Worksite Wellness Programs

In the near future, the federal government may offer help to corporations looking to begin a wellness program. the help would take the form of tax breaks to offset program costs.

A current United States  Senate bill would give businesss a substantial tax break for beginning wellness programs. Dubbed the Healthful Workforce Act, it calls for an business tax credit of up to $200 per staff member enrolled in a newly created wellness program.

For bigger firms, there is the $200 credit for the first 200 workers and up to $100 per employee thereafter. to qualify for the full credit, your wellness program would have to feature -

• health risk (assessment|appraisal}s

• worker education drives (e.g., targeted mailings, web-based tools)

• behavior change programs (e.g., tobacco use cessation, weight control, health coaches), and

• “meaningful” participation incentives (e.g., lower co-pays).

Certified employers would be able to claim the tax credit for up to 10 years after beginning a wellness program.

The bill has enjoyed bipartisan support, but like many things in Washington, the parties disagree over how to fund the cost of the tax credit. as a result, it has been bogged down in committee.

When and when the bill is ratified, businesss could claim the federal tax credit the following year.

In the meantime, whether or not your organization already has a formal wellness program, there are proven ways to make wellness part of the corporation culture. Best of all, they don’t have to cost an extra cent.

Wellness town meetings

It’s often said that successful wellness programs start at the top of the organization. Reason -  Workers select up fast on whether management practices what it preaches when it comes to wellness.

When the individuals  in management are smokers, obese or simply reluctant to talk about health issues, it’s a tough sell to get employees engaged in taking control of their health.

That’s the idea behind the wellness town meeting.

Once a week (or once a month), everybody in the corporation attends a short meeting to discuss their own recent efforts to get healthier.

Managers ordinarily go first, to break the ice about discussing some potentially sensitive issues like dieting or quitting smoking.

In most organizations, the meetings are arranged to encourage casual, free-flowing conversation.

One key -  Individuals  speak from where they’re seated, rather than standing up front, with all eyes staring at them.

Some organizations take a more formal approach, which can also work.  For example, at Old National Bank in Indiana, folks file into an auditorium to face their worst enemy, the scale.

Each week, everybody at the firm - from seasoned managers to the newest hires - comes in to get weighed. the only one who sees the number on the scale is the person getting weighed. Even so, the program has inspired a lot of folks to lose weight. for more on the firm’s program, click here.

Free tests and screenings

While there’s no substitute for having staff members undergo comprehensive health risk (assessment|appraisal}s, it’s also wise to home in on screening for common conditions that aren’t necessarily lifestyle related.

Example -  skin cancer. It’s not just sun worshippers who are at risk of the most common (and in its early stages, treatable) form of cancer. Heredity plays a part. So does luck.

Fortunately, companys can get their workers screened for free. Through the American Academy of Dermatology’s National Melanoma and Skin Cancer Screening program, volunteer doctors perform skin cancer screenings at no cost.

Likewise, other medical associations and public health agencies offer free or nominal-cost screenings for a variety of other common conditions.

In fact, it varies.  In some cases, an HSA-eligible plan may cost the same as a non-HSA high-deductible plan. In others, the premiums can actually be more expensive, a recent NHPI report locates.

As a matter of fact, a non-HSA plan offering similar coverage can carry a monthly per-employee premium that’s about $15 to $25 lower and a deductible that’s $500 to $1,000 lower than the HSA option.

Sometimes the difference is due to price-jacking -  the HSA plans are the ones that’ve been hyped in radio commercials and mentioned in newspapers in recent years.

Nowadays, fewer people  exploring high-deductible plans ask first about the non-HSA, so insurance companies sometimes slash prices to drum up interest in those choices, too. Another factor -  Not all deductibles work the same.

Deductible cuts both ways

Two deductibles can look similar but work differently, and the cost scales can tilt for either an HSA or a non-HSA plan. Example -  HSAs by law can no longer allow first-dollar coverage of prescription drugs. But a non-HSA plan can.

On the flip side, HSAs often feature better preventive-care coverage. In some non-HSA plans, a individuals who has yet to meet the deductible must pay out of pocket for standard tests (example -  cholesterol testing) that’re part of the routine physical. Only the office visit itself is covered.

Also, HSA-eligible plans have to follow rules that limit total out-of-pocket costs. But this can push up the premiums paid on the front end.

Best bet -  Double-check with your broker to make sure you’re comparing apples to apples when reviewing  the costs of HSA and non-HSA plans.

If your corporation has this common - and increasingly popular - fringe benefit you could be at legal risk without even knowing it.

Some companies have an on-site staff member fitness room as part of a formal wellness program. Others simply do it as a way for folks to get their juices flowing before work or blow off steam afterwards.

No matter the reason, companies with fitness rooms need to be aware that the benefit isn’t risk-free.

Over the last few years, a few privately owned fitness clubs have been sued - and agreed to costly settlements - after exercisers suffered sudden cardiac arrest (SCA) and died before help arrived. In each case, the facility either didn’t have lifesaving equipment on the premises or didn’t have personnel properly trained to use it.

Some legal specialists have expressed concern that businesss could also be at risk when the unthinkable happened on business premises while an staff member worked out.

SCA is of particular concern. Reason -  Even seemingly healthy, active adults are at risk of sudden cardiac arrest. It can’t be prevented. There’s no vaccine.

And few victims survive by the time an ambulance arrives. But there’s a way to save the employee’s life and potentially save your firm from a lawsuit.

Learning about SCA

Sudden cardiac arrest (SCA) is a frequently misunderstood killer. It’s different thing as a heart attack. SCA can affect anybody, anywhere, anytime. It occurs more than 600 times every day in the U.S., killing at least 250,000 individuals  each year.

