INSURANCE 101: Basic Medical Insurance

The purpose of medical expense insurance is to provide financial protection against costs associated with hospitalization, surgical procedures, physicians’ fees, as well as many other associated costs.  Considering that escalating medical expenses is one of the leading causes of bankruptcy, it is vital to be insured under some type of medical expense insurance.

Types of Medical Expense Insurance

• Basic Medical Insurance
• Major Medical Insurance

Basic Medical Insurance, also known as Basic Medical Expense plans provide limited benefits in the form of indemnity payments which are paid directly to the insured, and are provided as a limited benefit for services incurred by the insured.

The indemnity payment is limited to a specific amount of money that is provided by the insurer to an insured on a daily basis for a specific period of time to aid in offsetting costs incurred by the insured for his or her illness or injury.  Again, since this payment is limited to a specific amount, it is not designed to fully cover an insured’s medical expense.

It is also important to note here that the indemnity payments, once provided by the insurer, is the property of the insured, and as such, can be used to help pay for the incurred medical expenses, for which is provided, or for any other purpose in which he or she decides to use the money.  Again, the indemnity payments are considered the insured’s money.

Basic medical expense plans are also referred to as First-Dollar Coverage because they provide benefits up front to the insured without having to satisfy any plan deductible.

In comparison ‘major medical’ insurance provides comprehensive coverage and is less limited, covering most medical expenses completely after an insured meets certain plan stipulations such as the plan’s deductible.

Unfortunately, with the rising costs of health care, basic medical expense plans are less effective in covering healthcare costs since they are limited to the type and duration of services being covered as well as the amount associated with these services.  Basic medical expense plans, though limited, do provide some financial protection, and therefore, should be reviewed. Simply stated, basic medical expense plans provide limited coverage for basic hospital, surgical, and physicians’ fees.

Basic Medical Insurance Covers:

• Basic hospital expenses
• Basic physicians’ (non-surgical) expenses
• Basic surgical expenses
• Basic Hospital Benefits

Basic hospital benefits include coverage for an insured’s Room and Board, payable as either a fixed daily dollar amount or payable over a fixed period of time.

Additional charges covered by basic hospital benefits include the costs for medications, anesthesia, X-rays, as well as the costs involved with the use of an operating room.  Costs are covered up to a certain amount as specified in the insurance contract.

Though basic hospital expense insurance covers many expenses associated with a hospital, it does not include coverage for any surgeons or other physicians’ services performed while in the hospital, for that one needs the following ‘basic physicians’ benefits and basic surgical benefits

Basic Physicians’ (Non-Surgical) Benefits
Basic physicians’ benefits provide an insured with funds to help cover the costs rendered by non-surgical physicians while he or she is confined to a hospital, as well as physicians’ office visits outside of the hospital.  Physicians’ benefits are provided in the form of fixed indemnity payments made to the insured to help cover non-surgical expenses.  The amount of benefit for a physician’s visit is fixed, regardless of the actual expense incurred.

As an example, if the basic physician’s benefit contract provides an insured with a $100 indemnity payment per visit, but the actual expense of the visit is $120, then the insured is still responsible to pay the additional $20 for the physician’s visit.  On the other hand if the actual visit expense is $80, then the indemnity payment would also be $80, as not to exceed the actual cost, but still within the per visit limit established in the insurance contract.

Basic Surgical Benefits
Basic surgical benefits provide an insured with funds to help cover the costs associated with in-hospital surgeon’s services and services rendered by an anesthesiologist before surgery, though, the anesthesia drug, itself, is covered under the miscellaneous expenses just mentioned in a basic hospital expense plan.

Methods to Determine Surgical Expense Benefits

Schedule of Surgical Procedures
This is the primary method used to determine surgical expense benefits.  It determines the amount of benefit by assigning a specific value, or dollar amount, to each type of surgical expense provided; however, if the cost of surgery exceeds a specified amount, the insured would then be financially responsible for the remaining cost.

Usual, Customary, and Reasonable (UCR) Approach
This method follows the UCR approach explained earlier to cover the expense according to usual and customary costs based on other similar surgical procedures within a particular geographical area.  It also covers the expense of a surgery if it is deemed ‘reasonable’ when compared to other facilities performing the same surgery in the same geographical area.

