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    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

    Later, Dr. Marcinko was a vital and recruited BOD  member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.

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On Medical Office Fire Drills and Training

Office Fire Drills

By Dr. David E. Marcinko MBA

Fire Drills should be performed at least annually and documented.

When first opening an office or when a new employee is brought onboard, staff need to be trained on the use of a fire extinguisher, location of the nearest fire extinguisher and location of alarm pull station (if any) on the first day. Training should be documented and placed in the employee file.

Generally speaking, a fire extinguisher is required every 75 feet in office space and be the appropriate type for the nature of business and equipment in use. Most offices use a multi-purpose ABC extinguisher that can be used on most types of fires.

The types of fires are listed below:

  • Class A fires are for ordinary combustible materials such as paper, wood, cardboard, and most plastics.
  • Class B fires involve flammable or combustible liquids (gasoline, kerosene, oil, and grease).
  • Class C fires are those caused by electrical equipment (wiring, appliances, and outlets).
  • Class D fires are chemical fires that involve combustible metals i.e. potassium, sodium, and magnesium.

EXTINGUISHERS

Carbon Dioxide (CO2) extinguishers can be used for class B and C fires. These extinguishers are highly pressurized and are best suited for electrical or computer equipment. They have an advantage over dry chemical extinguishers for this use since they do not leave damaging residue. However, they are not effective for Class A fires.

It is important to know which type of extinguisher is best for the office and equipment since using the wrong type can be critical in an emergency.

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THE EMERGENCY LIST:

At a minimum, a physician office should have a safety program that addresses the following in the event of an emergency:

  1. Written Program
  2. Emergency Notification Procedures
  3. Warning and Evacuations Process
  4. Evacuation Procedures
  5. Facility/Department Evaluation or site review
  6. Means of egress clearly marked (map posted with exit route and nearest exit)
  7. Emergency Action Plan
  8. Fire Prevention Plan
  9. Fire extinguisher location(s), types and use (P.A.S.S. Pull, Aim, Spray & Sweep)

If you are in an area susceptible to weather emergencies such as tornadoes, the emergency plan should address these as well.

Assessment: Your thoughts are appreciated

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Five Ways to Protect Your Vehicle’s Exterior from Dings, Scrapes and Grime

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By Dr. David Edward Marcinko MBA with Nalley Collision Center, GA.

DEM with JAGSome automobile owners, like me and other medical professionals, take pride in their cars. Regardless of whether you bought a new car from the showroom or bought your car used, you want to keep your vehicle looking like new for a long time.

Unfortunately, modern life is the enemy of a great-looking car. Tar and stones from roadways can wreak havoc on beautiful finishes. Other drivers can carelessly dent your car in hospital or mall parking lots, and refuse to accept responsibility for the damage. Debris flying out of trucks, birds, and other problems add to the long list of threats to your car.

The Steps

Rather than accepting dings, scrapes and grime on your car as a fact of life, follow these five steps to keep the exterior of your car looking fabulous.

1. Get Covered

Rain, snow, and sunshine can all adversely affect the exterior of your car. You can do little about the weather while driving your car, but when you get home, you can cover your car to protect its beautiful finish. Although garages offer the best protection against outside forces for your car, you might find out that you can get similar results by using a car port or a portable garage. A portable garage is a flexible cover that you can put over your vehicle to protect its exterior while not in use.

2. Paint Protection Film 

Special products exist that help protect the finish of your car at all times, even while you drive. Paint protection film creates a layer of protection between the exterior surfaces of your car and the environment, so your car can withstand an array of road hazards. This type of product eliminates expensive trips to your dealer’s body shop for touchup work and preserves the resale value of your car.

3. Wash Your Car

Although a carwash can put the exterior of your car in jeopardy, it can help prevent harmful grime build up. If you care a lot for your car, you will give it a loving hand-wash, detail and wax periodically to keep its finish looking great. While you wash, you can look for new scrapes and dents that either you or your dealer can quickly repair before they become ugly and embarrassing.

4. Cautious Parking

Parking lots pose some of the most severe threats to auto exteriors. It is my pet peeve. Regardless of how carefully you park, someone else will come along and park too close to your car, giving your car a free dent. Although often minor, parking-lot damage can cost a lot to repair. Motorists these days live with the fear that a claim will cause their insurance premiums to rise, so they might not take responsibility for denting or scraping your car.

It’s time to take parking into your own hands. You can try taking up two spots when you park, making it impossible for other car doors to reach your vehicle. Also, you can park far away from other cars where most people will never park. The long walk will give you valuable health benefits, and the remote parking spot can help prevent damage to your car.

5. Common Sense

Your best defense against scrapes, dents, and grime might reside under your own hat. Common sense should tell you to avoid roads while they undergo paving line-painting work. Avoid attempting to enter narrow alleys and resist the temptation to drive up to your mailbox when you get home at the end of the day. Never drive your car near trees and bushes. Always avoid dirt or gravel roads. Also, keep your garage and carport clear of tools and other objects that can easily fall and damage your car.

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Classic XJ-V8-WB Jaguar

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DE's Jaguar Touring Sedan

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Jaguar front seat

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My Jaguar's engine after a steam

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Annuities Do Not Belong In 401(k) Plans

Here is Why?

By Rick Kahler CFP

Several weeks ago I wrote about the Setting Every Community Up for Retirement Enhancement (SECURE) Act, which will reform various aspects of US retirement laws. The Act was passed by the House in May and is currently stalled in the Senate.

One of the most troubling of the SECURE Act’s 29 provisions is that it will ease regulations to make it easier for financial salespeople to sell annuities to 401(k) plan participants.

This is alarming, as the act creates a safe harbor for annuities inside 401(k) plans. That means companies choosing to offer annuities would be shielded from liability—no matter how terrible an investment the annuity products may be. This provision has great potential for harm.

Annuities seem always to be a hot financial product in the market place. It’s rare when I interview a new client that they don’t have at least one in their portfolio. Often, it’s the only investment they own. Annuities are not hot because consumers are clamoring to buy them, but rather because annuity sales people love to sell them.

While I rarely recommend them, there are some good things about annuities, especially that earnings grow tax deferred until distributed. They can be useful in this regard in special situations—when stripped of their high fees and commissions. Therein lies the problem.

Sales

Most annuities sold by salespeople inherently contain high fees, big commissions, and high penalties to consumers for taking money out early. What that means for the investor is low returns. For those reasons, the negative aspects of annuities far outweigh any good.

Even worse, annuities have no place being owned by an IRA or, as the SECURE Act would allow, a 401(k) plan. Regardless of fees or commissions, no annuity belongs in a retirement plan. One of my top pet peeves as a financial planner is so-called “financial advisors” who sell people fixed and variable annuities for a retirement account. This makes no sense.

An annuity is a tax-deferred container to put investments in, not an investment itself. It’s what investments are inside it that matters. The same is true of  IRAs and 401(k) retirement plans. Since a retirement plan is already a tax-deferred investment container, it makes no sense to put an annuity—another tax-deferred investment container—inside of it. The silliness of this is obvious to even the most casual observer, unless your livelihood comes from selling these products.

Agents and their companies spare no expense in developing convincing storylines, half-truths, and slight-of-hand explanations of why it makes perfect sense for a retirement plan to own an annuity.

The bottom line is that annuities are sold, they are not bought. The only reason annuities are purchased in someone’s retirement account is because the salesperson receives a much higher commission from the transaction than selling a mutual fund, individual stocks, or CDs.

Why?

So why did our Representatives vote 417-3 to open up investors’ 401(k) plans to these high-cost, high-commissioned, financially disastrous products? I can only surmise that most of them didn’t fully understand what they were voting on and that the insurance lobby did their normal amazing job of selling the alleged benefits of annuities. Oh, and maybe there was a campaign contribution or two.

Assessment

Most annuities are expensive investment vehicles that benefit the salesperson and the company far more than they benefit you. If you are thinking of buying one, or in the future your 401(k) offers the option of buying an annuity, do some digging before you sign on the dotted line. Make sure you get advice first from someone other than the annuity salesperson—someone with no vested interest in selling you this product.

Your thoughts are appreciated.

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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What is Cryonics?

Cryonics: Using low temperatures to care for the critically ill

By Aschwin de Wolf

Introduction

In contemporary medicine terminally ill patients can be declared legally dead using two different criteria: whole brain death or cardiorespiratory arrest. Although many people would agree that a human being without any functional brain activity, or even without higher brain function, has ceased to exist as a person, not many people realize that most patients who are currently declared legally dead by cardiorespiratory criteria have not yet died as a person. Or to use conventional biomedical language, although the organism has ceased to exist as a functional, integrated whole, the neuroanatomy of the person is still intact when a patient is declared legally dead using cardiorespiratory criteria.

It might seem odd that contemporary medicine allows deliberate destruction of the properties that make us uniquely human (our capacity for consciousness) unless one considers the significant challenge of keeping a brain alive in a body that has ceased to function as an integrated whole. But what if we could put the brain “on pause” until a time when medical science has become advanced enough to treat the rest of the body, reverse aging, and restore the patient to health?

Myths: https://www.alcor.org/cryomyths.html#myth6

MORE: https://www.alcor.org/

Assessment

Your thoughts are appreciated.

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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What is the Feres Doctrine of Medical Malpractice?

The Feres Doctrine

A doctrine that bars claims against the federal government by members of the armed forces and their families for injuries arising from or in the course of activity incident to military service.

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https://en.wikipedia.org/wiki/Feres_v._United_States

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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LINK: http://www.msn.com/en-us/news/us/dying-us-soldier-fighting-for-the-right-to-sue-military-over-medical-malpractice/ar-AAAZ09p?li=BBnb7Kz

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LINK: https://connectingvets.radio.com/articles/feres-doctrine-closer-being-overturned-supreme-court

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MARCINKO’s New Risk Management and Asset Protection Textbook for MDs and Financial Advisors

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners]

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 Our New Text – “Take a Peek Inside 

Available – ORDER NOW!

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Foreword by J. WESLEY BOYD MD PhD MA

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Book Reviews

“Physicians who don’t understand modern risk management, insurance, business and asset protection principles are sitting ducks waiting to be taken advantage of by unscrupulous insurance agents and financial advisors; and even their own prospective employers or partners. This comprehensive volume from Dr. David Marcinko, and his co-authors, will go a long way toward educating physicians on these critical subjects that were never taught in medical school or residency training.”
—Dr. James M. Dahle, MD, FACEP, Editor of The White Coat Investor, Salt Lake City, Utah, USA

“With time at a premium, and so much vital information packed into one well organized resource, this comprehensive textbook should be on the desk of everyone serving in the healthcare ecosystem. The time you spend reading this frank and compelling book will be richly rewarded.”
—Dr. J. Wesley Boyd, MD, PhD, MA, Harvard Medical School, Boston, Massachusetts, USA

“Physicians have more complex liability challenges to overcome in their lifetime, and less time to do it, than other professionals. Combined with a focus on practicing their discipline, many sadly fail to plan for their own future. They need trustworthy advice on how to effectively protect themselves, families and practice, from the many overt and covert risks that could potentially disrupt years of hard work.
Fortunately, this advice is contained within ‘Risk Management, Liability Insurance, And Asset Protection Strategies For Doctors And Advisors: Best Practices From Leading Consultants And Certified Medical Planners™’. Written by Dr. David Edward Marcinko, Nurse Hope Rachel Hetico and their team of risk managers, accountants, insurance agents, attorneys and physicians, it is uniquely positioned as an integration of applied, academic and peer-reviewed strategies and research, with case studies, from top consultants and Certified Medical Planners™. It contains the latest principles of risk management and asset protection strategies for the specific challenges of modern physicians. My belief is that any doctor who reads and applies even just a portion of this collective wisdom will be fiscally rewarded. The Institute of Medical Business Advisors has produced another outstanding reference for physicians that provide peace of mind in this unique marketplace! In my opinion, it is a mandatory read for all medical professionals.”
—David K. Luke, MS-PFP, MIM, CMP™, Net Worth Advisory Group, Inc., Sandy, Utah, USA

“This book is a well-constructed, comprehensive and experiential view of risk management throughout the entire medical practice life-cycle. It is organized in an accessible, high-yield style that is familiar to doctors. Each chapter has case models, examples and insider tips and useful pearls. I was pleased to see multi-degreed physicians sharing their professional experiences in a textbook on something other than clinical medicine. I can’t decide if this book is right on – over the top – or just plain prescient. Now, after a re-read, I conclude it is all of the above; and much more.”
—Dr. Peter P. Sidoriak, Pottsville, Pennsylvania, USA

