests- If, when, and how

• Check the Benefits Package– How, when

© Triage Cancer

EXERCISE: LEGAL OR NOT LEGAL?How would you respond if posed these questions in a job interview?

• “I saw on Twitter you were raising money for a cancer organization. Have you had cancer?”

• “When I Googled your name, an article came up where you were interviewed about being diagnosed with cancer — are you still experiencing any problems or health needs?”

• “Is there anything about your health that I should know about?”

• “Are there any accommodations that you might need to meet these job requirements?”

• “We have had problems in the past with employees who took a lot of time off. Do you think you will be able to meet the attendance requirements?”


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WORKING IN A NEW JOB WITH A NEW EMPLOYER


• How do you assimilate?• How do you handle it if you are still in treatment?• Managing your energy• How can you succeed?• Asking for accommodations

DISCLOSURE IS A SPECTRUM

100% Private … … … 100%

Transparent

• Whether to disclose is a personal decision – How do you feel about privacy? – What benefits or legal protections might be available if you disclose? And, how much information is

necessary to access them?

• The amount you disclose may evolve, but that doesn’t mean it ever has to be every detail– Remember you can always choose to share more, but it is not possible to “un-share”

• Consider timing—and circumstance—before starting a conversation– Are you working during treatment and/or recovery?– Are you looking for a new job?


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ENFORCEMENT OPTIONSIf all you needed was a law . . .

1. File a complaint with federal (or state) agency• EEOC — ADA

• DOL WHD — FMLA

• DOL EBSA — COBRA

2. Consult an employment attorney

3. File an employment lawsuit• ADA discrimination

• ADA failure to provide reasonable accommodations

• FMLA failure to provide time off

• FMLA retaliation © Triage Cancer

True or False1. FMLA is only helpful if you don’t have vacation or paid time

off.

2. Patients should think through disclosure and make conscious decisions about where, when, and how to disclosure, both in the workplace and online.

3. Healthcare teams and patients should communicate about disclosure decisions.


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1. There can be a lot of anxiety about returning to work — be it a new or an existing job; focusing on practical solutions can help.

2. ADA (or similar laws) may protect you during the job-search process.

3. Being strategic about your job-search process is as critical as is being prepared.

TOP TAKEAWAYS


MANAGING LONG-TERM STRESS

Julie Larson, LCSW

This presentation is intended to provide general information on the topics presented. It is provided with the understanding that the authors and presenters are not engaged in rendering any legal,

medical, or professional services by its publication or distribution. Although this content was reviewed by a professional, it should not be used as a substitute for professional services. All rights reserved. This material may not be published, broadcast, rewritten or redistributed in

whole or part with out express written permission.© Copyright 2020 Cancer and Careers & Julie Larson, LCSW

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• What triggers my stress?• How do I recognize it?• What do I do with it?• How can I build up my

personal resilience?

PSYCHOLOGICAL DISTRESS PROTECTION PLAN

• Stress is your body’s way of responding to a demand.

• Our body has a physical, emotional & mental response to stress.

• There are different types of stress and not all stress is “bad”.

• Stress is subjective. Personal.

STRESS 101

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INCREASING SELF-AWARENESSHow does stress show up?

INCREASING SELF-AWARENESS: TRIGGERS

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• Withdrawl.• Indecisive.• Ability to multi-task impaired.• Memory harder to access.• Impulsive – less reasoning.• Hyper-responsive• FEEL = Exhausted. Incapable.

Dread. Overwhelmed. Anxious. Fear. Self-doubt.

• Motivate.• Focus.• Act decisively.• Block out distraction.• Connect with others – oxytocin • FEEL = Energized, Excited,

Enthusiastic, Confident, Capable.

STRESSRESPONSEThinking & Feeling

CH

ALL

ENG

E

THRE

AT

Adapted from The Upside of Stress: Why Stress is Good for You, and How to Get Good At It, by Kelly McGonigal, PhD.Published by Avery, am imprint of Penguin Group. Copyright 2015 by Kelly McGonigal, PhD.