The only hope -  using a device called an automated external defibrillator (AED) within 10 minutes.

The good news is any person at your company could be rapidly trained to use an AED - you don’t need any medical knowledge to use it. the training could be obtained for free through a local Red Cross or civic group. the devices themselves cost under $2,000.

Compare that to the financial risk of being sued for not having an AED near a workplace fitness room, and it’s a no-brainer that any company with on-site workout equipment should at least investigate an AED buy and training.

Employees, supervisors and upper-level managers alike will probably need education about SCA and AED use. A great teaching resource is available here.

Key talking points -  Without an AED, 90 percent of victims die. But when you have access to one, there’s a good chance to save an employee’s life. and it’s easy to teach supervisors and staff members how to use the device when it’s ever needed.

The vast majority of facilities with AEDs never need to use them - and that includes medical facilities. But it only takes one tragic event, and subsequent lawsuit, to cause pain for both the corporation and an employee’s family.

Remember -  Avoidance and education are always your company’s best tools for avoiding liability. In this case, where human life is involved, the choice seems rather obvious.

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

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

But what happens when there’s a legal dispute between one or more of your employees and the provider?

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 when it wasn’t an company’s intention to formally “sponsor” the plan.

If push comes to shove, the vendors will protect themselves. In truth, some attorneys warn that a voluntary plan insurer’s first move if sued by one of your staff members 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), primary health plan, etc.).

Also, when the provider offering the voluntary plan has competitors, you may want to remind staff members the provider of the voluntary plan isn’t the only game in town. Some firms pass along lists of competing providers.

Avoid 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 specialists 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 compensated by the corporation, even when employees pay the bulk of the cost.

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

While most employees compensated the entire premium - and firm made clear to  individuals  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 a lot of employers than absenteeism. Although many HR/benefits managers hate the admittedly overused term, presenteeism is nonetheless a real issue in almost every workplace.

Most widely,  presenteeism takes the form of workers coming to work sick. They’re  unproductive and endanger coworkers. Meanwhile, the staff member is not forced to use a sick day. A bad deal for businesss all the way around.

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

Troubling rationales

The No. 1 reason staff members cited for coming to work sick was a belief that they’d be “letting other individuals  down” if they call out. Nearly 30% 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 employee is too busy at work to be able to stay home a day (15%)

• the staff member saves up sick days for childcare/eldercare emergencies (12%), and

• the worker 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 staff members about taking legitimate sick time 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 staff members getting sick.

You have more power than you think to change your company culture if the “tough it out” mentality still applies to individuals  who come in sick. When  upper 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 when 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 staff members who misuse their sick days by attempting 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 decreasing 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 management and employees, the less prevalent the presenteeism problem becomes.

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

When used for the specific purpose of  starting - or evaluating  - 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 health 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 employee population, you are able to set disease management (DM) program priorities with greater confidence and accuracy.

Healthcare quality an issue

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

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

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

Nearly two-thirds of organizations with wellness programs offer employees incentives - financial or otherwise - to participate.

But only one firm in five has seen major betterment 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 type 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 - such as mammograms - are well worth the cost.

A single case of cancer identified early ordinarily saves thousands of dollars in medical claims and disability costs - not to mention trauma for the employee.

Smart worker wellness incentives

Medical Insurance Portability and Accountability Act (HIPAA) has tricky non-discrimination rules for offering staff members a break on premiums or copays. You needn’t worry about health insurance portability and accountability act (HIPAA) if you -

1. Structure the 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 HIPAA hoops.

2. Make the incentive available to all workers. for example, if you offer a discount to non-smokers, an staff member who recently quit smoking must also be eligible.

3. Allow staff members 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? When they’re done right, yes.

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

Making wellness programs simple

Many firms require workers to work with an individual “health coach” in order to earn premium discounts or other incentives. Generally, the employee 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 encouraging.

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 health coach, the health coach calls them.

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

Wellness starts upstairs

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

Example -  When your CEO is a smoker, chances are few employees will buy into a use of tobacco cessation program.

In like fashion, it’s hard to sell workers on subsidized fitness center 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 providers’ promises?

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

Here’s one proven way -  Create a provider scorecard. Scorecards alone won’t bring down your health care costs. But they’ll at least help make sure your business - and employees - 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 vendors 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 rapidly and thoroughly? 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 compensated claim and utilization reports?

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

• Worker education. Do your employees find the written and/or one-on-one services provided through the plan helpful in answering questions about managing specific chronic diseases (like diabetes or depression)? Do you receive support in educating your employees to make healthful lifestyle choices, like smoking cessation?

2. Select a workable rating scale

There are two schools of thought when it comes to choosing  a rating method -  subjective or objective. Many 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 provider’s guarantees (e.g., addressing disputed claims within 3-5 company 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 are able to meet to go over the numbers and prioritize the areas that need improvement. A lot of 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 company?

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

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

How does a tobacco use ban fit into the cost equation? If the smoker quits, medical costs even out.

But if the person only refrains from tobacco use on the job - but continues puffing away at home - the employer sees little to no health care cost decrease. the study  found similar patterns for absenteeism.

Bottom line -  A workplace tobacco use ban in combo with a tobacco use cessation program gets results. A tobacco use ban alone typically doesn’t.

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

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

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

• 17% allow workers to smoke offsite, but ban it on all corporation property

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

• 30% allow smoking anywhere outside the building, and

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

Public corporations get aggressive

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

For  instance, Florida is among the states at the forefront of the movement. Sarasota County recently became  the third Florida county to take a no-hire stance for control healthcare 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 workers, 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 businesss are able to take these steps -  the state supreme Supreme Court has ruled that refusing to hire smokers doesn’t break discrimination laws.

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