“When a practicing physician thinks about their risk exposure resulting from providing patient care, medical malpractice risk immediately comes to mind. But; malpractice and liability risk is barely the tip of the iceberg, and likely not even the biggest risk in the daily practice of medicine. There are risks from having medical records to keep private, risks related to proper billing and collections, risks from patients tripping on your office steps, risks from medical board actions, risk arising from divorce, and the list goes on and on. These liabilities put a doctor’s hard earned assets and career in a very vulnerable position. This new book from Dr. David Marcinko and Prof. Hope Hetico shows doctors the multiple types of risk they face and provides examples of steps to take to minimize them. It is written clearly and to the point, and is a valuable reference for any well-managed practice. Every doctor who wants to take preventive action against the risks coming at them from all sides needs to read this book.”
—Richard Berning, MD, FACC, New Haven, Connecticut, USA

“This is an excellent companion book to Dr. Marcinko’s Comprehensive Financial Planning Strategies For Doctors And Advisors: Best Practices from Leading Consultants and Certified Medical Planners™. It is all inclusive yet easy to read with current citations, references and much frightening information. I highly recommend this text. It is a fine educational and risk management tool for all doctors and medical professionals.”
—Dr. David B. Lumsden, MD, MS, MA, Orthopedic Surgeon, Baltimore, Maryland, USA

“This comprehensive text book provides an in-depth presentation of the cyber security and real risk management, asset protection and insurance issues facing all medical profession today. It is far beyond the mere medical malpractice concerns I faced when originally entering practice decades ago.”
—Dr. Barbara s. Schlefman, DPM, MS, Family Foot Care, PA, Tucker, Georgia, USA

“Am I over-insured and thus wasting money? Am I under-insured and thus at risk for a liability or other disaster? I never really had the means of answering these questions; until now.”
—Dr. Lloyd M. Krieger, MD, MBA, Rodeo Drive Plastic Surgery, Beverly Hills, California, USA

“I read and use this book, and several others, from Dr. David Edward Marcinko and his team of advisors.”
—Dr. John Kelley, DO, Orthopedic Surgeon, Tucker, Georgia, USA

“An important step in the risk management, insurance planning and asset protection process is the assessment of needs. One can create a strong foundation for success only after all needs have been analyzed so that a plan can be constructed and then implemented. This book does an excellent job of recognizing those needs and addressing strategies to reduce them.
—Shikha Mittra, MBA, CFP®, CRPS®, CMFC®, AIF®, President – Retire Smart Consulting LLC, Princeton, New Jersey, USA

“The Certified Medical Planner™ professional designation and education program was created by the Institute of Medical Business Advisors Inc., and Dr. David Edward Marcinko and his team (who wrote this book). It is intended for financial advisors who aim specifically to serve physicians and the medical community. Content focuses not only on the insurance and professional liability issues relevant to physicians, but also provides an understanding of the risky business of medical practice so advisors can help work more successfully with their doctor-clients.”
—Michael E. Kitces, MSFS, MTAX, CFP®, CLU, ChFC, RHU, REBC, CASL, http://www.Kitecs.com, Reston, Virginia, USA

“I have read this text and used consulting services from the Institute of Medical Business of Advisors, Inc. on several occasions.”
—Dr. Marsha Lee, DO, Radiologists, Norcross, Georgia, USA

“The medical education system is grueling and designed to produce excellence in medical knowledge and patient care. What it doesn’t prepare us for is the slings and arrows that come our way once we actually start practicing medicine. Successfully avoiding these land mines can make all the difference in the world when it comes to having a fulfilling practice. Given the importance of risk management and mitigation, you would think these subjects would be front and center in both medical school and residency – ‘they aren’t.’ Thankfully, the brain trust over at iMBA Inc., has compiled this comprehensive guide designed to help you navigate these mine fields so that you can focus on what really matters – patient care.”
—Dennis Bethel, MD, Emergency Medicine Physician

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Term Life Insurance Can Protect Retirement Plan Contributions

Term Life Insurance Can Protect Retirement Plan Contributions

By Rick Kahler CFP®

Some of the typical reasons for life insurance are to replace a breadwinner’s salary, pay off large debts, and pay estate taxes. Another reason to carry life insurance—if it’s the right kind—can be to fund a retirement plan.

Illustration

To illustrate, let’s imagine a couple, both 55, with two grown children, two good jobs, and no debts. They began funding their retirement only recently. Leigh’s entire salary of $124,000 a year goes into company retirement plan options: $64,000 into the 401(k) and profit sharing plan and $60,000 into the Cash Balance plan. The couple lives on Mischa’s salary of $60,000 a year.

Their financial planner has calculated that in 10 years they will have a good chance of having $1,500,000 saved in retirement plans. This amount will allow both of them to retire, continue to live on $60,000 a year for the rest of their lives, and have enough to fund long-term care for one of them or leave a nice inheritance to their kids.

The death, disability, or loss of a job of either of them is not a threat to their current lifestyle. However, it is a threat to their retirement plan. And the loss of Leigh’s job is the biggest threat. While finding a new job that would allow retirement plan contributions to resume is possible, it is not guaranteed.

Nothing can be done to insure against the loss of a job, but there are ways insurance could help protect this couple. They could purchase disability insurance to replace 60% of the income of either partner. This would allow them to still make a reduced contribution to their retirement plan.

Premature Death

But what happens if either of them should die prematurely, especially Leigh? It’s doubtful Mischa could cut expenses enough to put anything significant toward retirement, instead having to work as long as possible and then rely heavily on Social Security.

This a where a 10-year term life insurance policy on Leigh would make a significant difference. If they purchased a $1,000,000 term policy on Leigh now, the premium (for a nonsmoker in good health) would be around $1200 annually. Should Leigh die this year, if Mischa invested the insurance payment it would have a high probability of growing to $1,500,000 in ten years. This would allow Mischa to retire comfortably.

However, the older Leigh and Mischa get, the less they need the insurance. If Leigh died in the fifth year of the policy, the five years of savings plus the insurance proceeds would accrue more than $2,000,000 over the following five years.

One cost-saving strategy would be to buy two $500,000 10-year term policies and drop one after five years. This would still provide for a total of around $1,500,000 in retirement funds for Mischa by age 65 if Leigh should die before that time.

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If you proposed this plan to a life insurance agent, they might suggest putting Leigh’s salary into a cash value policy instead of buying term.

Let’s look at that

Contributing $124,000 into the retirement plan saves $24,000 a year in income taxes, so only $100,000 a year would be available to buy insurance. This amount would cover a policy with a $1.9 million death benefit and a cash value guaranteed to grow to $1,036,328 in 10 years. Given the extra tax payments, plus premium costs of $1 million over 10 years, that’s not a good investment for our couple. The commission of $72,500 makes it a great investment for the salesperson, though.

Assessment

Besides, in this circumstance, life insurance is not meant as an investment. It is an affordable way to replace the income that covers Leigh’s retirement contribution. 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

MORE FOR DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

THANK YOU

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Biohazard Insurance on Rental Property Protects Owners, Tenants

Expensive and Emotional

By Rick Kahler CFP®

The call I recently received from a distraught client dealt with a disturbing question I’d never heard in all my 45 years of owning and selling real estate and my 35 years in financial planning. “Rick, my tenant committed suicide in my rental house. He shot himself. It was such a shock.

And then the biohazard clean up and repairs cost $30,000. My insurance only paid $10,000. What can I do to cover the difference?”

This client, who does not earn a high income, saved for several years to buy her first rental. One year ago she proudly put $30,000 down and borrowed $120,000 to buy a two-bedroom home for $150,000. Like most rentals financed with a loan, excess cash flow is nonexistent; her expenses and loan payment basically equal the rent. Her intention was to eventually have a paid-off rental property to help provide her retirement income.

We explored some options. She could borrow $20,000 with a five-year loan and monthly payments of $377. This would definitely mean reducing her lifestyle. She could sell the house and probably net enough from the proceeds to pay the difference. This would seriously impact her future retirement income goal. She could consider asking the estate of the deceased to cover the costs. The phone went silent as she pondered this idea. “That would be hard.”

The thought of who is legally liable for the damages of such a terrible tragedy is not a pleasant subject to ponder. Compared to the emotional costs for the victim’s loved ones, of course, the financial costs are insignificant. Yet they still must be dealt with.

In a home where a violent death occurs or a natural death goes undiscovered for some time, the owner of the property faces significant biohazard cleanup costs that must be done by specialists. In addition, repairs and replacement furnishings are often required.

Bringing an action against someone’s estate to recover such costs is a choice anyone would be reluctant to make. The estate may not have the means to pay such costs. Even if funds were available, asking for payment could seem cruel, callous, and heartless.

As my daughter said to me, “Put yourself in the shoes of that man’s family for a moment. Imagine the expenses you already have to take care of: the funeral, a casket, a headstone, a cemetery plot, and other duties that you have to carry out while you’re still grieving—only to be told you need to cough up an additional $20,000 dollars on top of it all.”

Certainly, my client is in an unenviable lose/lose position. Through no fault of her own, she either suffers a significant financial setback or faces the possibility of filing a lawsuit against the estate of the deceased.

Sadly, all of this could have been avoided if my client had purchased the proper insurance. She thought she had, because her policy had a rider covering damages from a crime scene and biohazard clean-up. Unfortunately, the coverage capped at $10,000.

I asked Amy Borella, a property casualty agent with Great Western Insurance, what the industry standard is for this kind of coverage. She said, “Every policy can have different endorsements and every company can cover claims differently. There is no standard for how a claim like this would be handled.”

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Assessment

It was a relief to learn that my homeowners and rental policies did have coverage, with no cap. I strongly suggest, if you own rental property, to be sure the same is true for your policies. In case a tragedy should happen, adequate insurance provides protection for both you and your tenants.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

MORE FOR DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

THANK YOU

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

National Collector Car Appreciation Day

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Doctors … and their Cars

By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]

Friday July 13th, marks the eighth year in a row the Specialty Equipment Market Association (SEMA) has secured federal acknowledgement of “National Collector Car Appreciation Day (NCCAD),” an annual opportunity to recognize and generate awareness for the collector car hobby.

American Collectors Insurance has partnered with Rides.com to commemorate the occasion at its Cherry Hill, NJ headquarters with a night of cool rides and hot rods.

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Dr. Marcinko 1972 Vette

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DEM in his 1990 Miata

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3K33If3L35L75I45F2d5pcefa680cfd0b1c86

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Assessment

For details on the celebration at the American Collectors Insurance headquarters in Cherry Hill, NJ visit http://www.AmericanCollectors.com/NCCAD/ 

To learn more about National Collector Car Appreciation Day events across the country, visit: www.semaSAN.com/CCAD

MORE: https://www.worldnationaldays.com/collector-car-appreciation-day-2018/

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct DetailsProduct Details

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Life insurance issues that salespeople would prefer you NOT know!

More on Life Insurance

Rick Kahler MS CFP

By Rick Kahler MSFS, CFP®

Here are three points about life insurance that many life insurance salespeople would prefer you not to know:

  1. Not everyone needs it.
  2. Those who most need it are often least able to afford it.
  3. It is not a good investment.

Let’s take a deeper look at each point.

Not everyone needs life insurance. You probably don’t if you are single, financially independent, don’t have large debts, or own property or a business that will be liquidated upon your death. You need life insurance only if anyone would be put at risk or suffer financially because of your death.

Here are four circumstances when insurance is typically necessary:

  1. Parents with young children. Before the kids are born young couples, who typically are both employed, may not really need life insurance. However, when the first child comes along it’s imperative that there is enough insurance to raise each child to financial self-sufficiency.
  2. Business owners with large debts, key employees, or partners. Without life insurance to pay off business debts, an owner’s heirs might struggle to keep a company going or be forced to sell it. Companies often insure the lives of key employees whose loss would severely affect the business. Life insurance is also routinely used to fund “buy/sell” agreements which specify that the estate of the deceased will sell and the surviving partner(s) will buy the decedent’s interest in the company. This is especially important for a minority partner who could not afford to buy the shares of a deceased majority owner.
  3. Employed spouses close to retirement who haven’t fully funded their retirement plans. This is one that is commonly missed. If a surviving spouse depends upon several more years of retirement plan contributions from a partner’s salary in order to fund an adequate retirement, life insurance could make up the difference.
  4. People with large estates (over about $11 million per individual) in assets that can’t be easily liquidated. This need is rare, but we do see it occasionally. It may apply to farms or ranches where nearly 100% of the value of the estate is in land or a closely held business. In order for someone to pass the land or business on to heirs, it is important to have enough life insurance to cover estate taxes.