Relative Value Scale
This approach is similar to the schedule of surgical procedures mentioned above, except instead of assigning a specific dollar amount for each procedure, a pre-arranged point system is established. Points are based on the severity of the procedure as well as the part of the body in which the surgery is performed.

Additional Basic Benefit Plans
In addition to basic hospital, surgical, and physician’s benefits, basic medical expense insurance provides a variety of additional plans covering specific medical needs and associated expenses.  These additional plans provide limited coverage for maternity, mental health, private nursing care expenses, hospice care, nursing home and home health care expenses, as well as limited outpatient care coverage.

INSURANCE 101: General Exclusions in a Life Contract

Life insurance policies also include provisions and exclusions to protect the insurer in the event of likely death or illegal activity that might affect a life insurance policy’s proceeds.

The following are a few common life policy exclusions:

• False pretense or information provided on the application for life insurance with the intent to deceive and defraud the insurer
• If the policyowner dies as a result of a felonious act (death occurring while committing a crime, NOT the victim of a crime), death benefits will not be given to a beneficiary
• Private aviation (flying a private airplane) is often excluded due to the elevated risk level associated with such profession or hobby.  This exclusion normally pertains to private aviation, and not if death occurs during commercial aviation, such as being a passenger on a commercial airline
• Hazardous occupations or hobbies that are considered dangerous, such as structural metal workers, miners, heavy-equipment operators, stuntmen, race car drivers and other ‘hazardous’ occupations or hobbies are usually excluded from applying for coverage, though employers of these occupations often provide special protection for their employees
• Death resulting from military service is typically excluded from coverage.  Death benefits will not be paid if the policyowner’s death is the result of participation in war.  Military personnel receive governmental coverage under the rules and regulations of the U.S. military

iNSURANCE 101: Whole Life

Also known as Ordinary, Permanent, or Straight-Life insurance.  Whole life insurance provides coverage for an individual’s whole life, rather than a specified term (provided he or she continues to make premium payments).  Over the life of a whole life policy, both the face amount and premium remain level and the death benefit is guaranteed to the beneficiary.

An important feature of whole life insurance that is not associated with term life insurance is that a whole life policy includes an investment component which accumulates ‘cash value’ and increases over time based on earned interest.

A whole life policy’s Cash Value is considered a ‘living benefit,’ allowing the policyowner to take out a loan from the life insurer against the policy’s accumulated cash value, or use it as collateral on a loan.

With a whole life policy, a portion of the premium pays for the insurance and the rest accumulates tax deferred in a cash value account.  The policyowner can borrow against the cash value, and technically is not required to repay the loan; however, any unpaid loans on the policy’s cash value equally reduce the death benefit of the policy.

Whole life insurance policies also include a ‘cash surrender’ value, called the Nonforfeiture Value, allowing the policyowner to recover part of the premium invested in the policy if he or she stops making premium payments and forfeits ownership of the policy.

Whole Life Policy Maturity at Age 100
Compared to term life insurance which provides coverage for a specified period of time, whole life insurance covers the whole life of the insured.  However, whole life insurance matures at age 100, meaning that once the insured has reached age 100, his or her policy is considered to be paid in full and the insurer’s obligation to provide coverage ends.

Each insurer employs statistical analysts, or ‘actuaries,’ to analyze and predict potential loss in order to set and maintain premium pricing for the insurer’s products.  Although an insured can live past 100, statistically speaking, such a low percentage of individuals actually do that mortality tables predict loss only up to this age.

Whole life premium rates are based on the policy’s maturity at age 100, which is also the age in which the policy’s cash value has accumulated to the face amount of the policy.  Upon reaching age 100, the insurer provides the policy’s full face amount (the policy’s accumulated cash value) to the policy’s owner or designated beneficiary.

Whole Life Insurance Policies
As with term life insurance, whole life policies vary in how premiums are paid into the policy, whether it be a continuous premium, referred to as ‘straight life,’ limited payments or a single payment.  In addition, whole life insurance policies can be based on current interest rate trends, or combined with term life insurance to provide consumers with a more affordable alternative to traditional straight life policies.  The following types of whole life insurance policies include:

Continuous Premium (Straight Life)

• Limited Payment
• Single Premium
• Current Assumption

‘Economatic’ Policy

Continuous Premium (Straight Life)
Considered to be the most common type of whole life insurance sold, a policyowner stretches his or her premium installments over the life of the policy (to age 100 or death, whichever comes first).  Premium installments are both continuous and level throughout the policyowner’s life.

