Employee wellness plans and employee wellness programs

It’s tough to get personnel to take part in benefit programs that they don’t even know exist.

Seventy-one percent of employees lack basic knowledge of standard benefit programs, as reported by a new study by the American Payroll Association (APA).

Low participation rates

The ASA research study  focused on staff members knowledge of their company’s pre-tax benefits. While nearly three quarters of staff members say they live paycheck to paycheck, and would like to stretch their current salaries -

o  52 percent don’t take part in available flex spending accounts (and 6 percent of had never even heard of an FSA)

o  17 percent didn’t know their company offered a health savings account or health reimbursement arrangement (46 percent of those cognizant of the benefit still don’t participate), and

o  18 percent are unaware of existing transportation benefits or subsidies their company offers.

Compliance with HIPAA non-discrimination rules is a large challenge for health promotion programs.  The old rules were unclear about which incentives passed muster.

That’s all changed, with the rules established earlier this year by the DOL and United States  Treasury Department.  The rules themselves haven’t changed, but they’ve been clarified. Here is what you need to know -

â..Participation incentives’ are fine

As long as you structure incentives as rewards for wellness participation, the new rules provide a lot of freedom. All of these are fine under HIPAA -

o  reimbursing all or a portion of the cost of fitness center membership

o  financial rewards for undergoing health risk assessments so long as the reward is based on participation rather than test results

o  stimulating preventive care by waiving co-pays or deductibles for these services (i.e., well-baby visits or prenatal care)

o  reimbursing staff for the cost of tobacco use-cessation programs without regard to the result, and

o  offering rewards tied to workforce attending a monthly health education seminar or working with a wellness Coach.

Conditional rewards OK ifâ..

But what if you want to make the reward conditional on participants meeting specific health goals? Example – Workers who achieve a cholesterol count under 200 get a 20 percent reduction in the cost of their health plan contributions pending results of an annual cholesterol test.

The feds say it’s OK under health insurance portability and accountability act (HIPAA) to do this, too, but your plan must meet five additional requirements -

o  The reward can’t exceed 20% of the cost of employee-only (or, if you allow dependents to participate, employee-plus-dependent) coverage under your health plan.

o  The standards must be reasonable (e.g., you can’t limit rewards to folks who can run a marathon).  The rewards also can’t be used as a backhanded way to adversely single out certain personnel (e.g., rewards for all non-diabetics).

o  Participants must’ve the opportunity to qualify for the reward at least once annually (e.g., a smoker who fails to quit this year gets another chance next year).

o  Rewards ought to be available to all “similarly situated person.” In other words, you can’t make a company-paid weight management program available to certain staff but not others.

If, for medical reasons, it’s unreasonably challenging for a personal to satisfy conditions that are otherwise reasonable, you have to offer an alternative. Example –  A pregnant employee might not be able to meet certain standards, so you have to offer her an alternative.

Negative incentives violate HIPAA

So what’s not permitted under health insurance portability and accountability act (HIPAA)’s non-discrimination rules? Anything that punishes people  for their health conditions or health risks.

The rules prohibit businesss from charging different premiums, contributions, co-pays or deductibles based on personal health factors such as obesity or smoking. Nevertheless, it’s OK to reimburse these expenditures based on someone’s participation in your wellness program, without regard to success.

In addition, the feds have added an important new non-discrimination rule – Corporations’ medical programs can’t deny benefits for treatment of injuries resulting from a medical condition, even when the condition wasn’t diagnosed before the injury.

For example, some health care programs have a “suicide exclusion” that denies payment for treating self-inflicted wounds from a suicide try. Now let’s suppose the worker suffers from clinical depression. Even when the depression was undiagnosed prior to the suicide try, it’s illegal for your plan to deny benefits to this worker.

Ever set out to organize and dispose of old employee files and paperwork in the office? the job is tougher than it seems.

Best practice – Develop a records retention policy as your first step. A host of federal and state laws specify how long you must retain pay- and benefits-related documents.

Compliance is essential if a current or former employee sues or the DOL, IRS or the state audits your records.