Those who most need insurance but can least afford it are often young couples with young children.

Typically these are the years when couples struggle to make ends meet with the demands of student loans, house payments, and the costs of a growing family. The good news is that term insurance is usually very inexpensive.

Life insurance is not a good investment.

In my 35-plus years of doing financial planning I have never, not once, seen anyone fully or partially retire on a life insurance investment.

One reason why is that a significant portion of the premiums in the early years of the policy go to paying out commissions. The loss is really never made up, and it takes years just to get back to even. This fact is cleverly hidden in the sales materials that lead you to believe you will never lose a dime, receive guaranteed returns, and get a tax-free income for life. These claims are true, but they are not the whole story.

Assessment

When making decisions about life insurance, remember that it is not meant as a source of income, but as a means to replace income or to pay taxes or debts. Used appropriately, life insurance is a valuable and affordable financial planning resource.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Contact: MarcinkoAdvisors@msn.com

https://www.crcpress.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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USA Trends in Disability

Adjusted-Life-Years

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure. 

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

 Contact: MarcinkoAdvisors@msn.com

  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

Insurers Can Break the Gordian Knot of Commoditization

How Insurers Can Break the Gordian Knot of Commoditization

[A Bain Infographic]

Insurance companies don’t have much contact with customers, making it hard to build loyalty.

But, this Bain research shows how insurers can build loyalty by focusing on ecosystem services.

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http://www.bain.com/publications/articles/insurance-loyalty-2017-infographic.aspx

***

https://www.crcpress.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

Traditional Reasons for a Medical Practice Valuation

Some economic reasons for a medical practice valuation 

By Dr. David Edward Marcinko MBA CMP™

http://www.CertifiedMedicalPlanner.org

The decision to sell, buy or merge a medical practice, while often financially driven, and is inherently an emotional one for these impact investors who went into the profession largely because of a deep seated zeal to help others.

Still, beyond impact investing musings, there are other economic reasons for a practice valuation that include changes in ownership, determining insurance coverage for a practice buy-sell agreement or upon a physician-owner’s death, organic growth meter, establishing stock options, or bringing in a new partner; etc.

Practice appraisals are also used for legal reasons such as divorce, bankruptcy, breach of contract and minority shareholder complaints. In 2002, the Financial Accounting Standards Board (FASB) issued rules that required certain intangible assets to be valued, such as goodwill. This may be important for practices seeking start-up, service segmentation extensions, or operational funding. Some other reasons for a medical practice appraisal, and the considerations that go along with them, are discussed here.

https://www.crcpress.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

Estate Planning

Medical practice valuation may be required for estate planning purposes. For a decedent physician with a gross estate of more than current in-place tax limits, his or her assets must be reported at fair market value on an estate tax return. If lifetime gifts of a medial practice business interest are made, it is generally wise to obtain an appraisal and attach it to the gift tax return.

Note that when a “closely-held” level of value (in contrast to “freely traded,” “marketable,” or “publicly traded” level) is sought, the valuation consultant may need to make adjustments to the results. There are inherent risks relative to the liquidity of investments in closely held, non-public companies (e.g., medical group practice) that are not relevant to the investment in companies whose shares are publicly traded (freely-traded). Investors in closely-held companies do not have the ability to dispose of an invested interest quickly if the situation is called for, and this relative lack of liquidity of ownership in a closely held company is accompanied by risks and costs associated with the selling of an interest said company (i.e., locating a buyer, negotiation of terms, advisor/broker fees, risk of exposure to the market, etc.). Conversely, investors in the stock market are most often able to sell their interest in a publicly traded company within hours and receive cash proceeds in a few days. Accordingly, a discount may be applicable to the value of a closely held company due to the inherent illiquidity of the investment. Such a discount is commonly referred to as a “discount for lack of marketability.”

Discount for lack of marketability is typically discussed in three categories: (1) transactions involving restricted stock of publicly traded companies; (2) private transactions of companies prior to their initial public offering (IPO); and, (3) an analysis and comparison of the price to earnings (P/E) ratios of acquisitions of public and private companies respectively published in the “Mergerstat Review Study.”\

With a non-controlling interest, in which the holder cannot solely authorize and cannot solely prevent corporate actions (in contrast to a controlling interest), a “discount for lack of control,” (DLOC), may be appropriate. In contrast, a control premium may be applicable to a controlling interest. A control premium is an increase to the pro rata share of the value of the business that reflects the impact on value inherent in the management and financial power that can be exercised by the holders of a control interest of the business (usually the majority holders). Conversely, a discount for lack of control or minority discount is the reduction from the pro rata share of the value of the business as a whole that reflects the impact on value of the absence or diminution of control that can be exercised by the holders of a subject interest.\

Several empirical studies have been done to attempt to quantify DLOC from its antithesis, control premiums. The studies include the Mergerstat Review, an annual series study of the premium paid by investors for controlling interest in publicly traded stock, and the Control Premium Study, a quarterly series study that compiles control premiums of publicly traded stocks by attempting to eliminate the possible distortion caused by speculation of a deal.

Human Skull

Buy-Sell Agreements

The ideal situation is for physician partners to put in place a buy-sell agreement when practice relationships are amicable. This establishes the terms for departure before they are required, and is akin to a prenuptial agreement in the marriage contract. Disagreements most often occur when a doctor leaves the group, often acrimoniously. Business operations of the practice decline, employee and partner morale suffers, feuding factions develop spilling over into the office, and the practice begins to implode creating a downward valuation spiral. And so, valuations should be done every 2-3 years, or as the economic circumstances of the practice change. Independence and credibility are provided, and emotional overtones are purged from the transaction.

Physician Partnership Disputes

Medical practice appraisals are often used in partnership disputes, such as breach-of-contract or departure issues. Obvious revenue declinations are not difficult to quantify. But, revenues may not immediately fall since certain Current Procedural Terminology [CPT®] code reimbursements may actually increase. Upon verification however, lost business may be camouflaged as the number of procedures performed, or number of patients decrease after partner departure.

https://www.crcpress.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

Divorce

Physicians getting divorced should get a practice appraisal, and either side may hire the appraiser, although occasionally the court will order an expert to provide a neutral valuation. Such valuations should be done in light of both court discovery rules and IRS requirements for closely held businesses. Generally, this requires the consideration of eight elements:

• Practice specialty and operating history
• Economic and healthcare industry condition
• Estimates of practice risks and future returns
• Book value and financial condition of the practice
• Practice future earning capacity
• Physician bonuses, dividends and distributions
• Intangible assets
• Comparable practice sales

https://www.crcpress.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

Assessment

Sometimes, the non-physician spouse may even desire a lifestyle analysis to evaluate the potential for under reported income, by a forensic accountant, or appraiser. A family law judge is often the final arbiter of different valuations, and because of varying state laws there may be 50 different nuances of what the practice is really worth.

MORE: Valuation

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, urls and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Contact: MarcinkoAdvisors@msn.com

***

Royal College of General Practitioners Recommends: “Comprehensive Financial Planning Strategies for Doctors and Advisors”

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Comprehensive Financial Planning Strategies for Doctors and Advisors

RECOMMENDATION

***

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Drawing on the expertise of multi-degreed doctors, and multi-certified financial advisors, Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] will shape the industry landscape for the next generation as the current ecosystem strives to keep pace.

Traditional generic products and sales-driven advice will yield to a new breed of deeply informed financial advisor or Certified Medical Planner™.

The profession is set to be transformed by “cognitive-disruptors” that will significantly impact the $2.8 trillion healthcare marketplace for those financial consultants serving this challenging sector. There will be winners and losers.

The text, which contains 24 chapters and champions healthcare providers while informing financial advisors, is divided into four sections compete with glossary of terms, Certified Medical Planner™ curriculum content, and related information sources.

cmp

http://www.CertifiedMedicalPlanner.org

1. For ALL medical providers and financial industry practitioners
2. For NEW medical providers and financial industry practitioners
3. For MID-CAREER medical providers and financial industry practitioners
4. For MATURE medical providers and financial industry practitioners

Using an engaging style, the book is filled with authoritative guidance and healthcare-centered discussions, providing the tools and techniques to create a personalized financial plan using professional advice.

Comprehensive coverage includes topics likes behavioral finance, modern portfolio theory, the capital asset pricing model, and arbitrage pricing theory; as well as insider insights on commercial real estate; high frequency trading platforms and robo-advisors; the Patriot and Sarbanes–Oxley Acts; hospital endowment fund management, ethical wills, giving, and legacy planning; and divorce and other special situations.

The result is a codified “must-have” book, for all health industry participants, and those seeking advice from the growing cadre of financial consultants and Certified Medical Planners™ who seek to “do well by doing good,” dispensing granular physician-centric financial advice:

Omnia pro medicus-clientis

  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

DR. DAVID EDWARD MARCINKO MBA CMP™

ISBN Number: 9781482240283

Number of pages: 744

Publisher: CRC Press

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Home Owner’s Inventory

More on Home Owner’s Insurance

By Rick Kahler CFP®

In my experience, the number-one reason people engage a financial planner is to sleep better at night. That doesn’t mean planners give advice on what kind of mattress to buy. The sleep aids we provide are more about peace of mind.

Example:

For example, you may be sleeping just fine, thank you, because your home and contents are covered by homeowners insurance. A planner might disturb your sleep by helping you look at whether you’re getting the most protection from that insurance.

The first is having a detailed listing of all your home’s contents, along with proofs of purchase and serial numbers. If a fire or flood destroys some possessions, the insurance company will need a detailed list of everything that was lost.

You have that list, right? It’s safely stored in a secure location other than your home, correct? And you update it annually? Congratulations, you are one of the .01% of homeowners that do!

Now, let’s be serious. There is a high probability you don’t do this and you are not losing sleep over it. Last time you checked, the amount of insurance to cover your home’s contents seemed so high you could replace everything in your house and have enough left over to furnish your neighbor’s place.

While you may be right about that, you could be terribly wrong.

Do you know for sure?

Maybe, if you don’t have expensive artwork or jewelry, you assume your ordinary belongings wouldn’t be that expensive to replace. This isn’t necessarily the case. If your refrigerator or washer and dryer are old enough to vote, you might be shocked at what it would cost to buy new ones today. Or think about what you might spend if you had to replace all the tools in your garage at once. How can you know the true cost of replacing all the contents in your home and that your insurance is high enough to replace them? By having an inventory of them and a reasonable idea of their current replacement cost.

If that isn’t enough to disturb your sleep, consider this: A fire doesn’t burn your house to the ground, but the contents in just a portion of it are destroyed. Now you really need that list. How are you going to prove that your $5,000 upscale mattress wasn’t a generic $800 version, or that your silverware was actually made from silver, not steel? Just having enough coverage won’t help you in this situation. This may leave you thinking maybe you should have a better plan than praying, “If there is a disaster to my home, please let it be a complete one.”

***

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The good news is there is an easy way to document everything in your home without having to make a detailed list with attached receipts and serial numbers. Simply get out your smartphone, walk through your house, and make a video recording of everything in it. In addition to filming furniture, fixtures, and wall hangings, be sure to open drawers, closets, and boxes. Capture the serial numbers of big ticket items and be sure to include the garage, all collections, china, silverware, and expensive antiques. Then store copies of the video in several places, including on the cloud and at least one flash drive located outside your home. Update your video once a year.

Assessment

If updating the contents portion of your insurance and making a video inventory don’t help you sleep better, maybe the problem really is your mattress. My advice is to do some research through Consumer Reports before you buy a new one—and be sure you add it to your home-contents video. 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Leading Causes of Unintentional Injury Death

Ages 15-24 in 2015

By http://www.MCOL.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™         Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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MARCINKO’s Upcoming WEBINARS from MentorHealth

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MentorHealth

MentorHealth, the sponsor of these ME-P webinars, is a comprehensive training source for healthcare professionals that is high on value, but not on cost. MentorHealth is the right training solution for physicians and healthcare professionals. With MentorHealth webinars, doctors can make the best use of time, talent and treasure to benefit their continuing professional education needs.

So, it is no wonder why they partnered up with the ME-P to produce these three exciting and timely Webinars, delivered by our own Publisher-in-Chief and Distinguished Professor David Edward Marcinko.

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A Medical Malpractice Trial From The Doctor’s POV

Even among the sciences, medicine occupies a special position. Its practitioners come into direct and intimate contact with people in their daily lives they are present at the critical transitional moments of existence.

For many people, they are the only contact with a world that otherwise stands at a forbidding distance. Often in pain, fearful of death, the sick have a special thirst for reassurance and vulnerability to belief.