Limited Payment
Premium installments are paid for a limited period of time while guaranteeing coverage for the life of the policyowner.  Since the premiums are paid over a shorter period of time, the premium payments will be higher than under an ordinary whole life policy.  Cash values also build quicker than straight life policies.

Limited-payment policies are based on a predetermined number of years such as a 20-payment (20-pay) or 30-payment (30-pay) policy, or are based on age such as a ‘Life paid up at age 65’ policy.  While life insurance continues on the insured until death (or age 100), the policyowner is limited in payments towards the life policy.

Single Premium
A type of limited-payment whole life policy with a single lump-sum premium payment which is payable at the time the policy is issued.  Though it is a large initial expense, overall it is less expensive than the accumulation of periodic installments over the life of the policy.

Current Assumption
Also known as Interest-Sensitive Whole Life, this type of policy differs from an ordinary whole life policy where premiums remain level.  With a current assumption whole life policy, premium payments are flexible and can increase or decrease by the insurer (annually) based on current interest rate trends that result in higher or lower mortality rates or investment returns to the insurer. When an insurer experiences high rates of return, premium rates are generally reduced.  When the insurer experiences lower than average rates of return, premium rates are generally increased.  Premium adjustments are usually made on an annual basis to compensate for this market fluctuation.

‘Economatic’ Policy
Also known as Enhanced Ordinary Life or Extra Ordinary Life, this insurance option, offered by some mutual companies, allows a policyowner to maintain a higher insurance death benefit at a lower premium through the combination of a whole life and term life policy.

Example:
Let’s say that a policyowner wants to purchase a $250,000 whole life policy but cannot afford the required premium.  He or she could simply purchase a level or decreasing term life policy in addition to a lesser face value whole life policy.

Considering that term life insurance is less costly than whole life insurance, the policyowner could purchase a $150,000 whole life policy and also purchase a $100,000 term life policy with a combined death benefit of the desired $250,000.  Since $100,000 of the death benefit is under a term life policy, which is cheaper than a $100,000 whole life policy, the overall cost of the combined whole life and term life premiums equate to less than a straight $250,000 whole life policy.

As the whole life policy matures, dividends paid to the policyowner from the whole life policy will be used to purchase paid-up additions to the whole life policy, and at the same time, the policyowner will decrease the face amount of the term life policy so that the policyowner never exceeds a combined $250,000 death benefit.

Eventually, the term life policy will decrease to zero and the dividends from the whole life policy will allow the policyowner to purchase enough paid-up additional insurance so that the whole life policy equals the desired $250,000.



Essentially, this type of affordable whole and term life insurance option allows a policyowner to purchase a larger overall death benefit at a more affordable rate than a straight life policy.

INSURANCE 101: Term Life Insurance

A Term Life insurance policy is a basic type of life insurance that is lower in cost to a policyowner, is only in force for a specified period of time and does not accumulate cash value, nor does it provide the policyowner with any policy loan value.  A term life policy’s death benefit is payable only if the insured dies during the specified period of time stated in the policy.

The ‘term’ of a policy is the number of years that the policy’s insured is covered with a specific ‘face amount,’ or amount of principal payable to the policy’s beneficiary in the event the insured dies within the policy’s term.  Policy terms can range from 10 years to 30 years, or longer.

Term life coverage expires once the term has ended and can either be renewed for an additional term or be allowed to expire.  Assuming death has not occurred, the policy simply ends and the insurer assumes no further responsibility to the policyowner or beneficiary.  It is common for a term life policy to be renewed for additional terms, or converted to a whole life or other cash value policy.

Guaranteed vs. Non-Guaranteed Level Premiums
Term life policy premiums are based on the insured’s age, tobacco use, and health at the time of application.  Once issued, a term policy’s premium rate is either guaranteed to remain constant, or ‘level’ for the entirety of the term; or the policy’s premium rate is non-guaranteed, which enables the insurer to increase the premium rate during the contract period.

A guaranteed level premium policy is most commonly purchased. This type of policy calculates the total premium payable for the term of the policy and divides payments evenly to keep the premium rate level over the policy’s term.

A non-guaranteed level premium policy might provide for a lower premium initially with the possibility of a rate increase after a set period of time within the policy’s term.

