Health Wellness ProgramHealth and Wellness Programs and Wellness Program Consulting

For most firms, voluntary benefits are a win-win arrangement. But there may be hidden risks.

On the positive side, voluntary benefits cost companys next to nothing, yet improve employees’ morale and benefits satisfaction.  An Aon survey found 77% of organizations offer at least one voluntary benefit.

But what happens if there’s a legal dispute between one or more of your workforce and the vendor?

In many cases, employers unwittingly get dragged into court.  The provider may argue that the plan is covered by ERISA, and the employee’s lawsuit should instead be filed against his or her employer.

When the court agrees, the legal burden shifts.  Some courts have ruled that a voluntary benefits might  be covered under ERISA, even if it wasn’t an company’s intention to formally “sponsor” the plan.

When push comes to shove, the providers will protect themselves. In truth, some attorneys warn that a voluntary plan insurer’s first move when sued by one of your staff will be to try to get the legal burden shifted from itself to you.

Two seemingly innocent things that may be turned against you in court –

• The written announcement to tell staff members about the new voluntary benefit, and

• getting involved when there’s a dispute between an worker and the plan vendor.

Be cautious with announcements When you offer a new voluntary benefit, the natural tendency is to attempt to get staff members pumped up to participate. But you are able to get in trouble if individuals  get the impression the firm endorses the plan. Helpful practices –

• Don’t put the announcement on organizational letterhead

• Put a disclaimer on the description

•  either exclude your voluntary offerings from employees’ benefits manuals or list them separately, and

• hold open enrollment at a different time than for ERISA plans (401(k), main health plan, etc.).

Moreover, when the vendor offering the voluntary plan has competitors, you might want to remind staff members the vendor of the voluntary plan isn’t the only game in town. Some firms pass along lists of competing vendors.

Prevent involvement in disputes as with your ERISA plans, chances are staff members will come to you when they have a problem with a voluntary plan. Your first inclination is to help.

But many experts warn it’s better to stay out. Reason –  Courts see this as the action of a plan sponsor. But you are able to steer someone in the right direction (e.g., giving a contact name to call) while remaining neutral in the dispute.

Good intentions gone bad

From an ERISA standpoint, the most perilous voluntary plan design is one that is partially paid by the company, even if workforce pay the bulk of the cost.

In a major ruling several years ago (Burgess v. Cigna Life Insurance), a U.S.  district court ruled against an corporation with a voluntary supplemental disability plan in which the firm compensated a portion of premiums for its lower-compensated workforce.

While most personnel paid the entire premium – and firm made clear to people  the plan was a voluntary benefit -the court said it didn’t matter.  The act of contributing to some employees’ premiums made it an ERISA plan.

In the last few years, “presenteeism” has become an even larger concern for many corporations than absenteeism. Although many HR/benefits managers hate the admittedly overused term, presenteeism is however a real issue in nearly every worksite.

Most commonly,  presenteeism takes the form of workforce coming to work sick. They’re  unproductive and endanger coworkers. Meanwhile, the worker is not forced to use a sick day. A bad deal for companys all the way around.

A recent survey by LifeCare revealed that 93% of staff (polled from 1,500 businesses) admit that they at least ocassionally come to work when they’re sick enough to stay home. More important, the research study  looked at the reasons why folks do it.

Troubling rationales

The No. 1 reason employees cited for coming to work sick was a belief that they’d be “letting other individuals  down” when they call out. Almost 30 percent of respondents cited this as their main reason. Beyond that, the top responses were –

• It’s too risky, due to office politics or culture, to take time off (26%)

• The worker is too busy at work to be able to stay home a day (15%)

• The employee saves up sick days for childcare/eldercare emergencies (12%), and

• The employee saves up sick days to use as additional vacation time (8%).

A lot of of these rationales are troubling to HR/benefits managers.

In the first place, supervisors who hassle personnel about taking legitimate sick leave are, at best, being pennywise and poundfoolish.  Presenteeism costs more than absenteeism, once you figure in the uncharged sick days, lack of productivity and risk of other personnel getting sick.

