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Do Not Resuscitate Order For American Express Employees

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Healthcare Provider Update: Healthcare Provider for American Express American Express employees typically receive healthcare benefits through their employer-sponsored health plans rather than the individual marketplace. The company's health insurance offerings are generally provided through major insurers, with options varying by location and employee needs. It is essential for employees to review their specific plan details to understand coverage and benefits. Potential Healthcare Cost Increases for 2026 In 2026, health insurance premiums for plans purchased through the Affordable Care Act (ACA) marketplace are poised for significant increases, with some states reporting hikes of over 60%. A perfect storm of factors is driving this surge, including expiring enhanced federal premium subsidies and soaring medical costs. If these subsidies aren't renewed, a considerable majority of marketplace enrollees could face out-of-pocket premium increases exceeding 75%. This financial pressure will likely push many individuals and families, particularly those reliant on ACA coverage, to reassess their healthcare options and explore alternative strategies to manage costs effectively Click here to learn more

What Is It?

As a American Express employee, you have the right to decline medical treatment, even if you die as a result of your decision. Depending on your medical condition, your prognosis, and your views on the quality of life, you may wish to refuse lifesaving measures, such as cardiopulmonary resuscitation (CPR). Executing a do not resuscitate (DNR) order is one way of doing this. A DNR is a doctor's order that tells all other medical personnel not to perform CPR if you go into cardiac arrest. Cardiac arrest occurs when your heart stops beating, blood flow to your brain stops, and you stop breathing. If the blood flow is not quickly restored, permanent damage to the brain and other organs can occur. CPR simulates heartbeat and breathing, while attempting to restart these functions.

The term  CPR  actually encompasses a variety of separate procedures, including cardiac compression, endotracheal intubation, assisted ventilation, defibrillation, and cardiac medications. Most states recognize two types of DNRs. One is effective only while you are hospitalized. The other is used by people outside the hospital--for example, nursing home residents, hospice patients, and even those who are not receiving medical treatment.

Typically, terminally ill patients and elderly individuals execute DNRs to avoid prolonging their final illnesses. However, some states allow healthy adults to execute the orders, as well. Depending on the laws of your state, a DNR used outside the hospital may be called a 'pre-hospital DNR,' 'out-of-hospital DNR,' 'outpatient DNR,' 'DNR for EMS,' or 'CPR directive.' As a result of your request, your doctor generally notes an in-hospital DNR order on your chart. Out-of-hospital DNRs take various forms, depending on the laws of your state. ID bracelets, MedicAlert necklaces, and wallet cards are some methods of noting DNR status.

When Can It Be Used?

Availability of DNRs Is Determined By State Law

Not all states have DNR laws. For American Express employees, you may want to consider how your state's laws govern whether DNRs are permissible, who can execute a DNR, and what form the order must take. These laws may permit in-hospital DNRs, out-of-hospital DNRs, both of these, or neither of these. Some state laws allow any person of legal age to execute a DNR, while others permit DNRs only for individuals with terminally ill conditions. Some states allow children to participate in decisions regarding DNR in certain cases. Check the laws of your state and any other states where you spend a significant amount of time.

Strengths

Allows You to Exercise Choice In Medical Treatment

Cardiopulmonary resuscitation (CPR) has produced some miraculous results when used on normally healthy individuals in trauma situations. However, it can be a painful and even violent procedure. Its effectiveness is limited when used on terminally ill or hopelessly deteriorated patients. In some cases, CPR only delays the moment of death.

For example, CPR could restore your heartbeat, but if permanent brain or organ damage occurs during cardiac arrest, you may be dependent on life support machines. Executing a do not resuscitate (DNR) order allows you to choose a natural death.

Example(s):  Hal is hospitalized with a terminally ill condition. He is on a respirator and knows he has only a short time to live. Hal consults his doctor and learns that the laws of his state permit in-hospital DNRs. This will allow him to forego CPR if his heart fails. Hal asks his doctor to execute a DNR as soon as possible. The following week, Hal's heart stops. Because of Hal's DNR, hospital personnel do not attempt CPR.