When this trust is violated, whether rooted in factual substance or merely a conclusion lacking in reality, American jurisprudence offers several remedies with the core being civil litigation. We have personally witnessed a spectrum of reasons that prompts a patient to seek the counsel of an attorney.

Monday, February 6, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

Medical Workplace Violence Issues

Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control. Transporting patients,long waits for service,inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well.

A lack of staff training and the absence of violence prevention programming are also associated with the elevated risk of assault in hospitals.

Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk.

Wednesday, February 22, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

Romantic Patient Advances

Within the medical practice, clinic, hospital or university setting, faculty and supervisors exercise significant power and authority over others. Therefore, primary responsibility for maintaining high standards of conduct resides especially with those in faculty and supervisor positions.

Members of the medical faculty and staff, including graduate assistants, are prohibited from having “Amorous Relationships”with students over whom they have “Supervisory Responsibilities.” “Supervisory Responsibilities”are defined as teaching, evaluating, tutoring, advocating, counseling and/or advising duties performed currently and directly, whether within or outside the office, clinic or hospital setting by a faculty, staff member or graduate assistant, with respect to a medical, nursing or healthcare professional student.

Such responsibilities include the administration, provision or supervision of all academic, co-curricular or extra- curricular services and activities, opportunities, awards or benefits offered by or through the health entity or its personnel in their official capacity.

Monday, March 13, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

***

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WEBINAR NOTE: These are online interactive training courses using which, professionals from any part of the world have the opportunity to listen to and converse with some of the best-known experts in the HR Industry. These are offered in live & recorded format for single & multiple users (corporate plans ). Under recorded format each user gets unlimited access for six months. Corporate plans give you the best return on your investment as we do not have upper limit on the number of participants who can take part in webinar.

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Vital Financial Texts for Doctors

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PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET

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 Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™           Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

Front Matter with Foreword by Jason Dyken MD MBA

Enter the CMPs

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Money and Millennials?

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By TD Waterhouse

Savings Goals

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Family Caregivers Costs

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Out-of-Pocket Expenses

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graphoid112316

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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More on Private LTCI

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By http://www.MCOL.com

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Conclusion

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A Distracted Driving Video

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By Amanda Scherer

#PutDownthePhone 

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#PutDownthePhone – Canada Distracted Driving Video

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American Mortality Trends

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For 2000 – 2015

By http://www.MCOL.com

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Auto Rental Insurance Warnings!

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Rick Kahler MS CFPBy Rick Kahler MS CFP®

Doctors and many other travelers, including me, rarely purchase the insurance offered by the car rental company. The daily charge of $20-$40 is expensive, and the coverage often unnecessarily duplicates that provided by your credit cards and personal auto policy.

No Assumptions!

Before you assume you don’t need the rental insurance, though, it’s wise to take a closer look at where you’ll be traveling and whether your existing coverage will take care of all potential costs. There are times that taking the insurance can alleviate some nasty surprises.

The insurance can be a good idea if you rent a car outside of the US. As I’ve discovered first-hand, being in a country where roads double as paths for livestock, or one where people drive on the “wrong” side of the road, can increase your risk of minor accidents. While in some countries my US policy will cover damage, I don’t enjoy the prospect of spending countless frustrating hours as an intermediary between the foreign rental company and my US insurance carrier. I am happy to pay for the insurance and avoid heated arguments with the rental company over whether any damage was pre-existing, much less the hassle of negotiating repair bills.

It is important, though, to buy insurance carefully. On a recent trip to South Africa I rented a car and purchased the insurance online. When I returned the car, the agent said I had scratched the paint. Not wanting to waste time arguing, I pointed out I had purchased their insurance, thinking that was the end of the discussion. It wasn’t. The insurance offered on the site where I rented the car was a third party policy, not one offered by the car rental company. That meant the car rental company would charge me for the alleged damage. Then it was up to me to slug it out with the third party insurer. This left me taking pictures of the alleged damage, filling out damage reports, and arguing with the rental company agent. By the time I checked in for my flight home, I was tense and stressed: exactly what I intended to avoid by purchasing the insurance.

Beware loss-of-use Charges

Another instance where taking the rental company’s insurance can be beneficial is to avoid loss-of-use charges if you damage a rental vehicle. This is a fee the rental company charges to cover the income it loses while a vehicle is in the repair shop. Companies used to absorb this cost, but in recent years they have begun to charge consumers for it. The catch is that the coverage you have through your regular auto insurance or your credit card may not pay loss-of-use charges.

A few states (Alaska, Connecticut, Louisiana, Minnesota, New York, North Dakota, Rhode Island and Texas) mandate that insurers automatically pay loss-of-use claims. If you don’t live in one of these states, it’s a good idea to verify whether your credit card will cover these fees.

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DEM's Jag XJ-V8-L

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Visa and MasterCard Card?

According to AutoSlash.com, a website focused on helping consumers save money on car rentals, Visa does cover loss-of-use charges. However, it uses “fleet utilization logs” from the car rental company to verify the claim. Obtaining those records can take time and be a hassle.

MasterCard may cover some loss-of-use charges, but check the restrictions. American Express offers a separate car rental protection policy; the premium is likely to be cheaper than the premium charged by a car rental company.

Assessment

Never buying car rental insurance isn’t necessarily a wiser choice than always buying it. As the consumer, it’s up to you to do enough research to decide whether the insurance is a product you need.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

Life Expectancy Income Disparities

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By http://www.MCOL.com

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Conclusion

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Physician Characteristics Prone to Malpractice Claims

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By http://www.MCOL.com

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Conclusion

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The Importance of Talking about End-of-Life Care

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By Samantha Wanner  [VITAS Healthcare]

Watch this short animation to learn why advance directives are so important.

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What Do You Want?

It’s not easy, but the medical treatments you would want near the end of life need to be discussed with others. If you never bring up the topic and you were unexpectedly incapacitated and unable to speak for yourself, your medical wishes would never be known.

Despite the topic’s importance, only 27% of Americans report having talked with their families about end-of-life care. The best way to make your medical wishes known is to create an advance directive and share it with your family and your doctor.

Advance Directives

An advance directive is actually two legal documents that enable you to plan and communicate your end-of-life wishes.  When you create your advance directive, you are being proactive about your medical care and sparing your loved ones from having to make difficult medical decisions in a time of crisis.

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end_of_life_infographic

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Assessment

Don’t wait for a crisis. Create your advance directive, share copies with your loved ones and doctor and keep your copy in an accessible location others can find.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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 Harvard Medical School

Yale University

***

How Much Will a Ticket Raise My Car Insurance Rates?

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[By Dr. David E. Marcinko MBA]

Be careful out there!

A GMAC survey revealed that 1 in 5 drivers would not pass the written driver’s test if they took it today. And, getting a ticket will raise your car insurance rate, but by how much?

The Survey

The survey found that reckless driving triggers the highest hike — an average increase of 22 percent — yet many drivers aren’t even sure what constitute reckless driving?

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DEM in his 1990 Miata

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Reckless Driving

Depending on state laws, reckless driving can be defined as: driving over 80 mph, driving too fast for weather conditions, knowingly driving in a way that endangers others.

Conclusion

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The 5 – 100 Rule

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Don’t Fall Asleep on Variable Life Insurance Policies

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[By Dr. David E. Marcinko MBA CMP®]

http://www.CertifiedMedicalPlanner.org

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OK; I admit it. I held life insurance license for almost a decade. But, don’t hold that against me.

With any universal life insurance policy (and certainly all variable life policies), fluctuating rates of return, the actual timing of the premium payments, and potential internal policy changes by the insurance company, all contribute to results that will probably differ substantially from the original illustration. So, be sure to monitor them periodically.

The Rule

As a professor of health economics, I know the 5 – 100 Rule states that as a result of accounting for these elements, all initial projections of cash value beyond 5 years, will necessarily be 100 percent incorrect when compared to actuality.

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[Don’t Fall Asleep on Variable Life Insurance Policies]

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Assessment

A prudent physician policy owner should therefore keep on top of any changes and react accordingly.  If a policy owner ignores his/her policy for even 5 years, any adverse changes could be so drastic as to make rectifying them very costly.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Managing Risks as [Doctor] Parent

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Kids Create Substantial Risks for 

[Physician] Parents!

IKE

A Special ME-P Report

[By Ike Devji JD]

The number of ways that children are creating substantial risks for their [physician] parents is at an all-time high as many parents are unfortunately aware; as we begin 2016. Increased defensive planning or education by most parents despite increasingly common litigation for this vicarious liability has not increased commensurately with this risk.

Some of you believe that your kids are better behaved, smarter, and more sensible than those we hear about in the news. Such exposures are unpredictable and often arise from mundane activities you never imagined could be so serious.

Part of the discussion we encourage [physician] parents to have with their children includes a detailed explanation of the fact that you as a parents are personally financially and legally responsible (up to the level of criminal liability) for any harm, damage, or loss cause by their minor children.

Example:

In one example; a successful physician left town for the weekend with his wife, and his 17-year-old daughter threw a party at their home in a pattern repeated in nearly city in the country every weekend. Tragically, a teenager whom she had never met before crashed the party and died after he overdosed on drugs he brought with him resulting is a lawsuit against the young lady’s parents that sought damages in excess of three million dollars. Neither the young lady, nor her parents, nor anyone else in the tony private-school community of gated homes imagined that something like could happen in their nice neighborhood and the resulting claim was in excess of the limits of the homeowner’s liability policy the family had in place. Dozens of other parentally liability exposures seen over the years have come from much more mundane issues.

Negligent Supervision and Negligent Entrustment

Two ways liability is linked back to parents include negligent entrustment (providing the means or access to things or situations where some reasonably anticipatable harm occurs) and negligent supervision (basically infers that the harm would not have occurred if the minor had been properly supervised). This liability extends to others that have custody or are entrusted with supervision, so any guardian is at risk if the harm would have been prevented absent the access to the thing that created the harm and/or inadequate supervision. It also creates potential liability for you for the children of others you have custody of, even overnight for a slumber party.

Some Specific Recurring High Risk Issues:

  1. Automobiles: Minor children must be specifically named and insured on any vehicle they drive. Parents are generally liable for what minors do behind the wheel, permitted or not. If they are irresponsible drivers or if they take the car without permission you must take control of the car and treat it like a loaded weapon that’s pointed at everything you own and possibly their very own survival. Your high school senior cutting class with her friends and piling them into your car to go to Starbucks for “ditch day” is remarkably less charming when, for instance, she loses control of the vehicle on the way back to school and two of her passengers are critically injured as happened in one recent case. Thanks to commonly available and inexpensive software and tracking devices, not to mention the tracking software on your kid’s iPhones you can know where they and your vehicle are at all times.

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Waxed Jaguar

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  1. Access to Firearms and Other Dangerous Items: If you have guns in your home (or bows and arrows, ATVs, jet skis, a swimming pool, prescription drugs, or anything else that can be misused) you are legally and financially responsible for not only personal injury and property damage but in some states and fact patterns even criminal liability for the actions of your child and his friends. The cost of defense counsel alone could be financially fatal considering the possibility of someone getting injured or killed and the resulting liability and consequences.

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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The “Perfect” Holiday Gift for your Favorite Doctor – YES REALLY!

http://www.CertifiedMedicalPlanner.org

Now, is the perfect time of year to consider one, or all, of these texts as the perfect holiday gift for your favorite doctor, or allied health care professional.

Also, may be used as a client-prospecting tool for Financial Advisors, Wealth and Practice Managers, and CPAs, etc.

Smile, learn and prosper with iMBA in 2016.

***holiday_gift***

Last Generation Holiday Gift for MDs

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RECENT BOOKS FROM iMBA, Inc.

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)      

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14 Smart Things to Consider for Your 2015 Year-End Financial Checklist

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Be Ready for a Great 2016!

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[By Patrick Bourbon CFA]

1. IRA – 401(k) / 403(b) retirement accounts – Are you on track for a comfortable retirement?   You could increase the funding of your IRA and company retirement plan like a 401(k) or 403(b) accounts.   401(k) and 403(b) accounts allow individuals younger than 50 to contribute $18,000 each year, and individuals 50 and older to contribute $24,000. Some plans allow workers to make additional contributions of after-tax money.

For those under 50, the maximum is $53,000 for 2015. Doing so does not reduce your taxable income, but taxes are deferred on any earnings that the after-tax money makes. Later, some people roll these contributions into a Roth IRA, tax-free so the money would then grow tax-free.   Traditional and Roth IRAs allow individuals younger than 50 to contribute $5,500 each year and individuals 50 and older to contribute $6,500. Even if you earn too much to contribute to a Roth IRA directly, you can open a traditional nondeductible IRA and convert it to a Roth; there is no income limit on traditional nondeductible IRAs or conversions.    Returns generated in IRA and 401(k) / 403(b) accounts compound tax-free over their entire life.

