benefits mana 5322 dr. jeanne michalski [email protected]
TRANSCRIPT
Strategic Benefit Planning
Top- Down Approach Proactive process Regular review of benefits programs (all or part)
Backing-in approach Reactive process Reevaluate benefits when unexpected problems arise
Benefits Strategy Top Down Approach
STRATEG IC
TACT ICAL
Benefits Strategy Backing-in Approach
Tactical Question “ How should our health plan be changed to control employee health care costs?
1. What health care costs are increasing most rapidly?
Benefits Basics
Income Protection – Mandatory Social Security Worker’s Compensation Unemployment Insurance Health Care (?)
Income Protections - Non-Mandatory Health Care (medical, dental, prescription, etc) Welfare (Life insurance, STD, LTD, etc.) Retirement and Investment (DB,DC)
Pay for Time not Worked Vacations Holidays
Discussion Topics
Actions companies can take to reduce costs associated with legally required benefits. Social security Unemployment insurance Workers compensation
FLMA Issues
Health Care Costs
Discussion Topics
Creating successful Wellness Programs
Vendor Relationships
Benefits Administration considerations
Dealing with Intermittent FMLA
Have a doctor certify all FMLA leave for medical reasons. You’re entitled to ask for a second or even a third opinion.
Use a form that asks the certifying doctor for complete information on the claimed condition, including schedule of dates and times for treatments, and minimum amount of time leave will be needed.
Have the employee recertify the condition especially if patterns of abuse are apparent. This is at the worker’s expense and has proved to be a strong deterrent to bogus leave claims.
Dealing with Intermittent FMLA
Ask for a new certification for the claimed condition for each 12-month period.
Insist that the employee work with you in setting up a schedule that includes as many treatments as possible in off-work hours.
Transfer the employee to a position where absences are less disruptive. Keep pay and benefits equivalent to the previous job.
Look for obvious abuse patterns, such as the “Monday/Friday syndrome.” You are entitled to ask for recertification of a claimed medical problem if “the employer receives information that casts doubt on the stated reason for the leave”.
The Costs of Benefits
What are some of the factors that impact costs of benefit programs?
Consumer-Driven Health Plan
A type of health benefits plan that requires member responsibility for certain up-front medical costs; an employer-funded account that may be used to pay these up-front costs; and catastrophic coverage with a high deductible. Full coverage is provided for in-network preventive care.
Disease Management
People with chronic conditions — 44 percent of non-institutionalized Americans — account for a disproportionate share — 78 percent — of health care expenditures in the United States
Common Chronic Health Problems
Lost economic output associate with 7 common health problems total more than $1 trillion (includes lost time)
world at work, 2009 Cancer Diabetes Heart disease Hypertension Mental disorders Pulmonary conditions Stroke
Wellness Programs- What They Can Do
Wellness Programs
Use assessment activities to identify health risks Provide Health Screening Make self help materials available Include “self-care” programs
Nurse advice lines, software, educational materials Involve the employee’s family
Some Easy Examples of Wellness Changes Healthy foods in the cafeteria and/or vending
machines America Heart Association, American Cancer
Society, etc to conduct educational workshops Bike racks Free health screenings
HIPPA and Wellness Programs
The HIPAA nondiscrimination provisions generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, copayment or other cost sharing requirements based on a health factor. However, there is an exception that allows plans to offer wellness programs.
HIPPA and Wellness Programs
If none of the conditions for obtaining a reward under a wellness program are based on an individual satisfying a standard related to health factor, or if no reward is offered, the program complies with the nondiscrimination requirements. For example: A program that reimburses all or part of the cost for memberships in a
fitness center. A diagnostic testing program that provides a reward for participation
rather than outcomes. A program that encourages preventive care by waiving the copayment
or deductible requirement for the costs of, for example, prenatal care or well-baby visits.
A program that reimburses employees for the costs of smoking cessation programs without regard to whether the employee quits smoking.
A program that provides a reward to employees for attending a monthly health education seminar.
HIPPA and Wellness Programs
Wellness programs that condition a reward on an individual satisfying a standard related to a health factor must meet five requirements described in the final rules in order to comply with the nondiscrimination rules.
Five HIPPA Requirements for Rewards Based Wellness Programs1. The total reward for all the plan’s wellness programs that require
satisfaction of a standard related to a health factor is limited – generally, it must not exceed 20 percent of the cost of coverage under the plan.
2. The program must be reasonably designed to promote health and prevent disease.
3. The program must give individuals eligible to participate the opportunity to qualify for the reward at least once per year.
4. The reward must be available to all similarly situated individuals.
5. The plan must disclose in all materials describing the terms of the program the availability of a reasonable alternative standard.
Outsourcing Metrics