WHAT’S HAPPENING IN YOUR HEAD?

• How hard is this going to be?• Do I have the skills?• Do I have the emotional strength and

courage?• Is there anyone who can help me?

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EVALUATING

Prevents you from being present

“THE VOICE” INSIDE YOUR HEAD

CatastrophizingPersonalizing

All or Nothing

FortuneTelling

ShouldMust Ought

NegativeComparisons

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• How do you self-soothe?• Get connected to your body.• Tune into your five senses. (News Flash: Eight senses!)

• Slow your internal pace.• Stop fighting – Let go.• What gives you perspective?• What self-care options do you have at work?

DEVELOP YOUR RELAXATION PLAN

• Rested• Nourished• Hydrated• Connected• Acknowledged

• Tired• Hungry• Sick• Emotional

YOUR PHYSICAL RESOURCES:

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THE “YOU” INVENTORY• What personal attributes helped you through cancer?• What have you learned about yourself since you were

diagnosed with cancer?• What have you done to be prepared in the past?• Have you overcome challenges in the past? How?• What would your most supportive, empowering and

encouraging loved ones say to you right now? save for later?

Realize when you are stressed. Why?

Begin to learn your “Warning Signs”: • The build up to an emotional moment.

Know your people!• Who is good for you? • Who is challenging?

INCREASING SELF-AWARENESS

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COMPLETE THE STRESS CYCLE

BASELINE

STRESS TRIGGER

STRESS RESPONSE

REST & DIGEST

• Get Moving• Connect with others• Sleep• Self-Compassion• Acknowledge Strengths• Gratitude

REST & DIGEST

WAYS TO “REST” AT WORK

Do someone a favor. Let yourself procrastinate. Hide your phone.

Disappear for a bit. End your day like you mean it.

Break BEFORE lunch.

Connect with coworkers.

Source: Time Magazine Special Edition, Mindfulness: The New Science of Health and Happiness, April 2017

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Who Ya Gonna Call? • Healthcare Professionals• Peers (others who “Get It”!)• Friends and Family

CALLING IN SUPPORT REINFORCEMENT

• Identify the qualities uniquely important to you in this relationship.

• Points to consider:

– Practical: location, cost or insurance– Professional: training, background or experience– Interpersonal: gender, age or style

• A health professional who works well with one personmay not be a good fit for someone else.

CARING FOR YOURSELF: SEEK PROFESSIONAL SUPPORT

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CARING FOR YOURSELF: CONNECT WITH OTHER SURVIVORS

Benefits from connecting with other cancer survivors:• Feel more normal.• Share information.• Unite to effect real change.• Learn from others.• Provide support in fulfilling ways.• Find reassurance and validation.

CARING FOR YOURSELF: TURNING TO FRIENDS & FAMILY

Benefits of reaching out to friends & family:• You have a history within these relationships that may be informative.• May be more available to you on a consistent basis.• You may feel more comfortable sharing vulnerabilities.• They may serve as an escape or distraction.

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10 MINUTE STRETCH BREAK

Monica Fawzy Bryant, Esq.Chief Operating Officer, Triage Cancer

This publication is designed to provide general information on the topics presented. It is provided with the understanding that the author is not engaged in rendering any legal or professional

services by its publication or distribution. Although these materials were reviewed by a professional, they should not be used as a substitute for professional services.

© Triage Cancer 2020

HEALTH INSURANCE OPTIONS

© Triage Cancer

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Key Topics:• Getting and Keeping Health Insurance with a Pre-

Existing Condition

• Consumer Protections in the ACA

• Options when loosing group health insurance

• Tips on Picking a Health Insurance Policy

HEALTH INSURANCE OPTIONS

© Triage Cancer

DON’T UNDERSTAND HEALTH INSURANCE?YOU ARE NOT ALONE.