2. Start tax planning! It’s not too early to think about taxes. Asset location & Tax efficiency   Review your taxable and non-taxable accounts to ensure they are optimized for tax efficiency. If you have foreign bank accounts, make sure you comply with FATCA and FBAR (forms FinCEN 114, 8938, 8621…). If you have forgotten, you may look into the Offshore Voluntary Disclosure Program (OVDP) or Streamlined procedures.

3. Portfolio rebalancing   Make sure you have rebalanced your portfolios to keep them in line with your goals, time horizon and risk tolerance. The market movements this summer may have thrown off your portfolio balance between stocks and bonds.   David Swensen, the Chief Investment Officer at the Yale Endowment, performed an analysis that showed optimal rebalancing could add 0.4% to your annual return.

4. Harvest your capital losses   Maybe it is time to sell some funds, ETF, stocks to generate some capital losses?   Tax-loss harvesting is a method of reducing your taxes by selling an investment that is trading at a significant loss.  Find out if you have any loss carryovers from prior years to be applied against capital gains (from sale of funds, ETF, stocks… in your taxable/brokerage accounts). If your current year’s capital losses exceed your capital gains, you have a net capital loss. You can use up to $3,000 of that loss ($1,500 if you are married filing separately) to offset other taxable income such as your salaries, wages, interest and dividends. If the capital loss is more than $3,000, you can carry over the excess and apply it against capital gains next year.

5. Emergency fund   Don’t forget to establish or tune up your emergency fund. This is a good time to set aside money for next year’s cash needs. It is an account that is used to set aside funds to be used in an emergency, such as the loss of a job, an illness or a major expense.

6. Review your insurance policies   Do you have a life, disability and long term care insurance? Make sure you and your loved ones are well protected if something happens to you. Your life may have changed (birth, marriage …). If you do have enough coverage it is also a good time simply to review the different types of coverage you have. Whole life or Variable Universal Life may help you reduce your taxes.

7. Health Spending Account   Did you maximize your contribution to your healthcare HSA? The interest and earnings in this account are tax free! The maximum contribution for 2015 is $3,350 for an individual and $6,650 for a family ($1,000 catch-up over 55). The contributions are tax deductible and withdraws are non-taxable if they are used for medical expenses. Over the age of 65 you can withdraw funds at your ordinary tax rate (if the distribution is not used for unreimbursed medical expenses). Fidelity estimates that a 65-year-old couple retiring in 2014 will need $220,000 for health care costs in retirement, in addition to expenses covered by Medicare. The HSA can be a great source of tax-free money to pay those bills.

8. Required Minimum Distribution   If you are age 70.5 or older, remember to take your required minimum distribution to avoid a potential 50% penalty.

9. 529 Plan   Did you contribute to your 529 educational plan for your child/children?   You can contribute $14,000 per year (annual limit) for each parent or you can pre-fund in a single instance up to five years’ worth of contributions, up to $70,000 (5 x $14,000). Together, that means a married couple can open a 529 plan with $140,000.   Money saved in a 529 plan grows tax-free when used for eligible educational expenses, and some states have additional tax benefits for residents who contribute to a plan in that state.

10. Determine your net worth   Add up what you own (home, car, savings, investments…) and subtract what you owe (mortgage, loans, credit cards, …).   This will allow you to track your progress year to year. It may also give you some incentive to save more and create a better budget for next year.

11. Check your credit score Go to annualcreditreport.com and request a free credit report from each of the three nationwide credit reporting agencies. You’re entitled to one free report from each agency every 12 months.

12. Check your beneficiaries   You can check the beneficiaries on your retirement accounts or insurance policies at any time, but it’s a good idea to do this at least annually.

13. Update your estate plan   New baby? Newly married or divorced? Make sure your beneficiary designations reflect any changes. Don’t yet have an estate plan? Make that a new year’s resolution!  Estate planning may include updating or establishing a “will” or trust that can help avoid public disclosure of assets in probate.

14. Spending and automated savings – You want to look ahead   Did you review your budget and set up automated savings?   You may have started the year with a clear budget, but did you to stick to it?    Fall can be a good time of the year for your financial checkup and to reflect on your spending and develop a budget for next year.  It is also a very good time to put whatever you can on automatic. Bills, recurring payments, even savings—the more you can put on auto pay now, the easier your financial life will be next year.   With this year’s facts and figures in front of you, it will be easier to plan and prioritize your expenditures for next year.

Assessment

198174

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

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“BY DOCTORS – FOR DOCTORS – PEER REVIEWED – FIDUCIARY FOCUSED

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ME-P Health Economics, Financial Planning & Investing, Medical Practice, Risk Management and Insurance Textbooksfor Doctors and Advisors

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[HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET]

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Dr. David Edward Marcinko, editor-in-chief, is a next-generation apostle of Nobel Laureate Kenneth Joseph Arrow, PhD, as a health-care economist, insurance advisor, financial advisor, risk manager, and board-certified surgeon from Temple University in Philadelphia. In the past, he edited eight practice-management books, three medical textbooks and manuals in four languages, five financial planning yearbooks, dozens of interactive CD-ROMs, and three comprehensive health-care administration dictionaries. Internationally recognized for his clinical work, he is a distinguished visiting professor of surgery and a recipient of an honorary Bachelor of Medicine–Bachelor of Surgery (MBBS) degree from Marien Hospital in Aachen, Germany. He provides litigation support and expert witness testimony in state and federal court, with medical publications archived in the Library of Congress and the Library of Medicine at the National Institutes of Health.

***

About SAFEBEYOND and Digital Estate Assets

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[By Staff Reporters]

Digital Messages for Loved Ones From Beyond the Grave

***

No one wants to die. Even people who want to go to heaven don’t want to die to get there.
And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because death is very likely the single best invention of life.
It is life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away.
Sorry to be so dramatic, but it is quite true.
[Steve Jobs]
***

skeleton-jpeg

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Death in the Digital Age

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[What it is –  How it works?]

Life Continues when you pass away

> Ensure your presence – be there when it counts
> Leave messages for your loved ones – for FREE !
> Store for FREE digital assets in designated safes

Start Your Journey

Learn more: Death in the Digital Age

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  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™ Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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How Companies Value Body Parts?

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A ProPublica Price Check
By Lena Groeger and Michael Grabell
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        ProPublica

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Injured workers are entitled to compensation for permanent disabilities under state workers’ comp laws.

More:

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body

Price Check: How Companies Value Body Parts

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But – Texas has long allowed companies to opt out and write their own benefit plans.

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Assessment

Benefits for the same body part can differ dramatically depending on which company you work for.

Related Story »

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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[HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET]

Product DetailsProduct DetailsProduct Details

[Mike Stahl PhD MBA] *** [Foreword Dr.Mata MD CIS] *** [Dr. Getzen PhD]

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Is Social Security a Rip-Off?

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 “WHERE DID THAT MONEY GO?”

Rick Kahler MS CFP

By Rick Kahler MS CFP http://www.KahlerFinancial.com

A reader recently forwarded me an email that began, “Who died before they collected Social Security?” It asked how many people only collected a small portion of what they paid into Social Security because they, or a spouse, died soon after retiring. Then it screamed in all caps, “WHERE DID THAT MONEY GO?”

Introduction

The rest of the piece, after calculations of how much an average person pays into Social Security, suggested the government is short-changing those who die before they receive back in benefits everything they paid in. It claimed that Social Security premiums were to have been put in a “locked box,” that instead they were loaned to the US Treasury, and that Social Security is therefore running out of money.

The many misstatements and errors in this piece highlight a common misunderstanding about the Social Security insurance program. It is not an income tax. Nor; is it actually insurance – or an investment!

Example:

If you earn a salary, you are familiar with the FICA (Federal Insurance Contributions Act) tax that, like federal income tax, is withheld from your paycheck. Everyone must pay it on their first $118,500 of earned income. The current rate for employees is 7.65% (6.2% for Social Security and 1.45% for Medicare), an amount matched by employers. The self-employed pay 15.3%.

FICA payments are not an income tax, but are insurance premiums used to fund the Social Security program. It is a direct transfer program, meaning the money coming into the plan is immediately paid out to retired or disabled participants. The proceeds are not directly deposited to the general account to be spent however Congress wishes.

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train station

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The Tipping Point?

However, in the past, because more money came into Social Security than was paid out in benefits, the program did loan the excess to the US Treasury Department (receiving bonds in return) to fund the operating expenses of the federal government. The program built up a significant investment in US Treasuries until 2010, when it began paying more out in benefits than it receives from participants. The program is now beginning to redeem the bonds. Officials project that in 2033 the program will have depleted the investment in bonds and will need to either adjust benefits, raise the payroll tax, or borrow from the US Treasury.

What it’s not?

  • Social Security isn’t insurance in the sense that insurance pays only when a person suffers a loss. With Social Security, everyone who has worked for more than 10 years will collect a monthly income upon retirement.
  • SS is also not a savings account or a retirement plan like an IRA or a 401(k). It is not set aside in a segregated account with your name on it. The money you pay in doesn’t accumulate or earn interest. If Social Security were designed as a retirement plan that would refund what participants pay in, plus some type of return, the payroll tax would far surpass 15.3%.

What it is?

So if Social Security isn’t an income tax, an insurance plan, or a retirement plan, what is it? It’s an annuity. Participants are guaranteed a monthly income for life; a lesser amount if they retire at age 62 or a higher amount if they wait until full retirement age or later.

Like any annuity, when you die the payments stop. The amount of the payroll tax/premium incorporates actuarial estimates of how many people will die before the average mortality age or live long past it. The money paid in by people who die early is not “missing.”

Assessment

If you have questions about Social Security, you can find detailed information at www.socialsecurity.gov. It’s a much more reliable source than anonymous forwarded emails.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™


“The medical education system is grueling and designed to produce excellence in medical knowledge and patient care. What it doesn’t prepare us for is the slings and arrows that come our way once we actually start practicing medicine. Successfully avoiding these land mines can make all the difference in the world when it comes to having a fulfilling practice. Given the importance of risk management and mitigation, you would think these subjects would be front and center in both medical school and residency – ‘they aren’t.’

Thankfully, the brain trust over at iMBA Inc., has compiled this comprehensive guide designed to help you navigate these mine fields so that you can focus on what really matters – patient care.”

 Dennis Bethel MD [Emergency Medicine Physician]

 

The Disability Insurance Disconnect

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An Infographic

By DisabilityCanHappen.org

Think you’re invincible? You’re not alone. Most working Americans, and even some physicians, drastically underestimate the odds of experiencing an income-interrupting injury or illness that will last an extended period of time.

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acccidents

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Now consider that more than one in four of today’s 20-year-olds will have their income interrupted by a disability before they retire. That’s because some top causes of long-term disabilities aren’t catastrophic accidents, but common, everyday health issues like back pain, heart disease, arthritis, cancer, even pregnancy.

Yet; no matter how healthy, everybody has a risk that is too high to ignore.

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Ankle-Leg Trauma

[Copyright David Edward Marcinko and iMBA Inc., All rights reserved. USA]

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Assessment

You’ve probably protected your most prized possessions from damages and accidents, but what about the resource that makes all others possible — your paycheck? Learn more about the causes of disability and how you can defend your income from them at DisabilityCanHappen.org

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disability

[Click to Enlarge]

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM) 

Annuities and their Associated Costs

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Another Look at Expenses

By Rick Kahler MS CFP

Rick Kahler MS CFPAnnuities are popular investments; almost every new physician or other client I see has one. Part of any investment adviser’s due diligence is to understand the history and intentions of the investments in a portfolio.

When I ask why someone purchased an annuity, the most common responses are: “We didn’t have to pay any fees or commissions.” “There are no ongoing expenses.” “All my money is working for me.” “The principal is guaranteed.”

Warning … Warning!

Any time you read or hear “no fees,” “no commissions,” “no expenses,” “free,” or “guaranteed” used in conjunction with an investment, it’s a red flag. All investments, including annuities, have costs associated with them. You need to ask some probing questions about those costs before proceeding.

Fixed Annuity Example

Let’s look at the costs for one popular type of annuity, the fixed annuity. This simply gives you a stated rate of return that often can change annually, similar to a bank certificate of deposit.