Specifically Intended for an Emergency Situation

If you go into cardiopulmonary arrest, your DNR lets medical personnel know that you don't want CPR. Because of the emergency nature of this situation, other types of advanced directives are usually not timely enough to accomplish this goal.

Tradeoffs

Extremely Limited Usefulness

Although a do not resuscitate (DNR) order is a very powerful instrument, it is only effective under specific conditions. Generally, a DNR comes into play only if you go into cardiac arrest, and it frequently only allows you to refuse cardiopulmonary resuscitation (CPR), although in some states it may allow you to decline other drastic medical treatment as well. A living will or durable power of attorney for health care may be needed to convey other medical treatment instructions, such as your wishes regarding life support and intravenous feeding.

Out-of-Hospital DNR May Not Be Effective In Other States

As a American Express employee, it is beneficial to understand how an out-of-hospital DNR that is valid in your state may not be valid in other states. Therefore, if you spend a significant amount of time in another state, you should find out whether that state's laws recognize DNRs, whether you are eligible to have a DNR in that state, and what restrictions are placed on the form of the DNR.

Doctors May Be Hesitant to Broach This Topic or Reluctant to Write a DNR

If you are hospitalized with a serious illness, your doctor may not bring up the option of executing a DNR. If you don't want to be resuscitated, you should initiate this discussion with your doctor. Also, studies indicate that many doctors are slow to write DNRs, even when they are aware of their patients' preferences, although the reasons for this vary. If you are a American Express employee and want to ensure your wishes are followed, you should touch base with your doctor to make sure the DNR is placed on your chart.

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How to Do It

Research Your State's Laws Regarding Dnrs

Not all states provide for these orders. Each state has its own eligibility requirements, particularly for out-of-hospital DNRs.

Discuss Your Wishes With Your Doctor

Your doctor should be able to provide information on your prognosis and counsel you on your options. If you are a American Express employee, your doctor's signature will most likely be required on any DNR you execute.

Execute Your Out-of-Hospital DNR Properly And Keep It With You

If you are a American Express employee interested in DNR, you must consider how if your state allows out-of-hospital DNRs, there is probably a required format for the order. Examples of state-required DNR formats include ID bracelets, necklaces, wallet cards, and letter-size forms. If your DNR is not in the required form, it may not be honored. If medical personnel can't find your DNR order, they are obligated to give full and immediate care. Thus, it is extremely important to execute your DNR order properly and keep it with you (or in an appropriate place) at all times.

Example(s):  Hal is a resident of an assisted-living facility. Hal is 89 years old and feels he has lived a good life. He does not want to die in a hospital or be dependent on machines for his survival. Hal discusses his feelings with his doctor. Hal's doctor suggests executing an out-of-hospital DNR, which will instruct medical personnel not to perform cardiopulmonary resuscitation (CPR) if Hal goes into cardiac or respiratory arrest. Hal agrees and receives an ID bracelet noting his DNR status. Hal wears his bracelet faithfully. Six years later, Hal's heart fails as he jogs in the park. Medical personnel arrive on the scene, but immediately notice  Hal's DNR ID bracelet. CPR is not attempted.

Tell People About Your Decision

In general, other people cannot reverse your decision once you execute a DNR. As a American Express employee however, if your DNR is misplaced or for some reason is not followed, it would be important for your family and friends to understand your wishes. Although this topic may be difficult to discuss, those close to you are more likely to support and uphold your decision if they understand how you feel and why you feel that way. If you have appointed a representative in a durable power of attorney for health care (DPAHC) , it is especially important that this person be aware of your decision.

Coordinate All Advanced Directives

Since a DNR is so limited in scope, you may wish to establish a living will and/or DPAHC as well. If you do so, make sure your wishes are stated consistently throughout these documents. In some states, the most recent document will govern if there is a conflict, so you must make sure your wishes are clear.

Tax Considerations for American Express Employees

Income Tax

None

Gift And Estate Tax

None

Questions & Answers for American Express Employees

What If You Go Into a Coma Before Executing Your DNR, And You Can't Express Your Wishes?