• Only 23% understood terms used in their health insurance policy

• Only 50% knew their monthly premium

• Only a few understood acronyms: HMO (36%), PPO (20%) & HSA (11%) (eHealth, 2008)

• When asked to define insurance terms and calculate their bill only 50% got it right (The Regence Group, 2008)

© Triage Cancer

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HEALTH INSURANCE TERMS

© Triage Cancer

*Typically only for in-network services

Cost to Have Health Insurance• Premium — each month

Costs When You Use Your Health Insurance• Deductible — each year• Co-Insurance or Cost-Share — each time you get care (%)• Co-Payment — each time you get care ($)• Out-of-Pocket Maximum = deductible + co-payments + co-insurance

HEALTH INSURANCE EXAMPLEIf you have a $102,000 hospital bill, what do you pay?

1. Your deductible of $2,000$102,000-$2,000 = $100,000 left

2. Your co-insurance amount of 20%20% of $100,000 = $20,000

But OOP max is $8,000. So, you only pay the $2,000 deductible + $6,000 of the $20,000 co-insurance amount, for a total of $8,000

Your Plan:Deductible = $2,000

Co-insurance = 80/20 planOOP Max = $8,000

© Triage Cancer

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© Triage Cancer

https://TriageCancer.org/AnimatedVideos

1993-2010WHY WAS THERE A NEED FOR HEALTH

CARE REFORMS?

© Triage Cancer

• Confusion• Pre-existing conditions• Increasing cost / decreasing

coverage

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BANKRUPCIES IN THE U.S.

(Woolhandler, et. al., American Journal of Medicine 8/09)

© Triage Cancer

OPTIONS FOR HEALTH INSURANCE POLICIES

© Triage Cancer

Short-term plans:• ACA limited to 90 days• Don’t have ACA protections (e.g., pre-existing conditions)• Can exclude things like chemo• High out-of-pocket costs, even if lower monthly premium• Can end mid year• Does not = creditable coverage or trigger SEP• Trump HHS Regulation October 2018

• Now allowed to be 364 days long and can be renewed (but unlikely if you have developed a pre-ex)

• Renewable up to 36 months (more expensive than non-renewable plan)

Review of 45 short-term plans showed:• 43% don’t cover

mental health services;

• 62% don’t cover substance abuse treatment;

• 71% don’t cover outpatient prescription drugs; and

• None of the plans cover maternity care

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PATIENT PROTECTION & AFFORDABLE CARE ACT (ACA)

Signed into law on March 23, 2010© Triage Cancer

NEW BENEFITS

* Does not apply to grandfathered plans © Triage Cancer

1. No rescissions (cancellations)2. No lifetime or annual limits3. Young adults can stay on parent’s plan until 264. Clinical trials coverage*

• Routine care costs as of 1/1/14

• Existing law in many states

• See http://triagecancer.org/clinical-trials

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NEW BENEFITS

* Does not apply to grandfathered plans© Triage Cancer

5. Free preventative care* • No co-pays, co-insurance, or deductibles

• e.g., immunizations, blood pressure, diabetes, cholesterol, cancer screenings

• USPSTF Rated A/B (+ Mammography for women over 40)

• www.healthcare.gov/preventive-care-benefits- Colonoscopies AND removal of polyps

- BRCA genetic screening AND testing

HEALTH INSURANCE APPEALS

• Denials of coverage (aka “adverse benefit determination (ABD))

– Internal appeals (ERISA – employer plans)

– External appeals (ACA and/or state law – all private plans)

• AKA: Independent or External Medical Review or independent review entity (IRE*)

• State Health Insurance Agency

– Illinois Department of Insurance » Online Complaint: https://mc.insurance.illinois.gov/messagecenter.nsf

– www.triagecancer.org/stateresources

© Triage Cancerhttps://TriageCancer.org/QuickGuide‐Appeals

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1. Premium Rating: • Individual Plan/Family Plan

• Geographic location (by zip code)

• Age (64-year-old can’t be charged more than 3 times what a 21-year-old can)

• Tobacco (some states have eliminated this: e.g., CA, DC, CT)

2. No Pre-Existing Condition Denials/ExclusionsInsurance companies cannot look at:

• Pre-existing condition (physical or mental) or health history

• Gender or age© Triage Cancer

HEALTH INSURANCE RIGHTS (AFTER 1/1/14)

Most U.S. citizens & lawfully present must have health insurance

Penalty is collected through IRS annual taxes

What coverage counts?