Suppose Investor A is sold a fixed annuity with a guaranteed return of 3.5%. Investor B invests her money in a plain vanilla portfolio of mutual funds holding 60% stocks and 40% bonds, which has a long-term projected return of 6%.

The insurance company selling the annuity must earn enough of a return on Investor A’s money to cover their expenses, pay commissions, and return something to Investor A. There is no magic formula on how that’s done. The insurance company invests the money in the same asset classes available to anyone. For the sake of this example, it’s reasonable to assume the insurance company would hold the same 60/40 portfolio as Investor B.

The annuity incurs internal costs for administration, managing the money, insuring the return of principal, and commissions paid to salespeople. While these vary somewhat from company to company, a cost of 2.5% isn’t unreasonable.

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business-insurance

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If the company earns 6% and deducts 1% to recoup the upfront commission paid to the salesperson, 1.0% for management costs, and 0.5% for administrative fees, they pay out the remainder as a “fixed” return of 3.5%. Investor A only sees that 3.5% fixed return. If Investor A wants out of the policy before the cost of the up-front commission is fully recovered (usually 4 to 15 years), he will also incur a “surrender penalty” that is approximately equal to the remaining amount of commission paid to the broker selling the policy.

Investor B’s 60/40 portfolio will have the same 6% gross return as the insurance company’s portfolio. If Investor B purchases index funds from a company like Vanguard, her costs could be as low as 0.10%, leaving her a return of 5.9%.

Suppose Investors A and B each accumulates $1 million in retirement funds. The difference between Investor A’s guaranteed 3.5% return and Investor B’s average and unguaranteed 5.9% return is potentially an extra $2,000 a month in retirement income. Guarantees come with a cost.

Why Bother?

Given these numbers, you may wonder why anyone would purchase a fixed annuity? Why bother?

One reason is that many buyers don’t have the confidence that they can invest the money wisely or the stomach to watch the portfolio’s inevitable peaks and valleys.

Another reason is that most buyers don’t fully understand the costs.

Assessment

Unlike stocks, bonds, and mutual funds, most annuities are sold, not bought. I have never had a new client who independently purchased a no-load annuity. The annuities I typically see were sold by someone who received a commission. Commissions are not inherently bad, but in most cases they do inherently create a conflict of interest.

There are always fees associated with any investment. In my experience, the less transparent those fees are, the higher they are.

More:

Even More:

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

Do You Have These Horrible Investments in Your Portfolio?

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Beware Structured Products and Annuities

By Michael Zhuang

Principal of MZ Capital Management

[Contributor to Morningstar and Physicians Practice]

Recently, I had a new client. As part of the on-boarding process, I examined her old portfolio and found some things I didn’t recognize.

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Cusip Symbol Description Return
25190A104 N/A Deutsche Bk AG London BRH Ret Opt Secs Lkd Ishare MSCI Mexico Capped -21.15%
25190A203 N/A Deutsche Bk AG London BRH Ret Opt Secs Lkd Ishare Euro STOXX 50 Idx -26.60%
90273L815 N/A USB AG London BRH Notes Five 15 -22.30%

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Structured Products

What these products have in common is they don’t have a ticker symbol, meaning they are not publicly traded securities. They also have weird descriptions and they all lost a lot of money.

I called Fidelity (my custodian firm) to find out what they were and how I could get rid of them. I was told that they are structured products created by the bank(s) to shove into their clients’ accounts (The managing “advisor” works for UBS).

That rang a bell! My very first job was a financial engineer for a French bank – Societe Generale. My job was to create structured products that had appealing features and made the bank a lot of profits. Now, that I finally see them in action from, the client side of the equation; I am not proud.

Annuities

But, these structured products are not nearly as bad as an Allianz annuity that a client bought from an insurance agent “friend” a while back. He bought the annuity eleven years ago for $150-k, and over the years, saw it steadily increases in value to $189-k.

Then, there came a time when he needed the money. So, he called to cash out and was shocked to discover there was a $62-k surrender charge. In other words, he was able to get $127-k back. I subsequently called Allianz on his behalf to find out when the surrender charge would end and was told there was no end! In other words, there would always be a huge surrender charge.

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insurance

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What the Heck!

So, what in the heck does that value of $189-k really mean, when every time you want to take out the “value”, you have to pay a hefty ⅓ surrender charge?

Alas, Allianz explained the client can annuitize and take the amount out over ten years (or twenty years,) during which no interest will be accrued.  So, they will take your principal -or- they will take your interest, either way they screw you.

More:

Assessment 

Do you have structured products or annuities in your portfolio? Don’t know – Find out, now!

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

On Physicians and Automobile Leases

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Advantages, Disadvantages and Types

[By Dr. David Edward Marcinko MBA CMP™]

Dr. Marcinko 1972 VetteThe Rites of Spring!

As a former licensed state insurance agent, and financial advisor, I know that leasing a car may have advantages to a physician – and others – such as convenient maintenance, low down and monthly payments, no resale responsibility, and tax savings since you pay sales tax on the lease portion rather than the purchase price of the car.

It might also be worthwhile if the after tax borrowing cost of a home equity loan is less than the lease financing rate.

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Spring 2011 - NIH

[First Days of Spring 2017]

May Day Weekend 2011 [Dr. David E. Marcinko MBA]

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Types of Leases

There are two major types of leases: open and closed ended. In the former type, if the car is worth more than the set price upon expiration of the lease, you are responsible for the underage or coverage. In the more advantages later type, the responsibility of the value of the car is shifted to the leasing company. Other tips on care leasing include:

  • Inform the lessor how you want the auto equipped; do not accept unwanted options.
  • Obtain all delivery, and other, charges in advance, including down payment, security.
  • Deposit, registration fees, interest rates, residual value, rebates and all taxes (sales, personal property, use and gross receipt).
  • Know the capitalized cost (selling price) of the car
  • Know annual mileage limits, usually 15-18,000 miles, and all excess use charges.
  • Avoid maintenance and service contracts, and arrange for your own insurance.
  • Understand that terms, such as money factor, or interest factor, may be used instead of the term interest rate. In this case, simply multiple the rate by 24 for an estimate of the true interest rate involved.
  • Read the contract and understand all penalties, especially for premature or late termination, purchase or return terms, and consequences of theft.
  • Check the lease terms through an independent company, such as First National Lease Systems.

Rough Rules of Thumb

A rough rule of thumb to determine whether to buy or lease involves multiplying all the payments required by the number of months you will have to pay, and add the down payment to yield the total amount of the purchase. Then, multiply the lease payment by the number of months, and add required up-front costs, as well as residual value (end of lease buyout cost), to determine the total amount to lease. Compare the two figures to determine the most economical deal.

Typically, a cash deal is less expensive in the long run, providing a higher after tax rate of return is not available, as an alternate investment, for the funds.

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Jaguar Touring sedan XJ-V8-LWB***

Dis-Advantages

But, there are dis-advantages to auto leasing, too!

Perhaps the worse reason to lease a car is to drive one that you could not otherwise afford to drive. This is because most low monthly payments are only composed of two portions: interest on the note and the prorated cost of auto depreciation. No money is applied to ownership of the vehicle.

Assessment

Finally, beware Spring-Fever and do not likely buy “gap” insurance to cover the difference between what your auto insurer would pay if your car was totaled, and what you would owe the leasing firm. It’s usually too expensive and the risk is minimal.

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

***

Seeking Peer Reviewers for New Medical Risk Management Text Book

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Our Newest Text Book-in-Production

http://www.CertifiedMedicalPlanner.org

[By Ann Miller RN MHA]

CMP logo

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RISK MANAGEMENT, LIABILITY INSURANCE, AND ASSET PROTECTION STRATEGIES FOR DOCTOR AND ADVISORS

[Best Practices from Leading Consultants and Certified Medical Planners™]

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Skills Needed

If you are a physician, nurse, accountant, attorney, medical risk manager or healthcare executive, we need you.

Form below or contact us for details to peer-review, etc. MarcinkoAdvisors@msn.com

Assessment

Channel Surfing the ME-P

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

[Companion Text Book]

 

What’s New with Renter’s Insurance?

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Affordable and Ideal for Future Physicians

[By Thomas A. Mudlowney MSFS CLU AIF® CFP® CMP™]

http://www.SavantCapital.com

Muldowney

Renters insurance can protect you from damage caused by weather events like wind, rain, snow or lightning, as well as fire, vandalism or theft.

Some policies also include liability protection. This would be valuable if someone got injured in your home and sued you; doctor’s are at high-risk for this sort of liability.

Costs

Renters insurance tends to be cheap. For a low payment, usually annually, you can often get replacement coverage for your belongings and living expenses if you are displaced.

This means that you can get money to replace a damaged or stolen item as well as paying for a hotel or alternative rent if you are forced to leave your home because of damage.

Assessment

Renter’s insurance may be ideal for medical residents, fellows and interns etc; as they travel around the country for education and post-graduate training; etc.

Renter's Insurance

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

Beware Dubious Insurance Policies for Doctors

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Careful Consideration is Required

[By Dr. David Edward Marcinko MBA MBBS] http://www.CertifiedMedicalPlanner.org

Dr. David E. Marcinko MBAThe following insurance policies should be carefully considered before purchase, since they may be unnecessary, too expensive, provide only minimal benefits, or be duplicated in your other policies.

The Culprits

Disclosure: I was a licensed insurance agent for more than a decade.

So, the culprits include: credit life or home mortgage insurance  (decreasing term), life insurance for children, accident policies for students, hospital indemnity policies, dread disease insurance, credit card insurance, pet health insurance, life insurance for the elderly, funeral insurance, flight insurance, pre-paid legal insurance and most extended warranties on automobiles, televisions, stereos, home computers; other gadgets and the like.

New wave Health 2.0 culprits include: terrorist insurance, cyber security insurance and reputation management policies.

Assessment

On the other hand, the following types of coverage may be important, for some medical professionals, and in selected cases: trip cancellation insurance, termite insurance and flood and earthquake insurance.

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***

Insurance

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

*** Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

On Additional Disability Insurance Taxation for Medical Executives

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Additional Disability Insurance for Practice Owners and Physician Executives 

By Perry D’Alessio CPA

perry-dalessio-cpa

Some medical clinics, hospitals, health care employers and other business entities may offer disability insurance to their employees on a group basis as part of an employee benefit program. This is a good thing.

The expense for this coverage is typically deducted as an ordinary and necessary expense by the employer entity.

Additional DI

However, many entities also purchase additional disability insurance for the owners and executives; etc. This additional disability insurance expense should not be deducted on the entity’s tax return for two reasons.

  1. First, it would probably be considered a discriminatory benefit to the owners and, therefore, not be allowed as a deduction anyway.
  2. Second, and more importantly, when a person becomes disabled and qualifies for disability benefits whose premiums have been deducted as a business expense by the entity, the disability insurance proceeds are considered taxable income to the person receiving them.

A Catastrophe

This can be personally catastrophic since disability insurance covers only a portion (approximately 60 percent) of regular earnings. The coverage was designed to be paid on an after tax basis. The benefits would be tax free to the beneficiary and would be close to the disabled person’s net take home pay before being disabled.

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BandagesX

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Assessment

Here is one of those instances where the traditional tax planning thought process is overridden by a long term (potential) tax cost / benefit decision.

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

How to Protect Your Vehicle During Long-Term Storage

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Hibernation and Your Luxury Car

silver balls on snow with snowfall - blue heaven

[By Dr. David Edward Marcinko MBA]

[By Nalley-Lexus Roswell, GA]

An ME-P Special Winter Report

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DEM at Univ of Pittsburgh

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I was speaking at a seminar in Pittsburgh PA recently, and I realized how cold it gets there. Moreover, I just learned of an impeding Christmas Eve storm this year.

Hence this ME-P.

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Many car drivers use their vehicle every day, but from time to time – and during the winter – it’s necessary to consider long-term storage. Some physicians however, don’t use their car over the winter months, or need to leave the country for a while on vacation, and this means that it’s time to store away that luxury automobile.

The Storage Steps:

So, if you need to put your car into long-term storage, use the following tips to make sure that your vehicle remains in excellent working order.

Find a good place to store the car

You probably won’t want to leave your car exposed to the elements if you’re not going to use it. Find a sheltered place to keep the car like a garage, shed, or outhouse that can protect the vehicle from the rain. Search local ads for reasonably priced accommodation if you don’t have your own garage. If there’s nothing available, invest in a high-quality weatherproof car cover which will at least protect your car from the weather.

Thoroughly clean the car

Dirt and debris on your car may cause damage, so give the car a thorough clean before storing it. Remove bird droppings or tree sap, which can both damage paint work, and get rid of mud or oil from the wheels and fenders. Apply a good quality wax or sealant to the exterior, as this will protect the paint from any dirt or dust that accumulates in storage.

