literate

Plans must provide such information in advance of any final internal adverse benefit determination so that the claimant has a reasonable opportunity to respond prior to the determination.
Plans must take additional steps to avoid conflicts of interest and ensure independence and impartiality in the appeals process. For example, plans must not make decisions regarding hiring, compensation, and promotion with respect to any individual based on the likelihood that such individual will support a denial of benefits.

A notice of an adverse benefit determination must include significantly more disclosures, including diagnosis, treatment, and denial codes and an explanation of those terms. In addition, for a notice of a final internal adverse benefit determination, the notice must include a discussion of the decision. Model notices will be issued on the websites for the Departments of Labor and Health and Human Services.

If a plan fails to comply with all requirements of the internal claims and appeals process, a claimant will be deemed to have exhausted the process and therefore will be eligible to seek external review or judicial review of the claim. This remedy is available even if the plan has substantially complied with these requirements or the error was de minimis.

In addition, the regulations require group health plans to continue coverage pending the outcome of an internal appeal of an adverse benefit determination. Plans are generally prohibited from reducing or terminating an ongoing course of treatment without notice and an opportunity to review, and individuals in urgent care situations and those receiving an ongoing course of treatment may be allowed to proceed with an expedited external review at the same time as the internal appeals process. However, the regulations do not make it clear whether this continued coverage requirement applies to appeals of eligibility claims and rescissions.

New process for external review of appeals

The regulations also provide details of the new external review process for appeals of final internal adverse benefit determinations and rules determining whether a state or federal external review process applies.

Under the new regulations, an insured group health plan that is already subject to an existing state external review process must continue to comply with the applicable state process if such process includes, at a minimum, the consumer protections set forth in the National Association of Insurance Commissioners’ Uniform Model Act as in effect on July 23, 2010 (the “NAIC Model Act”). The Department of Health and Human Services will determine whether a state’s external review process complies with the requirements of the NAIC Model Act. However, the regulations provide for a transition period, such that all existing state external review processes, including those adopted by Washington, Oregon, and California, are deemed to be in compliance with the requirements until the first day of the first plan year beginning on or after July 1, 2011.

Plans that are either not currently subject to a state external review process, such as self-insured plans, or (for plan years beginning on or after July 1, 2011) are subject to state external review processes that do not meet the minimum standards of the NAIC Model Act must comply with a federal external review process. Standards for this process will be similar to those found in the NAIC Model Act and detailed in future guidance.

New notice requirements for internal appeals and external reviews

Under the regulations, group health plans must provide notices of an adverse benefit determination and of available internal claims and appeals procedures and external review processes in a culturally and linguistically appropriate manner, including in a non-English language if 25 percent of all participants are literate in the same non-English language (for plans with 100 or more participants, if the lesser of 500 participants or 10 percent of all participants are literate in the same non-English language).

If the threshold is met, the plan must provide notice in the non-English language and include a statement in the English version of all notices, prominently displayed in the non-English language, that such notices are available in the non-English language. Once a request for a non-English notice has been made, all future notices to the claimant must be provided in that non-English language. In addition, any other customer assistance offered by the plan (for example, a telephone hotline) must be available in the non-English language.

For more information on health care reform please refer to Davis Wright Tremaine’s health care reform Web page.

You can tell a lot about a personas emotional state by looking at their face. A quick glance can give you an idea of whether a person is, say, happy or angry, allowing you to modify your behaviour accordingly.

The rapid and accurate recognition of some emotional states a particularly fear or anger a would have been advantageous in our evolutionary history. For instance, being able to determine when someone is angry with you might give you time to run away before they attack.

For this reason, you might think the way emotions are expressed on the face would be the same across all races and not substantially influenced by culture.

But new research, published in the Proceedings of the National Academy of Sciences by psychologist Rachael Jack and colleagues seems to show this isnat the case.

What are you looking at?

Facial expressions are produced by the movement of facial muscles, with distinct patterns of movement thought to convey certain expressions.

For instance, the activation of the zygomaticus major muscles leads to an upturned mouth and activation of the orbicularis oculi muscles enhances creases around the eyes, both of which are often associated with happiness.

It is often claimed there are at least five discrete, basic emotions a anger, happiness, disgust, sadness, fear a and perhaps more (surprise and contempt), each with their own characteristic facial expression.

One of the first to propose a limited number of biologically based and universal expressions was Charles Darwin in 1872, in The Expression of the Emotions in Man and Animals.

And there is strong support for this position. Certain facial expressions appear in a similar form in humans and primates, as well as infants and young children.