Indeterminate Level Premiums
A term life policy can also include an ‘adjustable premium’ schedule which is indeterminate at the time of policy issuance and can fluctuate over the term of the policy. The policy’s premium rate is determined by the insurer’s current mortality rates, interest earned from premium investments, and company expenses.

Policy premiums are guaranteed to never exceed a certain amount; however, if the insurer’s profits are greater than at the time of policy issuance, the ‘current’ premium will be lower than at the time of issuance.  If profits are lower, the premium will be higher than at the time of issuance, but the premium will not exceed the policy’s guaranteed maximum rate.

Types of Term Life Insurance Policies

In addition to the premiums paid for a term life policy, benefits provide from the policy can also vary.  The policy’s face amount can remain level, it can decrease, or it can increase over the term of the policy.  In addition, term life policies can provide a policyowner with the option to renew, purchase additional coverage, or convert to a whole life policy in the future.

Level Term
A level term life policy’s face amount remains constant, or ‘level,’ for the term of the policy.  The only aspect that changes, if renewed, is the increase in premium due to the increased age of the policyowner.

Decreasing Term
A decreasing term life policy’s face amount decreases over the term of the policy.  For instance, a decreasing term insurance policy with a face amount of $100,000 and a 10-year term will provide the full $100,000 of coverage if the insured dies within the 1st year, $90,000 of coverage the 2nd year, and so on until the benefit amount reduces to zero at the end of the 10 years.

This type of coverage is often purchased to protect against home mortgages, student loan debt or any situation in which the need for insurance is greater at the beginning of the policy, as opposed to the end of the policy.

Increasing Term
In comparison, an increasing term life policy’s face amount increases over the term of the policy.  Although this type of policy is not often sold as a stand-alone insurance product, it is typically incorporated into a whole life policy as an added rider.

Special Features of Term Life

Renewable
A renewable term life policy does not require evidence of insurability at the time of renewal; however, premium rates increase according to the age of the insured at the time of each renewal.  This type of premium rate increase is often called Step-Rate Premiums.

Re-entry Option
An option that allows an individual to reapply for, or ‘reissue’ his or her term life policy every few years (usually 5 years) and receive a premium lower than their guaranteed renewal rate. However, in order to receive this lower rate, evidence of insurability must show that the policyowner is maintaining good health. If not, the policyowner will instead have to pay the guaranteed renewal rate if they want to continue their coverage.

Convertible
A term life policy can also be ‘convertible,’ meaning that a policyowner can convert his or her term policy to a whole life or other cash value policy in the future without being required to provide evidence of insurability.  The ‘option to convert’ is provided to the policyowner who may or may not elect to convert to a long-term policy in the future.

When converting to a long-term plan, the policyowner can use either his or her current age, referred to as his or her ‘attained age,’ or the whole life policy can be written using the original age of the policyowner used at the beginning of the original term policy.  If a policyowner’s original age is used when converting to a whole life policy, he or she will pay a lower premium based on the younger age in comparison to his or her current age; however, the insurer will require interest to be paid, as well as an additional payment amount equal to the difference in age that the insurer would normally charge for a policy written using the current age of the policyowner.

Although both methods of conversion seem to add up to the same amount for the policyowner, instead of incurring a higher premium, the policyowner is actually building up his or her cash value quicker than would occur if he or she paid a higher premium using his or her current age.  Essentially, instead of paying a higher premium, the policy’s cash value increases quicker as a result of the bulk payment and increased interest.

Interim Term
A type of convertible term policy, referred to as an Interim Insuring Agreement, is commonly provided by insurers to ensure immediate temporary term life protection during the underwriting of a whole life policy.  Referred to as ‘interim term’ coverage, an individual who wishes to purchase a whole life policy in the near future, or who is waiting for his or her whole life policy to be underwritten by the insurer, may be temporarily covered under a term policy which is then automatically converted to a whole life policy within a short period of time.

An interim term policy is commonly issued for a period of 1 month up to 11 months, at which time the policy automatically converts to a whole life policy.  As a result of this short period of time before conversion, premiums for the whole life policy are based on the age of the policyowner when the interim policy converts to the whole life policy, not the age of the policyowner at the time the interim term began.