Fill up your gas tank

Some doctors and other drivers make the mistake of emptying the gas tank when they put their cars into storage.

Follow your car dealer recommendations but use premium if you can. Topping off your gas tank stops moisture from accumulating inside the tank, and will also make sure the seals don’t dry out. Gas is cheap currently, so do not forget this step.

And, consider adding a fuel stabilizer, which may protect the engine from rust and ensure the fuel doesn’t deteriorate [debatable issue].

Charge the battery

Even though you aren’t going to drive the car for a while, it’s a good idea to make sure the battery charge doesn’t run out. If you can’t get somebody to come and visit the car, charge and disconnect the battery completely.

Otherwise, you can buy a battery tender [not trickle charger] that plugs into the electricity supply and continuously gently charges the battery. I have one for my vintage 2000 Jaguar XJ-V8-XL and they are great.

Inflate your tires

It’s always a good idea to inflate your tires to the manufacturer’s recommended pressure. While the car is stationary, the weight of the vehicle pressing on the tires can cause damage, particularly in cold temperatures.

Another solution to consider is removing all four wheels and jacking the car up on all four corners. This is hard work, but it’s worth it for cars that will be stored for a month or more.

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My Jaguar XJ-V8

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My Jaguar***

JaguarBoot

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Protect the car from pests

Cars give rats and mice lots of places to hide and keep warm and these creatures can cause damage if they gnaw at wires. Plug obvious places (like the exhaust pipe) where rodents could get in, and consider laying traps or poison. Make sure you close all the car windows tightly and remove any food or trash from the car that may attract pests.

Don’t cancel your insurance

Your car is a valuable asset. Even though it’s not on the road, it could still suffer damage in storage. If you cancel your insurance, you may have to pay more when you decide to start driving it again. Talk to your insurance company about the options available to you.

More:

Assessment

It’s important to prepare your car properly for long-term storage. Your vehicle is probably worth a lot of money, so protect your investment and make sure your car is just the way you left it when you come back.

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Product Details

***

The PP-ACA [Game Changer for Health Care Financing]

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The fuel which fires the self-funded engine of employee health and welfare plans

[By William Rusteberg]

A SPECIAL ME-P REPORT

PP-ACA Taxes for 2015

Introduction

The Affordable Care Act (ACA) has had a fundamental impact on health care financing in this country. It has effectively provided added incentives for plan sponsors to consider modified self-funding arrangements for their employee health and welfare plans in lieu of fully-insured plans. The advantages of doing so are clear.

Health care costs continue to rise despite passage of the ACA. While the ACA addresses many aspects surrounding the delivery of health care, it does little or nothing to identify and offer solutions to constantly rising costs. On the contrary, many ACA provisions are driving cost up.

Plan sponsors have a choice between assuming a passive strategy with little or no control through fully-insured funding arrangements or the alternative. The alternative affords more control and less cost. It rewards innovation and creativity. It utilizes all the tools a risk manager requires as part of his trade.

More plan sponsors are turning to self-funding in response to the ACA.

Product DetailsProduct DetailsProduct Details

The Market Leading Up To the ACA

The financial and benefit advantages of self-funded health and welfare plans became evident with the passage of the Employee Retirement Income Security Act (ERISA) of 1974. Dramatic growth in self-funding occurred when ERISA preemption, clarified legal environment, rising health care costs, widespread use of risk management, the cost containment movement (Managed Care) and high interest rates were all being experienced.

Fully insured plans continued to be a large segment of the market, especially among smaller employer groups. However, a significant number larger groups remaining fully-insured moved towards minimum premium plans, or plans which were rated retrospectively on an administration cost plus basis. This approach among larger employers mirrored self-funding advantages to some degree, however the insurance companies ultimately bore the entire risk and maintained full control over plan expenses and claim costs. These types of fully-insured funding arrangements were the carrier’s response to the growing phenomenon and popularity of self-funding.

With the advent of managed care in the early 1980’s, the entire dynamics of health care delivery changed. Third party intermediaries became an important element in the health care equation.  These intermediaries performed valuable services in cost containment which initially had a positive impact on health care benefits and costs to the advantage of both the consumer and payer.

Carefully selected health care givers were aggregated into exclusive networks of preferred providers. The theory behind the scheme was valid; selected health care providers would agree to discount their usual fees for service in return for more patients. Steerage was accomplished by rewarding consumers with improved benefits when seeking care through these “preferred” providers. All worked well, with health care costs temporarily softening.

Consumers no longer had to satisfy deductibles to receive most care. Instead, co-pays as low as $10 to see a doctor became the norm. Prescription drugs benefits, now accounting for as much as 25% of a plan’s total spend in today’s market, were easily accessed by paying a small co-pay. Access to care became easier and affordable. Utilization increased.

With increased utilization, consumers began to demand more doctors and hospitals to be added to networks. Over time, just about every doctor and hospital in a given geographic area were all on networks. Competition among insurance companies hinged upon who had the broadest network. The pressure to add medical providers became intense. A seller’s market for medical providers became an established trend that continues to this day. Preferred Provider Organizations (PPO) thus gained the advantage of a seller’s market they created while end users became subject to a weakened and impotent buyer’s market.

Over time PPO’s lost their core characteristic. There was no longer any steerage. The scheme that worked so well in the beginning began to unravel. Costs increased dramatically, year after year.

Plan sponsors failed to recognize the slow progression towards failure of managed care. They continued to subscribe to the theory behind managed care based upon reliance of advice and guidance from “trusted” insurance companies, third party administrators, agents, brokers and insurance experts posing as consultants. Unfortunately, and unknown to plan sponsors, these trusted advisors maintained a vested interest in continuing the scheme. A de facto conspiracy of third party intermediaries formed. The conspiracy continues to this day. It is one of the health care industry’s best kept secrets.

No one can dispute that managed care has failed. Health care costs have continued to increase at double digits year after year, becoming unaffordable for most Americans. Plan Sponsors, concerned and desperate for answers and solutions continue to rely on advice and guidance from third party intermediaries whose vested interests is in maintaining the status quo. To more and more employers health care costs can mean the difference between profit and loss.

The perception that private enterprise has failed in reining in costs is widespread. Private and public budgets can no longer sustain the current level of spending, let alone future health care inflation.

Pointing to failure of the market to keep medical costs affordable, many looked to government for solutions.

Product DetailsProduct Details

The Affordable Care Act & The Impact on Health Care Financing

With the passage of the ACA, we find ourselves in a dynamic and somewhat unpredictable market, particularly the political dimensions as the ACA continues to evolve. However, we do know to a large degree, how the market will be affected and what plan sponsors must do to maintain affordable health care for their employees.

The ACA’s most significant impact centers upon how group medical plans will be financially structured for years to come. The ACA effectively makes fully-insured plans less attractive while providing advantages to self-funded arrangements. Carriers have come to recognize this and are moving to increase their market share. Currently the BUCA’s (Blue Cross, United HealthCare, Cigna and Aetna) administer more self-funded business than fully-insured business on their respective large group blocks of business. They are now actively expanding this funding method to the small group market.

The ACA’s universal intent is to provide government mandated means for affordable health care for all Americans. However, the ACA as it is now written does not address cost of care nor does it mandate parameters around which cost of care is to be based. Instead, the ACA mandates rigid requirements that address what insurance companies can offer in the way of benefits, as well as profit and operating margins. There is nothing in the Act that addresses what medical providers charge and what they are paid.

These far reaching rules have dramatically impacted fully-insured plans. All ACA mandates apply to these plans, whereas self-funded plans are exempt from many of them. Fully-insured plans are effectively handcuffed affording little leeway to be proactive and innovative in plan design and cost basis. Unlike self-funded plans, little can be done to control costs under fully insured plans.

An example of a reverse outcome of good intentions pertains to the Minimum Loss Ratio mandate required of all fully insured plans but exempted under self-funded plans. Fully insured large groups are required to maintain a loss ratio wherein health care claims cannot be less than 85% of premium leaving insurance companies with15% of premium to cover their costs and earn profits. However this has had a reverse effect, the opposite of which is higher costs. The greater the cost (claims), the greater the profit to the insurance company. Fifteen percent of a larger number is larger than 15% of a smaller number.

Insurance companies remaining in the fully-insured market have little or no incentive to reduce health care costs except to remain competitive in the market. With only a handful of fully-insured carriers in any given market there is less competition. Shadow pricing between competitors can very often be an effective means of maximizing insurance company profits at the expense of the plan sponsor and plan participants. A 15% operating and profit margin becomes greater when insurance rates are higher.

A good example of a constricted market can be found in San Antonio, Texas, a market we know well. There are only four major players in the fully-insured market: Blue Cross, United Healthcare, Aetna and Humana. Employer groups who continue to fully-insure will contract with one of these four carriers.

The Lower Rio Grande Valley in deep South Texas, on the other hand, has only one major carrier in the fully-insured market. Blue Cross is the dominant carrier, with occasional, cyclical and short lived forays into the Valley by Aetna and Humana..

Fully insured health insurance carriers have developed proprietary provider networks as an integral part of their insurance plans. None to our knowledge market plans that do not utilize their PPO network as part of the offering. There is an economic reason for this and it has nothing to do with lowering health care costs.

To insure continuing higher profits, health claim costs must continue to escalate. Third party intermediaries negotiate provider agreements in secrecy with both parties agreeing to non-disclose of terms, conditions and pricing to the public. It is our opinion that if you are not allowed to see a contract you are probably paying more than you should. Plan sponsors have simply become third party beneficiaries, accessing provider agreements they cannot see, examine or audit.

Fully insured group medical insurance in today’s market requires accessing proprietary, secretive PPO contracts. These contracts drive costs up each year primarily due to automatic escalator clauses. Other contract provisions include provider re-pricing fees and shared savings provisions based on egregious charge master rates no one ever pays. There are other contract provisions that guarantee continued cost increases but we will save that discussion for another day.

Self-funding provides plan sponsors a means to comply with the ACA with less restrictive mandates and lower costs. In addition, plan sponsors have the ability to design benefits that are far more flexible. They gain the freedom to choose provider reimbursement methods based on transparency, benchmarked off costs instead of phony discounts based on inflated sticker prices no one ever pays. They have the ability to eliminate expensive third party intermediaries that bring no value, They have the ability to directly contract with willing providers based on transparent benchmarking, achieving savings of 20% or more.

The ACA’s adverse impact on fully insured plans include community rating and minimum essential benefit requirements, 3:1 age band rating, pre-existing condition inclusion, and benefit expansions. All of these mandates drive cost up.

A self-funded plan is not subject to community rating nor are they required to include all ten (10) essential benefits. In addition, self-funded plans are not subject to the 3:1 rating rule and can mitigate pre-existing inclusion through selective lasers. Lasers are an underwriting technique that increases exposure/costs only when a loss occurs. If no loss occurs, there is no effective additional load to plan costs unlike fully-insured plans that load the premium costs at the beginning of the plan year, effectively passing on a cost that may or may not be necessary.

Complementing the advantages of self-funding under the ACA, ERISA preempts the state’s ability to mandate health insurance contract terms and benefits, impose premium taxes, impose underwriting constraints and mandated premiums (varies by state) and limit employee benefit plan options.

Product Details  Product Details

The Future under the ACA

Health care costs continue to escalate. Both private and public sector budgets can no longer sustain the current level of spending, let alone future health care inflation.

Over 170 million Americans are insured through employer sponsored health plans today. These employers, fearing the effects of the ACA on their bottom line, are concerned and desperate for answers and solutions to ever increasing health care costs. To more and more of them health care costs can mean the difference between profit and loss.

Acceptance to change, historically, has been slow among employers who have traditionally relied on third party intermediaries to guide them through the complicated maze of our health care system. The ACA has effectively changed that mindset among many plan sponsors.

We are seeing a movement away from managed care by some employers, and to a lesser degree, by health care providers, particularly health care professionals. Employers, for the first time, are questioning managed care contracts they cannot see but upon which their health care costs are based.

We are seeing a major shift to self-funded arrangements which enable plan sponsors to effectively manage costs through avoidance of certain ACA requirements, underwriting advantages, and pro-active risk management.

Assessment

Product Details

Although ERISA was passed into law over 35 years ago, with the advent of the ACA more plan sponsors are accepting full fiduciary responsibility to assure that plan assets are expended prudently and in the best interests of plan participants.