You’ve more power than you think to change your business culture if the “tough it out” mentality still applies to individuals  who come in sick. When senior level management is confronted with the real dollars and cents of presenteeism, lowering the problem generally becomes a priority.  At the very least, firms shouldn’t invite it.

In terms of supervisor- and employee-education, repetition of the “stay home if you’re sick” message is the key. Eventually, it’ll sink in.

Of course, there’s still the problem – as evidenced by the survey – of workforce who misuse their sick days by trying to hoard them for other purposes.  

Adopting PTO, no-fault absence policies or use-it-lose-it sick leave are the three most common ways of lowering the risk, but be aware that each of these policies have risks of their own.

At the end of the day, the more open the lines of communication are between executive management and staff, the less prevalent the presenteeism problem becomes.

In many segments of society, we  hear about ethnic and racial profiling in negative ways. But what about when it comes to wellness programs?  

When used for the specific purpose of starting – or reviewing  - a wellness or disease management program, profiling isn’t just legal. It’s also encouraged.

Affects health risks

Different ethnic and racial groups tend to be more at risk – for genetic and/or cultural reasons – of certain medical problems. Examples –

• African-American, Latino, Native American and Pacific Islanders are  at higher risk of diabetes than Caucasian employees

• Chinese women are statistically twice as likely to get cervical cancer

• Caucasians have disproportionately high rates of obesity and high blood pressure, and

• Latinos have higher rates of asthma and chronic obstructive pulmonary illness than other groups.  The HIV/AIDS population is also disproportionately Hispanic.

Bottom line –  By investigating  the ethnic breakdown of your staff member population, you can set disease management (DM) program priorities with greater confidence and accuracy.

Health Care quality an issue

A few studies also show there’s an unfortunate relationship between ethnicity and quality of health care. A lot of times, minority workforce receive inferior treatment and health education at the same facilities where others receive top-notch care.

This typically happens for innocent reasons. A common scenario –  a lack  of Spanish-speaking physicians in the network for your Latino staff. But the result is typically higher health costs for you and, often,  greater reluctance among minority staff to seek needed treatments.

By profiling workers against the physicians in the network, you ultimately help workers get the care they need and the corporation to better control long-term costs.

Almost two-thirds of businesses with wellness programs offer workforce incentives – financial or otherwise – to participate.

But only one firm in five has seen major improvement in employees’ health status (and lower costs) within two years of launching the incentive. Here are three keys to getting good results – and a red flag for failure.

Cancer screenings pay off big

Most wellness programs feature health-risk assessments for things like high cholesterol and diabetes. But many overlook the need for early detection of cancer, which can affect any employee, regardless of his or her age or general health.

In many cases, you can line up certain screenings, like skin cancer detection (the most common kind of cancer and, in its early stages, the most easily treated) for free or at a nominal cost.

These resources are often available through community agencies or the American Cancer Society. More involved and costly screenings – like mammograms – are well worth the cost.

A single case of cancer identified early generally saves thousands of dollars in medical claims and disability costs – not to mention trauma for the worker.

Smart staff member wellness incentives

HIPAA has tricky non-discrimination rules for offering staff a break on premiums or copays. You needn’t worry about health insurance portability and accountability act (HIPAA) when you –

1. Structure the wellness program as a cost-break for workers who embrace wellness. on the flip side, imposing surcharges for uncooperative workers can force you to jump through health insurance portability and accountability act (HIPAA) hoops.

2. Make the incentive available to all staff members. for  instance, when you offer a discount to non-smokers, an staff member who lately quit smoking must also be eligible.

3. Allow employees who fail to earn the incentive to have another shot at it next plan year.

Bottom line –  Make the financial incentive a reward, not a punishment. Do the incentives work? If they’re done right, yes.

Firms offering monetary rewards for wellness ordinarily save about $20 to $50 a month, as reported by some estimates.

Making wellness programs simple

A lot of firms require staff members to work with an individual “health Coach” to earn premium discounts or other incentives. Normally, the staff member sets up appointments and reports to the health coach on a regular basis, either by phone or in individuals.

The good news –  the early results are often stimulating.