Return of Premium (ROP) Term Life Policy
A Return of Premium Term Life, or ROP, policy is a more expensive type of term life insurance that provides an ‘end benefit’ to the policyowner at the expiration of his or her policy’s term by returning 100% of the premiums paid into the policy when the insured survives the policy’s term.

For example, if an insured survives past a 35-year return of premium term life policy and the policyowner does not surrender it beforehand; the policyowner would receive 100% of the premiums paid into the policy upon the insured satisfying the 35-year term.

Although a return of premium provides extra incentive to purchase, deciding to purchase an ROP term life policy should be considered carefully as the extra premium costs involved might be better invested in an interest-bearing retirement account, such as an IRA.

INSURANCE 101: Employee Retirement Income Security Act (ERISA)

The Employment Retirement Income Security Act (ERISA) was enacted by Congress in 1974 as a result of increased awareness towards employee benefits in the workplace and the lack of regulation over employer-sponsored welfare plans.  Before ERISA, employers had little incentive for providing welfare benefits to employees, and if provided, company welfare plans were often vulnerable to funding mismanagement and abuse due to a lack of disclosure and adequate safeguards concerning their operation.

Commonly referred to as ERISA, this federal law established minimum guidelines pertaining to the administration of employer-based pension plans and employee welfare benefit plans such as life, health and disability insurance.  The overall purpose of the law is to protect participating employees and their beneficiaries from unethical or unlawful practices in regards to the funding, management and distribution of employee retirement and insurance benefits.

ERISA is regulated by the Department of Labor and is administered and enforced through the department’s Employee Benefits Security Administration.  ERISA regulation applies to all non-governmental, private employer-groups in the U.S. who offer employee benefit plans.  Government employees as well as religious organizations are exempt from ERISA rules, as are individuals who purchase private individual retirement and insurance plans.

It is important to note that ERISA does not ‘preempt,’ or supersede state insurance laws, as the states ultimately regulate insurance; however, since employer-sponsored plans involve interstate commerce, such plans also fall under federal jurisdiction for federal taxation purposes because they substantially affect the revenues of the United States due to the preferential Federal tax treatment provided to such plans.

ERISA regulation does not pertain to the types and levels of plan benefits, nor does it mandate that groups establish pension or insurance plans; however, for those groups that do establish such plans, ERISA regulation pertains to the administration of the group’s benefit plan in how it is managed to ensure it benefits the members of the group for which it was established.

Reporting and Disclosure
ERISA mandates the reporting and disclosure of plan eligibility, benefits provided under the plan and the limitations of the plan to participating employees by the employer or other group sponsor through a Summary Plan Description (SPD), in addition to any policy summary provided by the insurer.  Under ERISA, the plan sponsor must establish a written policy, whether purchased by an insurer or self-insured by the sponsor itself, the sponsor is ultimately responsible for providing such disclosures to members of the group, and is held accountable for ERISA compliance.  While state laws mandate insurer disclosure, ERISA mandates employer disclosure, in addition to material provided by the insurer.

Under ERISA, the group’s sponsor has the fiduciary responsibility to act in the best interests of the plan’s participants and to ensure proper participation and vesting standards are met.  It is the responsibility of the plan sponsor to ensure safeguards are in place to ensure proper collection of plan funds, as well as distribution and claims processes to avoid discrimination within the group.

INSURANCE 101: Social Security Disability Insurance (SSDI)

Enacted by Congress as part of the Social Security Act of 1935, Social Security Disability Insurance (SSDI) is a federal program that is funded primarily through employer and employee payroll taxes, known as ‘FICA taxes,’ and provides benefits to eligible individuals in the form disability income benefits.

SSDI is available to all working Americans that pay FICA taxes who have qualified as ‘fully insured’ for benefits upon becoming totally disabled.  Benefits are not provided unless an individual qualifies as both ‘fully insured’ and ‘totally disabled.’

An individual becomes fully eligible for Social Security Disability benefits based on his or her Insured Status, which is determined by how many Quarters of Coverage or Credits he or she has accumulated while being employed and taxed under FICA.

One credit can be earned for each quarter in the calendar year that an employee pays FICA payroll taxes, with a maximum annual accumulation of 4 quarters of coverage, or credits, per calendar year, beginning after an individual turns 21 years old.