Your healthcare representative, if you have appointed one, may be able to have a DNR executed on your behalf. As a American Express employee, there must be evidence that this is what you would want. You might include these instructions in your durable power of attorney for health care , especially if the laws of your state do not allow out-of-hospital DNRs. Be aware, however, that this method of instruction is useless in an emergency if your representative is not present. In some states, with your family's consent, your doctor may be able to execute a DNR on your behalf. Again, it would be unwise to rely on this course of action in an emergency.

Can You Change Your Mind?

Yes, it is possible to revoke a DNR order. If you have an out-of-hospital DNR, you may be able to revoke it by simply removing the bracelet or the wallet card. However, some states also have a database of DNR patients. If this is true in your state, you may need to take additional steps to revoke your DNR. When your doctor writes the DNR, ask what steps are necessary to revoke the order.

Additionally, medical personnel must give emergency care to anyone who requests it. For example, Emergency Medical Service guidelines in Wisconsin instruct personnel to perform cardiopulmonary resuscitation (CPR) if a person rips off his or her DNR bracelet or asks for CPR during cardiac arrest.

How does American Express ensure the adequacy of retiree medical coverage options for employees, especially in aligning with the current healthcare needs specific to its retirees? What factors does American Express consider when determining if changes to the retiree medical plan are necessary, particularly concerning federal and state regulations?

Comparison of American Airlines' 401(k) Plan to Others in the Airline Industry: American Airlines' Super Saver 401(k) plan typically includes employer matching contributions and a variety of investment options, which is common across major airlines. However, the specific matching percentages and investment fund choices may vary, so it's important for employees to compare these details to other airlines to determine where they can maximize their benefits.

In what circumstances can employees of American Express change or cancel their retiree medical coverage? What procedures does American Express recommend to ensure that changes in status or eligibility do not result in gaps in health insurance coverage?

Historical Changes After Bankruptcy: Employees should note that after American Airlines’ Chapter 11 bankruptcy filing, there may have been changes to retirement plans, such as revised matching contribution rates or plan restructuring. Current employees need to understand how these changes affect their retirement savings and future benefits.

As American Express continues to evolve its healthcare offerings, how does the company assess employee satisfaction regarding retiree medical plan options? What mechanisms does American Express use to gather feedback from retirees about their medical plans, and how does this feedback inform future plan design?

Financial Planning Resources: American Airlines probably offers resources like financial counseling, retirement calculators, and online planning tools to help employees assess their retirement readiness. Employees can access these resources through HR or their benefits portal to make informed decisions about their future.

What should American Express retirees know about their rights under ERISA concerning their retiree medical benefits? How does American Express communicate these rights to its employees to ensure awareness and understanding during the transition to retirement?

Maximizing Contributions: Employees should ensure they contribute the maximum allowable by the IRS, currently $22,500 per year (2024 limit), or $30,000 if age 50 or older, to maximize their tax benefits and company match. Understanding the annual contribution limits helps employees avoid over-contributing while still taking full advantage of their plan.

How can employees of American Express contact the company for more information regarding their retiree medical plan options? What specific resources or contact points does American Express offer for retirees seeking detailed guidance on medical benefits?

Contacting HR or Benefits Administration: Employees can typically contact American Airlines’ HR or benefits administration through a dedicated helpline or online portal to inquire about the Super Saver 401(k) plan or other retirement-related concerns. Timely communication ensures employees receive the assistance needed for a smooth retirement process.

With the current political climate we are in it is important to keep up with current news and remain knowledgeable about your benefits.
American Express offers a Defined Benefit Pension Plan and a 401(k) plan with company match. The pension plan provides a monthly retirement benefit based on years of service and salary. The 401(k) plan includes various investment options and financial planning resources.
American Express announced a restructuring plan in 2024 involving significant layoffs and changes to employee benefits. The company aims to streamline operations and cut costs in response to economic pressures. The restructuring includes adjustments to pension and 401(k) plans, focusing on reducing long-term liabilities.
American Express provides RSUs to its executives and key employees. RSUs typically vest over a three to four-year period, promoting long-term goals and company loyalty.
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For more information you can reach the plan administrator for American Express at 200 Vesey Street New York, NY 10285; or by calling them at (212) 640-2000.

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