Here is a records-retention schedule recommended by employment lawyer Jacqueline McManus -

o  Retain for two years worker personnel files, including performance reviews and training.

o  Hold these for three years –  wage records, including time cards, base pay and overtime wage-rate calculations and records explaining wage diferentials for staff members performing the same job, and hold I-9 forms for three years from hire date or one year after termination, whichever is later.

o  Keep these four years –  all Payroll documents, including – home address records, and all wage records, including weekly OT earnings, straight time pay, deductions, bonuses, pay period designations and payment dates.

o  Use a five-year retention window for worker health info like medical and first-aid records from on-the-job injuries, and drug and alcohol testing records.

o  Keep this benefits data for six years (or one year after plan termination) –  elections and enrollment forms, benefit change documents, and COBRA notices.

o  Retain 401(k) files indefinitely.

Many businesss attempt to reward personnel during the holidays. But be cautious -

There’s a common misbelief that the IRS considers gift cards worth $20 or less de minimus benefits and, as a result, they’re tax free. Unfortunately, that’s not true.  With few exceptions, the IRS considers almost anything with cash value a taxable form of compensation.

Practically speaking, the IRS is unlikely to go after your firm or an employee over a few small-value gift cards for which you withheld no taxes. But they could, particularly when your firm regularly hands out gift cards.

At some firms, those $5 to $20 cards can add up to several thousand dollars worth of unpaid taxes in several years. Each $15 gift card would usually require about $5.55 withheld.

To be safe, you can use gift cards sparingly and pay the tax for the recipient. Or else you can educate folks proactively that Uncle Sam requires you to take out for taxes.

Read the fine print

Gift cards could be money-wasters or or morale-killers when personnel have a bad experience attempting to redeem them. Read the fine-print before you buy. Three common pitfalls to watch -

o  expiration dates. Some retailers offer cards that last forever. But many have expiration dates, rendering the cards worthless after a period of time

o  dormancy fees. A $50 card can end up worth only $40 at stores that deduct “dormancy fees” after a certain period of time, and

o  redemption fees. Some stores charge a fee for redeeming cards that may be used in multiple locations.

The good news –  There are some good deals out there. Business use of gift cards has doubled since 2001, and related sales bring in $20 billion a year to retailers. With such fierce competition, it compensates to shop around.

In recent years, it’s become increasingly common for companys with as few as 200 workforce to explore self-insurance. But beware of hidden traps.

If your corporation is weighing self-insurance â.” or has already taken it â.” here are three pitfalls that can create unexpected costs.

1. Unfavorable worker mix

It’s impossible to completely eliminate the risk of unexpected, high-dollar health claims. But here’s a guideline to reduce your risk. Health claim stats suggest the “ideal” worker population for a self-insured plan is predominately young, non-use of tobacco and male.

Be aware that stop-loss insurance carriers often “laser” those employees considered higher risk. Lasering means that your corporation would’ve to pay out much more in claims for these employees before the stop-loss coverage kicks in.

2. Loss of network discounts

Some firms learned after the fact that going the self-insurance route caused them to lose providers’ network discounts they previously received under fully insured plans. When reviewing  plan vendors’ administration-only choices, ask -

o  Will the provider’s network alliances work in your best interests, cost-wise?

o  Will the provider only oversee claim payments or negotiate to build the best provider network, quality-wise, for your employees.

Bottom line –  You ought to get the same types of plan designs, networks and discounts as a fully insured plan.

3. Wasteful reinsurance contracts

When the language of your reinsurance contract doesn’t match your health plan’s summary plan description, you could be paying for coverage you don’t need and can never use.

It’s also key to be certain your firm has enough money in reserve to cover run-out claims and other costs that may occur before reinsurance will cover payments. Best practice –  annual audits of your financial reserves.

Evidence-based medicine has become a large buzzword in healthcare over the last few years. But certain non-traditional treatments, like chiropractic care, may also prove effective in certain cases.

The key –  Using these treatments and to â.” not in lieu of â.” conventional medicine may prove more cost-efficient in the long term.

What the latest research says

Do these five common complimentary treatments belong on your health plan? Here’s what recent research suggests -

1) Chiropractic care. Studies suggest these treatments may help cut absenteeism for personnel with uncomplicated lower back pain, particularly for people  who’ve had it for less than a month.

2) Acupuncture. Research studies show acupuncture can help relieve osteoarthritis, chronic migraines, post-operative pain, low-back pain, fibromyalgia and carpal tunnel syndrome. There’s less evidence about its effectiveness as a tandem treatment for other conditions.