These same facial expressions are even depicted in identical ways by people who are born blind (that is, without the ability to see and copy expressions).

But perhaps the most convincing evidence in support of Darwinas universality hypothesis came a century after it was first proposed, with psychologist Paul Ekmanas research on cross-cultural facial expression recognition.

Ekman and colleagues demonstrated that a preliterate culture in Papua New Guinea, the Fore, as with 21 literate cultures also studied, could label facial expressions representing anger, happiness, sadness and disgust (although they could not discriminate between surprise and fear).

The Fore also generated facial expressions of basic emotions that were well recognised by other cultures.

Therefore, it seems the capacity to generate and recognise these basic expressions was not learned through media or other social influences. Instead, it had developed in isolation, providing compelling evidence in support of the universality hypothesis.

But Ekmanas research has not been without its critics. Over the past four decades there has been considerable debate about whether facial expressions of emotion are, in fact, universal or whether they are instead shaped by oneas culture.

Which brings us back to the research of Rachael Jack and colleagues.

Their paper, unambigiously titled Facial expressions of emotion are not culturally universal, casts doubt on the universality hypothesis.

Faces on a screen

Jack and colleagues created a computer program that randomly generated thousands of 3D facial movements, some of which formed characteristic patterns of facial expressions (see video below).

Observers, half of whom were Western Caucasian and half East Asian (with little experience of each otheras culture), were asked to categorise each animation as one of six basic emotions a anger, happiness, fear, sadness, disgust or surprise a or aothera, and judge the emotional intensity of each animation.

For Western Caucasian observers, the facial movements categorised as each of the six basic emotions appeared distinct and all observers identified the same emotions.

By contrast, these same distinct movements were not seen in the categorisations made by East Asians, who showed a high degree of overlap in the categorisation of certain movements. This was particularly the case between fear and surprise, as well as anger and disgust.

Other differences were also apparent between the observations of Western Caucasians and East Asians. In particular, the perception of emotional intensity in some expressions was cued by rapid changes to the eye region for East Asians, whereas Western Caucasians took their cues from other parts of the face.

This study, along with other research over the past decade, is forming a consistent argument: there are cultural differences in the kind of facial expression movements thought to constitute certain emotions.

Jack and colleagues argue that if facial expressions were once universal, they have since evolved. If this is the case, one can only wonder what kind of facial signals will evolve in the future to communicate not just internal emotions, but intentions and deceptions.

What then, does this mean for communication between cultures in our increasingly globalised world?

Well, it seems obvious that we canat assume our facial expressions communicate the same meaning to everyone.

This in turn poses interesting questions: are the feelings that underlie our facial expressions also culturally diverse? Or is it merely the external depiction of our emotions, in the form of facial expressions, that have been shaped by culture?

As always, there is much still to learn.

Megan Willis is a Lecturer with the School of Psychology at Australian Catholic University. Romina Palermo is the Associate Professor with the ARC Centre of Excellence in Cognition and its Disorders & School of Psychology at University of Western Australia.

Fully 76% of 1,520 adults polled late in March do not take tax implications into consideration every time they make an investment decision while 37% aren’t confident they’re taking taking advantage of all tax incentives available to them. And 89% aren’t certain how recent changes in federal budgets impact their personal tax situation.

This suggests many Canadians don’t fully understand their personal tax situation,  says BMO Nesbitt Burns manager of tax planning John Waters [pictured, below right]:   “People have the opportunity to pay less tax if they take the time to understand the basics and seek advice when needed.”  

Tax implications as important as risk/return tradeoffs

He suggests that when considering an investment, tax implications should have equal mindshare as risk tolerance and expected return.  BMO Nesbitt Burns is also recommending that Canadians keep in mind personal tax implications when planning their investment strategy. Waters says the 2010 federal budget introduced several measures to improve tax fairness. These ranged from tax treatment of stock options to enhancements to the Registered Disability Savings Plans (RDSPs).

In my own experience, one of the most important topics is one addressed in last week’s blog suggesting tax changes to how different types of investments are taxed. Interest income is taxed at the top marginal rate (46% in Ontario) if not held in shelters like RRSPs or Tax Free Savings Accounts. More favorably taxed capital gains and Canadian dividend income are better candidates for holding in taxable plans than interest income. Because foreign dividends are taxed like Canadian interest, they are arguably better held inside RRSPs and TFSAs.

Ironically, the Financial Literacy Task Force swept through Toronto today gathering input on how Canadians can become more financially literate. This survey is Exhibit A on why their work is needed. 

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