• Employer or Individual Plans

• COBRA/HIPAA Plans

• Medicare, Medicaid, Veterans Health

• High Risk Pools, & others

Year Adult Penalty

Child Penalty

Family Max or % of Income, whichever is more

2014 $95 $47.50 $285 1%

2015 $325 $162.50 $975 2%

2016-2018

$695 $347.50 $2,085 2.5%

2019+ $0

HEALTH INSURANCE REQUIREMENT

How much is the penalty?

© Triage Cancer

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WHERE WE GET HEALTH INSURANCE

Insurance

Company

The Government: Medicare, Medicaid, VA, High Risk Pools

Employer

© Triage Cancer

EMPLOYER-SPONSORED HEALTH INSURANCE

COBRA Qualifying EventMax

COBRA Coverage

Employment ends or hours reduced 18 months

Loss of dependent child status 36 months

Employee enrolls in Medicare 36 months

Divorce or legal separation from employee 36 months

Death of employee 36 months

© Triage Cancer

COBRA• Keep employer-sponsored coverage• Employers with 20+ employees

• Local and state governments• Federal employees and church and

church-related organization employees not covered

• Temporary Continuation of Coverage (TCC) tracks with COBRA

• Cost up to 102% of applicable employee rate = Employer amount + Employee amount + 2% fee

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STATE COBRA LAWS

*Triage Cancer Chart of State Laws© Triage Cancer

States with COBRA statutes:• AR, CA CO, CT, FL, GA, IL, IA, KS, KY, LA, MA, ME, MD, MN,

MS, MO, NV, NH, NJ, NM, NC, ND, OH, OK, OR, RI, SC, SD, TN, TX, UT, VT, WV, WI, WY

• Details vary by state• Most cover employees with 2–19 employees• Coverage lasts between 3–36 months

• Ex: Cal-COBRA = 36 months; Georgia = 3 months; IL = 12 months

MEDICARE

© Triage Cancer

• Eligibility– 65+ years old– On SSDI 2+ years– ESRD or ALS

• www.Medicare.gov

• 2020 Medicare and You: www.medicare.gov/pubs/pdf/10050.pdf

• Open Enrollment: 10/15 – 12/7

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MEDICARE IN 2020Part A: Hospital Insurance

(Free monthly premium for most people)

Part B: Medical Insurance(Premium $144.60

(w/exceptions) & Deductible $198)

Part D: Prescription Drugs (Annual deductible not more

than $435)

Or . . . Part C: Medicare Advantage Plans

(Getting your Medicare Parts A, B, & D through a Medicare

managed care plan)

May pick up your Part B premiums, deductibles, and

other benefits.

Less provider choice, whereas original Medicare is fee for

service.

Original Medicare

© Triage Cancer

NEW MEDICARE BENEFITS

© Triage Cancer

1. Free Wellness Visit

2. Free Preventative Care

3. Lowers the cost of prescription drugs

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Initial Coverage

Deductible The Donut HoleCatastrophic Coverage

Patient pays $295deductible out of pocket

Until total drug costs = $2,700

After total out‐of‐pocket drug costs = $4,350

Patient pays 100%

Medicare pays 0%

Patient pays 25%

Medicare pays 75%

Patient pays greater of 5% or $2.40 generic/ $6 brand

Medicare pays 95%

Medicare Part D – Donut Hole before ACA

© Triage Cancer

Initial CoverageDeductibleCatastrophic Coverage

Patient pays $435 deductible out of pocket

After total out‐of‐pocket drug costs = $6,350

Medicare Part D – Donut Hole 2020

Patient pays 25%

Medicare pays 75%

Patient pays greater of 5% or $3.60 generic/ $8.90 brand

Medicare pays 95%

© Triage Cancer

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Eligibility: low income + low resources +

MEDICAID: ONLY OPTIONS PRIOR TO 1/1/14

“Aged, Blind, Disabled”