The bad news –  Once employees realize there’s ongoing effort involved, many lose interest. But many firms have found a simple alternative. Rather than having participants contact the wellness Coach, the wellness coach calls them.

In many cases, this minor health promotion program tweak keep folks on the right track and cuts dropout rates.

Wellness begins upstairs

No matter how much money your company spends on wellness, the odds of success depend largely on the example set by top management.

Example – When your Chief Executive Officer (CEO) is a smoker, chances are few workforce will buy into a smoking cessation program.

Similarly, it’s hard to sell workers on subsidized gym memberships when your organization culture is sedentary. for wellness to work, the top brass must practice what the firm preaches.

Are your health care programs delivering on your vendors’ promises?

Just as importantly, how can you hold providers accountable when you’re not getting what you compensated for?

Here is one proven way – Develop a vendor scorecard. Scorecards alone won’t bring down your healthcare costs. But they’ll at least help make certain your organization – and staff members – get everything you’re compensating for.

The tool can help you measure plan performance with greater precision – and identify specific areas that need improvement. Best of all, any corporation can adopt the technique to fit their needs. Here’s how it works.

1. Pick specific rating areas

Benefit pros who’ve successfully adopted the scorecard system recommend grading providers on five to 10 measurable areas, like –

• Claims processing. Are employees’ medical claims turned around in a timely fashion? Are you hearing complaints that the explanations of benefits (EOBs) are slow to arrive or hard to understand?

• Disputed and resolved claims. Do worker questions and complaints about denied or still-pending claims get answered quickly and thoroughly? Precisely how often are you forced to go to bat for employees?

• Accessibility. Are plan reps quick to answer phone calls? Do they attend regularly scheduled meetings?

• Reports. Do you receive timely paid claim and utilization reports?

• Open enrollment. Did you receive effective support preparing for and conducting open enrollment events?

• Staff Member education. Do your workers find the written and/or one-on-one services provided through the plan helpful in answering questions about managing specific chronic illnesss (like diabetes or depression)? Do you receive support in educating your workers to make healthy lifestyle choices, like use of tobacco cessation?

2. Choose a workable rating scale

There are two schools of thought when it comes to picking  a rating method –  subjective or objective. A lot of benefit pros – in particular those from smaller firms – use a simple pass/fail or 1 to 5 score to rate their satisfaction.

Others develop more elaborate, statistic-based ratings. One method –  take the vendor’s guarantees (e.g., addressing disputed claims within 3-5 business days) and then measure by percentage how often these goals are met.

These rating data can be acquired through quarterly performance reports, worker surveys, issue and complaint files and, for larger plans, external audits.

3. Feedback causes improvement

It’s good practice to share your scorecard system with the provider before meeting to review the results. Reason –  This lets you iron out any provider questions about the review categories and scoring system.

Once that’s settled, you can meet to go over the numbers and prioritize the areas that need improvement. Many firms then add a new scorecard category – providers’ followup.

At the end of the day, is it worthwhile to ban use of tobacco on the premises at your business?

It depends on the steps you take to support employees attempting to kick the habit, finds a recent published study .  The Journal of Tobacco Policy and Research found that smokers do, in truth  take more sick days than their non-smoking peers.

And even when the smoker is in relatively good overall health (i.e., isn’t obese, does not have chronic health conditions), he or she’s still likely to have higher health costs than a comparable non-smoker over the last three years.

Just how does a smoking ban fit into the cost equation? If the smoker quits, health costs even out.

But if the individuals only refrains from use of tobacco on the job – but continues puffing away at home – the company sees little to no healthcare cost decrease.  The research study  found similar patterns for absenteeism.

Bottom line –  A workplace smoking ban in combo with a smoking cessation program gets results. A smoking ban alone ordinarily doesn’t.

In the last few years, there’s been a rising trend for public companys – not just private corporations – to ban tobacco use. Here is what your peers are doing.

What’s New in Benefits and Compensation lately surveyed 374 of our readers from both the private and public sectors to determine their organization’s policy on authorizing workforce to smoke on-site and hiring smokers in the first place. Here’s what we found –

• 11% have created a policy of hiring only non-smokers

• 17% allow staff to smoke offsite, but ban it on all company property

• 39 percent restrict tobacco use to designated areas outside the building

• 30% allow tobacco use anywhere outside the building, and

•  3% allow tobacco use in break rooms or other indoor areas.