Average Indexed Monthly Earnings (AIME)
Social Security benefit amounts are based on an individual’s lifetime earnings that were taxed under the FICA payroll tax using an indexed earnings average, called the Average Indexed Monthly Earnings (AIME).  This average, which is computed over a 35 year period of time, reflects changes in wage levels and more accurately accounts for inflation when determining benefits.  This average is used within a formula to determine the individual’s ‘primary insurance amount,’ or ‘PIA.’

Primary Insurance Amount (PIA)
The Primary Insurance Amount (PIA) is the benefit amount that an individual receives when he or she chooses to begin receiving retirement benefits at his or her normal retirement age.  Based on the AIME amount, the PIA determines the correct amount of Social Security benefits for each recipient based on the amount of annual income he or she produced while in his or her working (and FICA taxed) years.

Insured Status (Currently vs. Fully)
An individual qualifies as partially insured, also referred to as Currently Insured, if he or she has accumulated at least 6 quarters of coverage within the last 13 calendar quarters.  The minimum requirement for individuals under age 24 to obtain currently insured status is 6 credits in the last 3 years.  Beginning at age 24, additional credits are required to obtain currently insured status based on the individual’s age at the time of disability.

An individual qualifies as Fully Insured when he or she has accumulated the required quarters of coverage based on their age.

To be fully insured, an individual needs to obtain at least one credit for each calendar year after turning age 21, and the earliest of the following:

• The year before attaining age 62,
• The year before death, or
• The year an individual becomes disabled
• The minimum number of credits needed is 6 and the maximum number needed is 40.  Any year (all or part of a year) that was included in a period of disability is not included in determining the number of credits needed to be fully insured.

Unlike private disability insurance, Social Security Disability Insurance (SSDI) only provides benefits to individuals who are totally disabled, as oposed to partial or short-term disability.  SSDI defines total disability as the inability to engage in any substantial gainful activity due to physical or mental disability and must last at least 12 months or end in death.  Benefits are paid after a 5 month waiting period to ensure the individual is totally disabled.

In addition to being totally disabled, an individual needs to be fully insured and have earned at least 20 quarters of coverage in the last 40 calendar quarters (last 10 years) ending with the quarter in which the disability begins.

A qualified beneficiary will receive 100% of his or her PIA.  In addition, his or her spouse and dependent children under 18 years of age will receive 50% of the worker’s PIA.

Insurance 101: Workers’ Compensation Insurance

U.S. labor laws require all businesses to either pay for their employee’s medical care, or provide insurance to cover such costs for any work-related medical expenses that occur while working due to a work-related accident.  Workers’ compensation is the type of insurance purchased by a business to cover such work-related medical expenses.

Regulated on the state level, but administered through the Department of Labor, businesses can purchase workers’ compensation insurance from a private company or it can purchase such coverage directly from the state.

Although all businesses in the U.S. are required to pay for work-related illness and injury of their employees, some states, known as ‘elective’ states allow employers and employees the decision of providing or not providing such insurance, while ‘compulsory’ states require all employers to provide workers’ compensation coverage for their employees.

Workers’ compensation provides benefits to cover both an employee’s medical expenses as well as providing a percentage of lost income while disabled.  The goal of this type of insurance is to make the employee ‘whole’ again, and to enable him or her to return to work as quickly as possible.

Coverage only applies to job-related illness, injury or disability that occurs while working, but does not provide for such illness, injury or disability claims that occur outside of one’s employment.  For non-work-related injury and disability coverage, it is advisable to purchase and maintain private disability insurance.

Under the Extra-Territorial Provision, an employee is covered under the workers’ compensation laws of the state in which employed, even if the employee is temporarily working in a different state.

Workers’ compensation insurance provides the following benefits:

Disability Income Benefits
Benefits that replace lost income due to an occupational injury and are paid on a weekly basis or as a lump sum (or combined).  Temporary disability is usually paid weekly, while a permanent disability is generally paid as a lump-sum benefit.

Medical Expense Benefits
Benefits that fully cover any medical treatment as a result of the occupational injury.

Death Benefits for an Employee’s Survivor
Benefits paid to the surviving spouse of a deceased employee due to occupational death.  Payments are based on the deceased employee’s average earnings as well as the number of surviving dependents.

Rehabilitation Benefits
As a result of the Federal Vocational Rehabilitation Act, federal aid is provided towards employee rehabilitation in every state to help the employee return to the workforce.