Pregnant women for up to 6 months after

baby’s birth

People with minor

children

Minor children

© Triage Cancer

New category (door) of eligibility:

• No asset/ resource test

Household Size 138%*

1 $17,609

2 23,791

3 29,974

4 36,156

5 42,338

6 48,521*Except Alaska & Hawaii

NEW HEALTH INSURANCE OPTIONMedicaid Expansion

Adults with household

income under 138% of federal

poverty level

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Expanded

37Not Expanded

14AK5, AR4, AZ, CA, CO, CT, DC, DE, HI,

IA4, ID11, IL, IN, KY, LA7, MA, MD, ME8,

MI1, MN, MT6, ND, NE12, NH3, NJ, NM,

NV, NY, OH, OR, PA2, RI, UT10, VA9, VT,

WA, WV

AL, FL, GA, KS, MO, MS, NC, OK, SC, SD, TN, TX, WI, WY

STATE MEDICAID EXPANSION IN 2020

Updated: 9/1/2019 (info changes frequently, please check for updates)1 MI expansion began 4/1/14 2 PA expansion began 1/1/15 3 NH expansion began 1/1/164 IA and AR implemented expansion through premium assistance & wrap around Medicaid5 AK expansion began 9/1/156 MT enrollment began 11/2/15 for coverage that begins 1/1/16; expires 6/197 LA Governor signed Executive Order for expansion that began 7/1/16

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8 ME Governor signed Executive Order 1/3/19, awaiting HHS approval, coverage will be retroactive to 7/2/189 VA expansion began 1/1/1910 UT Voters approved a proposition in 11/18; awaiting HHS approval to begin coverage 4/1/1911 ID Voters approved a proposition in 11/18; awaiting HHS approval12 NE Voters approved a proposition in 11/18; awaiting HHS approval

http://triagecancer.org/medicaid-expansion

STATE HEALTH INSURANCE MARKETPLACES

Ins.

Company

Government: Medicare, Medicaid,

VA, etc.

Employer

© Triage Cancer

• “Exchanges” = insurance shopping mall

• Benefits:

– Cap on OOP max: : $8,150 individual / $16,400 family (2020)

– Financial help

• Premium tax credits

• Cost-sharing subsidies

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• Standardized cost-share:

HEALTH INSURANCE MARKETPLACE

Catastrophic coverage (under 30 or $ hardship)© Triage Cancer

Household Size

100%(2020)

138%(2020)

250%(2019)

400%(2019)

1 $12,760 $17,609 $31,225 $49,960

2 17,240 23,791 42,275 67,640

3 21,720 29,974 53,325 85,230

4 26,200 36,156 64,375 103,300

5 30,680 42,338 75,425 120,680

6 35,160 48,521 86,475 138,360

Premium Tax CreditsMedicaid

STATES EXPANDING MEDICAIDCost-Sharing Subsidies

(Silver Plans Only)

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Household Size

100%(2020)

138%(2020)

250%(2019)

400%(2019)

1 $12,760 $17,609 $31,225 $49,960

2 17,240 23,791 42,275 67,640

3 21,720 29,974 53,325 85,230

4 26,200 36,156 64,375 103,300

5 30,680 42,338 75,425 120,680

6 35,160 48,521 86,475 138,360

Premium Tax CreditsMedicaid

Cost-Sharing Subsidies (Silver Plans Only)

STATES NOT EXPANDING MEDICAID

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DIFFERENCES BETWEEN PLANS?

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• Networks of doctors and hospitals– Check to make sure your doctors are covered by the plan you choose

• Co-payments• Prescription drug coverage

– Which drugs are covered?– Is there a separate drug deductible?