3) Acupressure. There’s no meaningful research to show this needle-free variation of acupuncture (a therapist applies pressure to specific points on the body) has the same medical benefits.

4) Biofeedback. As reported by the Mayo Clinic, there’s now some research to suggest this treatment can help with some kinds of chronic pain, specifically tension headaches and muscle pain.

Precisely how it works –  Monitors display a patient’s heart rate, breathing patterns, body temperature and muscle activity. A therapist then teaches the patient how to lower these readings via relaxation.

5) Aromatherapy.  As yet, there’s no evidence of direct medical benefits. While it can be a relaxing treatment to reduce stress, few firms â.” if any â.” foot the bill on employees’ behalf.

When an employee ignores directions from a physician, who’s responsible when the employee causes a serious accident on the job?

In some cases, it’s your firm that ends up on the hook â.” both for workers’ comp and for other individuals ’s injuries caused by misuse of a prescription drug.

Situations such as these raise three questions that even HR/benefits pros have trouble answering. Just how are you â.” or supervisors â.” supposed to know what meds people  are on and whether they’re taking them as directed by their physicians?

In most cases, you won’t.

Are you able to find out without violating health insurance portability and accountability act (HIPAA) or other laws?

You can’t, unless the staff member volunteers the info or a physician notes the effects of medication being the reason for the accident.

So when you won’t know and can’t find out, how on earth can your firm be held responsible after the fact?

It all depends on the circumstances. Three key danger signs -

o  A supervisor already has knowledge of an employee’s health condition, if not the meds themselves. Example –  the staff member requested a schedule change and said it was as a result of a particular health problem

o  The person has a history of erratic behavior that management suspects is medication-related, and/or

o  The employee’s job involves potentially dangerous situations.

Spotting possible danger

A Florida case (Johnson v. Rentway) is a classic example of the two of the three large danger signs.

1.  The supervisor knew an employee had insulin-dependent diabetes.

2.  The staff member was under doctor’s orders to take insulin at specific times, which required the organization to adjust the employee’s schedule.

But because of short staffing, the employee was often forced to work shifts that overlapped with times he was supposed to take injections.

What’s more, the worker worked a potentially dangerous job (he was a professional truck driver).

In conclusion, the inevitable happpened.  The employee suffered a diabetic blackout at the wheel, causing a serious crash that injured himself and another driver.

The employee filed for workers’ comp, and the injured driver sued the organization.  The firm fought â.” and lostâ.” both cases. Total cost –  $5 million.

Having even one problem drinker on your medical plan – including a covered family member with abuse issues â.” can cost your organization big.

Some estimates place the potential cost as high as $35,000 a year per case. What’ your company’s risk?

Many wellness programs are geared toward managing employees’ health risks associated with illnesses like diabetes or asthma.

But unless the wellness program is integrated with an employee assistance program (EAP), chances are alcohol abuse-related risks go undetected. Here are two strategies that’re getting good results.

1. Include alcohol in health screenings

When you already sponsor confidential staff member health-risk assessments, it’s easy to screen for alcohol risks, too. This may be as simple as making sure three questions are added to the current appraisal -

o  Just how often do you have a drink containing alcohol?

o  Precisely how many alcoholic drinks do you have on a typical day? And

o  How often in the last month have you had six or more drinks?

For male workforce, more than 14 drinks per week, or one or more episodes of heavy drinking suggests a possible problem. for women, more than seven drinks in a week, or one or more episodes of drinking four or more drinks, is a red flag.

Alternative – When you don’t offer appraisals, you can refer staff to a free, confidential web-based screening.

Benchmarking tools

A lot of specialists say drug-free workplace policies and worker assistance programs (EAPs) are the two most proven solutions within companies’ grasp for minimizing the risks and costs of alcohol abuse by medical plan enrollees.

To see if sponsoring an employee assistance program (EAP) makes financial sense, you are able to calculate your own firm’s current cost risk for free here. Plug in your business kind, locale and number of workforce.

You’ll get a personalized estimate of yearly direct (absenteeism, disability, ER visits) and indirect (presenteeism, turnover) costs from alcohol misuse by a covered worker or family member.