Public employers get aggressive

While much of the publicity about no-hire policies for smokers centers on private organizations, it’s actually public companys in certain states who’ve been the most aggressive of late.

For example, Florida is one of the states at the forefront of the movement. Sarasota County lately became  the third Florida county to take a no-hire stance for control health care costs.  

New hires must take a drug test that detects nicotine and sign a pledge certifying that they haven’t smoked in the past 12 months.

The ban won’t affect current workforce, but the county has undertaken use of tobacco cessation programs aimed at employees’ wallets.

Non-smokers pay less for coverage through various incentives and the county covers the cost of participating in tobacco use cessation programs.

The reason why Florida public corporations can easily take these steps –  the state supreme Supreme Court has ruled that refusing to hire smokers does not break discrimination laws.

But your state laws may vary, so proceed with caution before considering similar policies.

Quitting use of tobacco at any age can improve a person’s health.  And believe it or not, older personnel often fair better with use of tobacco cessation than younger employees.  

According to the Journal of American Medicine, Duke University reseearchers tracked 573 older patients over 10 years. They found that just 16% of those who joined the smoking cessation program later returned to smoking.  

Previous research has found young smokers who try to quit have a 35% to 45% relapse rate within two years.

Given that personnel nationwide are retiring later and the cost of retiree healthcare is sky high, you might want to keep trying with use of tobacco cessation programs, even for the oldest personnel on your health plan.

In this recession economy and out-of-control staff member debt, many businesss who don’t have automatic 401(k) enrollment have seen participation drop.

Here’s how one small business in Arizona cleverly tied 401(k) education to employees’ other financial concerns. Rather than simply holding its usual 401(k) open enrollment education meeting, it held a “financial health fair.”

Stressed 401(k) importance

Exactly how it worked –  on the same day the company’s 401(k) vendor sent a plan rep to discuss the retirement plan, the corporation also arranged for a certified financial planner to speak to workforce.

The financial planner went first. She began the session by pointing out that she wasn’t affiliated by any method with the management of the 401(k) plan.

That was vital both for the company’s legal protection under ERISA and for building trust with workforce. She then discussed why it’s vital for individuals  to take part in the 401(k) plan, and offered attendees budgeting tips and basic strategies for cutting their debt.

The financial planner’s talk cut to the heart of several major issues that hurt both worker salary satisfaction and 401(k) participation. Numerous studies show that the No. 1 reason many people  avoid 401(k) participation is that they feel they can’t sacrifice any part of their entire paycheck and still survive financially.

The second part of the session was the standard 401(k) enrollment presentation from the vendor. End result – Workers were more attentive and there was a noticeable uptick in both new 401(k) enrollments and salary contributions from already-enrolled workers.

The event was such a smash that the company plans to make the Financial Health Fair a regular part of 401(k) enrollment. While the financial planning advice is generic (the company may add third-party personal finance planning as a voluntary benefit in the future), it’s also timely.

The 401(k) signup appeal comes while the financial planning tips are still fresh in employees’ minds and they’re aroused to do something to help themselves.

Looking for incentives to get overweight workers to buy into a health promotion program? A recent published study  suggests many workers are even willing to pay much – or all – of the cost themselves.

Roughly 35% of firms with health promotion programs focus on providing workforce with convenient access to weight loss resources.

A poll of 1,352 staff members by the Strategies to Overcome and Prevent Obesity Alliance found that many people  would gladly chip in for the cost of the health promotion program if they believed it’d help them lose weight. What staff members want –

• confidential support and counseling

• Access to a expert nutritionist or fitness trainer, and

• on-site fitness programs.

Until lately, only large businesses were able offer such health promotion programs as part of their wellness benefits.   But the fastest growth of these health promotion programs in the last two years has been in smaller firms (sometimes with as few as 50 full-time employees).

The majority of firms split the cost with staff members. Typically, staff members pay up to about 25 percent of the cost. But some plans are fully employee paid.