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TYPES OF MANAGED CARE PLANS

© Triage Cancer

Smaller network of providers

PCP referral to specialists

Lower costs (i.e., premiums, co-pays, deductibles)

Usually no out-of-network coverage

Can be a staff model (e.g., Kaiser) or a group/ network model (e.g., Anthem)

Larger network of providers = more choice

But no out-of-network coverage

PCP not necessary

Higher costs

Larger network of providers = more choice

May have some out-of-network coverage (e.g.,

50%)

PCP not necessary

Higher costs

PPO (Preferred Provider

Organization)

HMO (Health Maintenance

Organization)

EPO (Exclusive Provider

Organization)

HOW TO ENROLL

Enrollment: • Website: HealthCare.gov• Toll-free phone hotline: 800.318.2596• Paper application: mail or fax• In-Person: places to get help enrolling- Marketplace Assister Organizations- www.healthcare.gov/contact-us/

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AGENTS & BROKERS

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WHEN TO ENROLL?

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*Plans are for a calendar year

• Medicaid applications accepted year round

• 2020 Marketplace Open Enrollment: Closed.

• 2021 Marketplace Open Enrollment: Nov. 1 – Dec. 15, 2020*

– State Marketplaces may be longer

– https://TriageCancer.org/Blog

• Medicare: Oct. 15 – Dec. 7*

• Employer plans: Varies (often in the Fall)

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SPECIAL ENROLLMENT PERIODWhen you have a life-changing event . . .

. . . you have 60 days to enroll in Marketplace plan

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LIFE-CHANGING EVENT

Trying to fill coverage gap while waiting for Marketplace plan to start? Can chose COBRA coverage only until Marketplace plan is effective, but get Marketplace plan first, then COBRA

Lane 2:Marketplace

Special Enrollment

Lane 3:Other group plan

(spouse or parents)

Lane 4:Medicaid or Medicare?

Lane 1:COBRA or

State COBRA

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COMPARING PLAN OPTIONSMarketplace

Plan

Marketplace

Plan

Employer Plan

Employer Plan

Marketplace

Plan

Employer

Plan

Medicare

Plan

Medicare

Plan© Triage Cancer

WHERE TO START?

www.HealthCare.gov/see-plans © Triage Cancer

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© Triage Cancer

© Triage Cancer

The Math Matters!

Total potential costs for year = 12 months of premiums + OOP max

#1: $294.71x12 = $3,536.52+ OOP = $8,150Total = $11,686.52

#2: $376.53x12 = $4,518.36+ OOP = $8,150Total = $12,668.36

#3: $432.54x12 = $5,190.48+ OOP = $5,900Total = $11,090.48

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DIFFERENCES BETWEEN PLANS?• Cost

– Premiums, Out-of-Pocket Max, Deductibles, Co-Payments, Cost-Share

– Spreading payments throughout the year

• Networks of doctors and hospitals– Check to make sure your doctors are covered by the

plan you choose

• Prescription drug coverage– Which drugs are covered?– Is there a separate drug deductible?

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CHECKING PROVIDERS & DRUGS

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ACA CONSTITUTIONAL?

• California v. Texas• January 2020 both

sides appealed to SCOTUS

• Case may not be decided by SCOTUS before 2020 election

© Triage Cancer

https://TriageCancer.org/Blog

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True or False1. If I don’t have health insurance now, I will never be able to get

insurance unless I get a job.

2. When searching for a health insurance plan, I only need to weigh the costs.

3. I can be charged more for health insurance if I have been diagnosed with cancer.

TOP TAKEAWAYS

© Triage Cancer

1. Can’t be denied health insurance and can’t be charged more because of your health condition - for now!

2. Weigh your options carefully — when looking at plan options, the math matters!

3. Learn more about how the ACA & other laws impact the cancer community.- Triage Cancer Blog: http://TriageCancer.org/blog- Quick Guides & Other Resources:

http://TriageCancer.org/healthinsurance- Webinars: http://TriageCancer.org/webinars

4. Be an advocate. #vote

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REVIEW: ERIN


• After college, Erin worked as an assistant at a large company for 3 years. At the age of 24, she was diagnosed with cancer.

• After talking with her healthcare team, she decided her best course of action was to take some time off work. When she shared her diagnosis with her employer, she was told that she would have to be let go.