To design a drug-free workplace policy â.” or check if your existing one is up to par and compliant with the law – more guidance is available here.

It’s easy to feel like your PBM holds all the power over you. In most cases, it does.

A landmark 2004 study compared what drug store benefits managers (PBMs) charge businesss’ plans to what they actually pay pharmacies.

Scientists found staggering overcharges – namely for generic drugs. Regrettably, four years later, the situation has scarcely changed. All too often, PBMs improve their own bottom line at the expense of the plan sponsor’s.

Chances are, it’s your health insurance provider – not yourself – who contracts with the PBM to administer the prescription drug portion of your health benefits.

So how can you feel confident your firm is getting the best value and service? Start by asking your health-plan broker these four questions about the current or prospective PBM.

1. Precisely how does the PBM calculate price?

Many PBMs gain hidden profits off your plan through a practice called “differential pricing,” says consultant Gerry Purcell.

In other words, the PBM pays one price to drug retailers and then sets a lesser discount off the typical wholesale price (AWP) for your company’s plan. Example -

o  The PBM compensates the drugstore the AWP minus 18%

o  your plan and staff members pay AWP minus 15 percent for meds, and

o  The PBM pockets the difference.

Now for some good news. You do have some leverage in this area. When your drug plan is covered beneath the ERISA umbrella, the PBM must disclose this info.

Ideally, you’ll find the rates are the same on both contracts. But if there’s differential pricing, insist your firm get the full discount.

2. What’s the PMPM?

One key cost figure PBMs can’t manipulate is the per-member-per-month (PMPM) cost of your plan. This number will show when your plan’s costs actually increased or decreased.

The PMPM is calculated by dividing the total costs spent by the number of staff enrolled in the drug plan.

It’s also a excellent tool for comparing different PBMs to see which is the most cost-efficient for the size of your company, says Peter Reed of Managed Benefits Strategies.

3. can we get rebates, too?

Some PBMs receive money from drug companies that your brokers won’t tell you about – but could  be able to leverage to your plan’s advantage. Example – Many PBMs get rebate checks from drug companies (typically 50 cents to $1.25 per claim) for assisting increase the sales of their products.

When you push hard enough for it, your broker may able to work an arrangement where you either -

o  split rebates from your plan evenly, or

o  let the PBM keep the entire rebate in exchange for a price break on administrative fees.

Important –  Ask to determine all the payment kinds the PBM gets from the drug firms. Rebates are often couched in the form of grants or classified as access fees or formulary fees.

4. How do changes in the formulary work?

In most states, PBMs can change your plan’s list of approved medications without prior notice.

The problem –  PBMs often make mid-year switches that save them money, but might not save your organization or staff a dime.

Example – When the PBM adopts a mail-order-only coverage policy on a certain formulary drug, an employee who needs same-day access to the medication might  be forced to pay full price for it at a drug store.

Meanwhile, your plan is still charged the formulary price.To avoid such unpleasant surprises, insist the PBM give written notice of formulary changes, including the addition of new generics.

The best staff member recognition practices are often the simplest.

Here’s one that’s recently been adopted at the publishing corporation where I work –  a progam called “See something good, say something good.”  It’s a way for staff to bring positive attention to things that their colleagues, managers and the company’s different departments do well.

Just how it works –  the business provides colorful index cards, placing them conspicuously in a few commonly traveled areas in the building. When staff and supervisors want to publically recognize someone else’s efforts, they can grab a card and fill it out. It takes very little time.

When the index card is filled out, the staff member drops it into a wrapped box (there are two in the building).  The boxes are later gathered and the cards displayed in a room the organization uses periodically for meetings, presentations and quarterly staff member appreciation events.

In order to build awareness and participation in “Say Something Good,” management put up fliers around the building, so individuals  from every department can see them, in addition to visitors and job applicants who’ve come in for interviews.

The wellness program, which was originally thought up by the head of our product advertising and marketing division, doesn’t cost anything apart from the cost of the index cards and paper. There’s minimal administration time, and it takes workforce only a moment or two to fill out a card on a fellow employee’s behalf.

But the return is a lot of, and the recognition possibilities are endless. It’s a good way to improve morale, encourage productivity and differentiate the corporation culture from work environments where the negative things seem to get the lion’s share of the attention.