Conclusion

As it stands today, the ACA is the fuel which fires the self-funded engine of employee health and welfare plans, providing flexibility, control and lower costs. It is the parking brakes of fully-insured plans.

About the Author

Bill Rusteberg is a fee based insurance consultant and principal of RiskManagers.us since 1998. He has been involved in the insurance industry for over 41 years specializing in self-funded employee welfare plans. Bill has spoken nationally on continuing changes affecting our health care delivery system, most recently at the Physician Hospital of America (PHA) annual forum in 2013 and the Health Care Administrators Association (HCAA) Executive Forum in 2014. Bill walks his audience through the complicated maze of the American health care delivery system. He exposes industry secrets that drive costs by outlining specific findings not generally known to Plan Sponsors. Bill offers common sense solutions to ever increasing health care costs. Armed with the knowledge industry insiders have kept hidden for years, Plan Sponsors are, for the first time, empowered to negotiate with insurance companies, managed care organizations and other third party intermediaries from a position of strength and can better achieve cost effective health care for their employees while often improving benefits at the same time. Bill is a licensed Risk Manager, Life & Health Counselor, Property & Casualty / Life & Health Insurance agent and Surplus Lines broker in Texas. He holds reciprocal licenses in several other states.

About RiskManagers.us

RiskMangers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Financial Planning MDs 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Reviewing Physician Disability Insurance Policies

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Including Policy Checklist

By Dr. David Edward Marcinko MBA http://www.CertifiedMedicalPlanner.org

Dr. DEM

The Basic Premise 101

Could you continue to support your family and pay your bills if you were unable to work for any length of time because of illness or injury? If you were to become disabled, do you know how much money would be coming in each month and from what sources?

The Checklist

As a doctor I covered the ER, and was an insurance agent, for almost a decade. But, I reformed and am now a Certified Medical Planner™ and B-school professor. And, I know that every disability insurance policy has different features.

The following checklist will help you compare policies you may be considering:

  1. How is disability defined? Is it defined as the inability to perform your own job, or inability to do any job? We recommend all our clients, as physicians, to obtain a policy that protects them in their own specialty. This kind of policy is defined as an own-occupation policy, which protects the income you earn in your own specialty and continues to pay benefits if your disability requires that you choose a new specialty or occupation.
  2. Are benefits available for partial or residual disability, as well as for full disability? The most comprehensive policies will pay you a benefit even if you are not completely disabled. If you can only earn up to 20% of your income you are deemed totally disabled; if you can earn 80% or more you are deemed totally well. Partial or residual policies pay benefits when you fall in the category between 20-80%.
  3. Are full benefits paid, whether or not you are able to work, for loss of sight, loss of hearing, or loss of limbs? This is called presumptive disability. Some policies do not cover presumptive disability, some cover you for a specified amount of time, and some protect you for life.
  4. What is the maximum benefit I am eligible for? The amount is based on your income to a maximum of $15,000 per month for one company, and $20,000 total.
  5. Is the policy non-cancelable, guaranteed renewable, or conditionally renewable? The most comprehensive policies are non-cancelable and guaranteed renewable; these put you in total control, not the insurance company, practice or association. The insurance company cannot raise rates, cannot reduce benefits, add exclusions, or cancel your policy at anytime. You are in control, and the policy is portable and goes wherever you go.
  6. How long must you be disabled before premiums are waived? Premiums are waived at the end of the waiting period and refunded for the amount paid during the waiting period.
  7. Is there an option to buy additional coverage, without undergoing additional medical tests or examinations, at a later date? This kind of coverage is called guaranteed issue disability insurance and is available to those who qualify.
  8. Does the policy offer an inflation adjustment feature? If so, what is the rate of inflation? Is there a maximum? This feature is available by an added rider. Ask a licensed DI4MDs.com agent if inflation protection fits your needs at this time.

***

Ankle-Leg Trauma

[Back When I Covered the ER]

[Copyright David Edward Marcinko and iMBA Inc., All rights reserved. USA]

***

Other Items

  • What is an adequate level of benefits in relation to your present and future obligations?
  • How long a waiting period (until benefits begin) should you select to fit your situation?
  • How long do you want to receive disability income should it become necessary? How much coverage can you get at your current salary?

More: More on Disability Insurance for Physicians

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Financial Planning MDs 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

Much More Ado About Healthcare Business Buy–Sell Insurance Agreements

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HOW THEY SHOULD BE STRUCTURED?

By Dr David Edward Marcinko MBA CMP™

Dr. DEMwww.CertifiedMedicalPlanner.org

A buy–sell agreement provides a ready market for the sale of a medical practice or healthcare business interest, provides liquidity on a timely basis, and provides for a smooth transfer to the desired successors.

A buy–sell agreement may be funded to insure retirement, disability, and death protection. A properly designed agreement may help provide for a smooth financial and managerial transition.

The buy–sell agreement should also include the method for determining the value of the medical office or healthcare business-entity; and the payment terms. A buy–sell agreement may be structured in one of two ways: [1] redemption or a [2] cross-purchase agreement.

Redemptions

A redemption is an agreement between the medical business owner in which insurance proceeds, or other corporate funds, are used to buy out the deceased or retired physician owner’s interest. If life insurance proceeds are to be used to fund the buy-out of a deceased owner, the potential risks that need to be considered include:

  • The possibility of alternative minimum tax (AMT) that would only affect a C corporation.
  • The potential for insurance proceeds to be exposed to corporate creditors.
  • The possibility that undesirable dividend treatment may occur if the constructive ownership rules of Code Section 318 are met. (This requires close scrutiny of Sections 302, 303, and 318 when structuring a plan.)

Private medical business owners who currently have redemptions in their estate plans may desire to switch to a cross-purchase agreement. This modification prevents exposure of the insurance proceeds to corporate creditors and the potential for corporate AMT.

Cross-Purchase Agreements

A cross-purchase agreement between or among the parties, unlike the redemption agreement, provides a stepped-up outside basis. It may be cumbersome to coordinate funding with many shareholders because life insurance policies must be acquired on each particular life. Some CPAs, financial advisors, insurance agents and attorneys suggest that a business insurance trust can solve this, but the current popular solution is a partnership.

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Buy-Sell

***

Example:

Drs. Jon, Bob, and Brent are three unrelated physicians who are shareholders in a professional corporation. They sign a cross-purchase buy–sell as shareholders, agreeing to purchase the outstanding stock of a deceased shareholder based upon a formula including the prior year’s earnings and the current net worth. They purchase life insurance policies on one another so that they have a way to fund the purchase of the shares from the decedent’s estate. The policies are an approximation of the required funds and are reviewed annually to verify that sufficient insurance exists to cover the needs. They have created a funded cross-purchase agreement.

The shareholders considered having a disability buy-out clause also, but have been unable to agree upon appropriate dollar amounts and have had problems selecting disability insurance coverage. They felt that it was best to have a signed contract on the portion that they could agree on, rather than tie the whole process up seeking agreement on everything.

“Wait and See” Buy–Sell Agreements

The less frequently used option of the “wait and see” buy–sell agreement postpones the decision on how to transfer the business until after the death of the business owner, when more information is available. The purchase price and funding are established currently, but the identity of the purchaser is left open. Typically, the business has the first option to buy. Then, after a set period, the owners have the option to buy. Finally, to protect the heirs of the deceased, if neither of the first two options is exercised, the business must purchase the stock.

Estate Valuation

Certain criteria must be met for a buy–sell to fix the value of the medical business interest for estate tax purposes. For agreements entered before October 9, 1990, that have not been substantially modified, the values established in the buy–sell agreement should serve to establish the value for estate tax purposes, unless the agreement was a device to transfer the business to a family member below fair market value or if the agreement is not a bona fide business arrangement.

For agreements substantially modified after October 8, 1990, or those entered into after that date, the value of the property is determined without regard to any option, agreement, or right to acquire or use the property at less than fair market value or any restriction on the right to sell or use such property, unless the option, agreement, right, or restriction:

  • Is a bona fide business arrangement, and
  • Is not a device to transfer such property to members of a decedent’s family for less than full and adequate consideration in money or money’s worth, and
  • The terms of the option, agreement, right, or restrictions are comparable to similar arrangements entered into by persons in an arm’s length transaction.

If the buy–sell option meets these requirements, its terms may be utilized in the valuation of the interest transferred for estate or gift tax purposes. [IRC § 2703]

If these specific tests are not satisfied, the buy–sell agreement will not establish the value for estate tax purposes and the valuation factors of Revenue Ruling 59-60 probably would prevail. This may leave the estate in the position of having to litigate if the taxing authorities set a value higher than the actual sale value.

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Business

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To assist in meeting the three criteria, advisors should not encourage the use of formulas as in the past; but individual appraisals and personalized valuations. Some practices or entities even fix the value of the business annually and justify this by pointing out that nobody knows whether there will be a purchaser or a seller. They have every incentive to try to make a fair valuation. But, the advisor should keep in mind that such a valuation could be used against an owner in the event of a divorce or separation, so he or she should use prudence before publishing a stated value.

In most cases, the IRS will argue that the agreement doesn’t meet the requirements of Code Section 2703 because of the need for the agreement to be comparable to similar arrangements. This means the buy–sell agreement may not be solely determinative in valuation issues, regardless of how carefully it is constructed.

Assessment

A buy–sell between unrelated parties who are not the “natural objects of each other’s bounty” is deemed to have met the three tests for exclusion from Code Section 2703. This means that the new rules generally only apply to intrafamily transfers, although some experts believe that this term may be broad enough to include any potential heir.

More:

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Drilling Down on Camouflaged Annuity Taxation

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A Fee by any other Name

[By Rick Kahler MS CFP®] http://www.KahlerFinancial.com

Rick Kahler CFPWe South Dakotans can be smug about the economic advantages of residing in our income tax-free state. While those advantages are big, we do have a few lesser-known taxes.

These include a 6% franchise tax on banks and a 4.5% energy minerals severance tax on mining and oil companies. Like many other states, we also tax life insurance premiums; our rate is 2.5%.

The Hidden Annuity Premium Tax

I recently learned about another “hidden” tax, one on annuity premiums. A recent article in Investment News lists the eight states or territories that have such a tax: California, Florida, Maine, Nevada, Puerto Rico, South Dakota, West Virginia, and Wyoming. The tax ranges from 1% in Florida, West Virginia, and Wyoming to a whopping 3.5% in Nevada. South Dakota’s rate is 1.25%.

If you have purchased an annuity while living in one of these jurisdictions, you’ve paid this tax. You may have not been aware of it, as there are many hidden fees associated with purchasing annuities.

The Fee that is a Camouflaged Tax

I learned about the tax when our client service specialist questioned a 1.25% expense charged by the company on a new “no load” annuity. I thought the company had charged a commission of some type to the account, which was puzzling since we don’t accept any commissions. After sorting things out, we discovered the fee was actually the 1.25% premium tax that South Dakota charges on every contribution going into an annuity.

Impact

While states charge the tax just once on new money invested into the annuity, it still serves to decrease the total return of the annuity. If you held an annuity for a year, the premium tax would reduce your overall return by 1.25%. If you held the annuity for 10 years, the overall impact would be much less, reducing the return by 0.125% annually.

Specifics

The states leave the method of collecting the tax up to the annuity company. Most annuity companies that pay a salesperson a commission to sell the product build the fee into the overall costs. This is often easy, since the upfront commissions can range up to 10% and annual expenses up to 7% a year. I have seen more than one annuity where the fees and commissions eat up the majority of any potential return. Many no-load annuities, like Jefferson National, charge the tax to their customers.

The States

If you live in a state that taxes annuity premiums, you might have the idea of buying an annuity in a non-taxing state. This isn’t an option, as companies must levy the tax based on your state of residency.

On the surface, there appears to be some good news for residents of Maine, Nevada, South Dakota, and Wyoming. Residents who purchase an annuity in a qualified plan like an IRA or 401(k) don’t pay the tax. That benefit is somewhat moot, as owning an annuity in a qualified plan is rare. It generally makes little sense for a tax-deferred qualified plan to own a tax-deferred annuity, especially considering the annuity fees.

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Tax

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Rule-Outs?

If you live in a state that taxes annuity purchases, should you automatically rule out annuities? Not necessarily. Just be aware you will have to pay the piper. For residents of South Dakota, Florida, and Wyoming, lawmakers argue that maybe the tax isn’t such a heavy burden since these states don’t have an income tax.

Assessment

Still, no matter how you want to figure it, a tax is a tax. It’s one more factor to consider in deciding whether a given annuity product is right for you. Whatever amount you pay in state taxes is just that much less of your money that goes to work for you.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Financial Planning MDs 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

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