• Erin took COBRA to keep her health insurance coverage, but her 18 months are up and she is concerned about how to get insurance coverage with a pre-existing condition. ACA, Marketplace, Medicaid

• Erin is now 26 and is ready to get back into the workforce.

• She isn’t sure how to deal with the gap on her resume, and how to address it in an interview — or if she even has to. ADA, State Law, Disclosure, CAC job-search tools, CAC Resume Review

• Erin also has monthly medical appointments and has been experiencing chemo brain. She is worried this will keep her from getting a job. ADA, State Law, Reasonable Accommodations, FMLA

RESOURCESCancer and Careers• Accredited Balancing Work & Cancer Webinars

(Survivors and Healthcare Professionals) www.cancerandcareers.org/en/community/events/webinars

• Accredited Educational Series for Healthcare Professionals www.cancerandcareers.org/en/community/events/healthcare-professionals

• National Conference on Work & Cancer (June 22, 2018, NYC)www.cancerandcareers.org/en/community/events/conference

• West Coast Conference on Work & Cancer (October 13, 2018, Los Angeles)www.cancerandcareers.org/en/community/events/westcoast-conference

• Newsfeed www.cancerandcareers.org/newsfeed

• Resume Review www.cancerandcareers.org/resume_reviews/new

Cancer and Careers & Triage Cancer• In-Service Trainings for Healthcare Professionals —

Navigating Cancer: Work & Insurance

Triage Cancer• Educational Blog TriageCancer.org/Blog

• Events TriageCancer.org/Events

• Cancer Survivorship Webinar Series TriageCancer.org/Webinars

• National & State Resources TriageCancer.org/Resources• Quick Guides TriageCancer.org/Resources/QuickGuides• State Resource Contact Information• Links to Partner Publications

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ADDITIONAL RESOURCESEmployment Rights & Options

• Equal Employment Opportunity Commission www.EEOC.gov

• Job Accommodation Network www.AskJan.org• U.S. Department of Labor (COBRA)

www.dol.gov/EBSA• U.S. Department of Labor (FMLA)

www.DOL.gov/WHD• FlexJobs www.flexjobs.com• Workplace Transitions

www.workplacetransitions.org

Disability Insurance Rights & Options• Social Security Administration www.SSA.gov• National Organization of Social Security Claimants’

Representatives (NOSSCR) www.nosscr.org

Legal Assistance• LawHelp www.lawhelp.org• Lawyer Referral Service

http://apps.americanbar.org/legalservices/lris/directory

• National Cancer Legal Services Network www.NCLSN.org

• Illinois State Bar Association Lawyer Finder http://www.illinoislawyerfinder.com

Rebecca V. Nellis, [email protected] www.CancerandCareers.org

Twitter@CancerAndCareer

Facebookwww.Facebook.com/CancerandCareers

Newsletterwww.cancerandcareers.org/en/community/newsletter

CONTACT INFORMATION

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CONTACT INFORMATIONMonica Fawzy Bryant, Esq.

[email protected]

http://TriageCancer.org

Twitter@TriageCancer

Facebookwww.Facebook.com/TriageCancer

Bloghttp://TriageCancer.org/blog

CONTACT INFORMATION

Julie Larson, LCSW

http://www.julielarsonlcsw.com/

Email

[email protected]

Twitter

@JulieLarsonLCSW

Facebook

http://facebook.com/Julielarson.lcsw

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The planners and presenters for this program have not disclosed any pertinent financial

relationships or conflicts of interest. The opinions expressed at this event are those of the

participating faculty and do not imply endorsement by the CEU/PDC approvers (ANCC,

SHRM, CABRN, NASW or the New York State Education Department’s State Board for Social

Work) of any commercial products discussed. This educational program does not include any

information about off-label, investigational or unproven use of products other than those

approved by the Food and Drug Administration (FDA).

This presentation is intended to provide general information on the topics presented. It is provided with the understanding that the author is not engaged in rendering any legal, medical, or professional services by its publication or distribution.

Although this content was reviewed by a professional, it should not be used as a substitute for professional services. © Copyright 2020 Cancer and Careers, Triage Cancer & Julie Larson, LCSW

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