Chapter: 1

Introduction

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1.1 Introductions:

 

GrameenPhone is a dynamic and leading countrywide GSM communication solutions provider. It is a joint venture company between Telenor and Grameen. Grameenphone Ltd., the largest telecommunications service provider in Bangladesh, received its operating license in November 1996 and started its service from March 26, 1997. Now, after 13years of successful operations, Grameenphone is the largest mobile phone service provider in Bangladesh, with more than 28 million subscribers as of November 2008.

In this research, we want to know the customer perception, satisfaction of the service quality of Grameenphone.

 

1.2 Scope of the Study:

 

The study will be conducted on’ The Practice and Administration of Human Resource Management in Grameenphone Ltd. to construct a critical analysis on Recruitment and Selection. It also includes the Training, Compensation and Awards for employment perspective from a holistic point of view. This Project report covers:

 

1. Literature Review – A brief review on the theories and principles of Grameen phone Ltd. operating in Bangladesh.

 

2..Description of Grameenphone Ltd. as a company – A description of the establishment of Grameenphone Ltd. its mission, vision, goals, objectives, approaches, activities, areacoverage, administrative structure, legal entity and other information.

 

3. Various Employment Sectors and Services of Grameenphone Ltd. – The different types of products and services offered by Grameenphone Ltd.

 

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4.Human Resource planning of the organization – Overall description of HR planningsystem of the company Grameenphone Ltd.

 

5. Process of Recruitment and Selection in the organization – By identifying a specific job the total recruitment and selection process has been discussed with various issues.

 

6. Training and Development process of the organization – a brief discussion of the HR training and development process and practices of the organization.

 

7. Performance Appraisals and promotions of the organization – A brief description of theorganization’s current practice in the sectors of performance appraisals and promotions.

 

 

8. A Summery of the Findings and Evaluation – A brief description of the findings and evaluation of my study from a holistic point of view.

 

This is merely a descriptive report. Most of the data’s and information’s are collected through informal interviews with the respective executives.

 

 

1.3 Objective of the Study:

 

The main purpose of the study is to compare the theoretical knowledge with practical scenario and at the same time get an in-depth knowledge about Human Resource planning and personnel policies. In order to serve this purpose the following

 

Objectives have been satisfied:

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•To learn about the important environmental influences effecting Grameenphone Ltd.

•To learn about the HR practices of Grameenphone Ltd.

•To learn about the Organizational Culture of Grameenphone Ltd.

•To develop and recommend some implemental suggestive measures. After successful completion of the course works, this report is prepared and presented by the group members to the Project Supervisor for the evaluation of their practical perspective. The Project Report is prepared on a real life study with the text perspective in a practical way.

 

 

1.4  Sources of Data

 

All the required information were gathered at the source through informal interviews, careful observation, consultation of books, Grameenphone Ltd’s internal circulars, Grameenphone Ltd’s HR manual and office records. For this purpose the General Manager and some Executives (Admin) has been interviewed. The major sources of information for study are as follows:

 

1. Secondary Data:

a)Reports and Documents of the Grameenphone Ltd. i.e. Annual Reports, Brochures etc.

b)Internet.

c)Business and Trade Journals.

d)Newspapers and Magazines.

e) Others.

 

2. Primary Data:

a) Interview with the Grameenphone Ltd’s Employees and Personnel.

B) Observation.

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1.5 Methodology used for the Data Collection:

 

1. Literature review– A wide range of literature will reviewed to gather necessary information about the subject matters of this study. These literatures include the texts, profile, annual reports, documentation, different Manuals etc.

 

2.Observation– A thorough and insightful observation will be conducted on the variousAdministrative, Interventional and Marketing philosophies, approaches and practices tocollect benchmark information.

 

3.Interview– Study and information gathering through interviewing employees and personnelinvolved in the ACI’s interventions, administration and other activities.

 

4.Field visits– Visit to the field level activities to generated vital information and enhanced thestudy.

 

5. Discussion– Discussion with the staffs and other related persons to generated benchmark information for the study as a comprising tool and also important instructions from the project supervisor.

 

 

1.6 Limitations of the Study:

 

The major limitation of this report is that no previous study is done before on GrameenphoneLtd.’s overall HR practices. So no secondary study material was available. The study is heavily relied on observational and informational method which has its own disadvantages and not a very effective method. There is a particular department for HRM

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but they don’t share all things for their law. Although the MD and the administrative officers’ & HR officer’s give someinformation about HR practices. Employees were reluctant to give information, as they are afraidthat their corporations’ information might get licked outside. Some other limitations of the study are mentioned below –

 

1. Competitors’ information could not be gathered due to their privacy policy. That’s why competitive analysis could not be made.

 

2. The volume and magnitude of information collection is another limitation of this project. The amount of information needed to conduct such type of assessment is vast, but that could not be gathered. That’s why; the project might lack sufficient clarity and credibility. Rather, it recommends further and larger study on the matter.

 

3.The study area will be the non-government organization so the collection of information’s quite hard.

 

 

4. The organization is rigid to reveal the data associated with the employment policy and labor relations.

 

Though I knew & had access to much information, but there are still some important things which I couldn’t get hold of & they don’t even prefer to disclose those in front of general people.

 

Chapter: 2

 

2.1 Company Introduction:

 

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Grameenphone Ltd. has stepped into its 11th year of operation, having completed its tenth year on March 26, 2007.

It is the leading telecommunications service provider in the country with more than 16 million subscribers as of December 2007.

 

Grameenphone has been recognized for building a quality network with the widest coverageacross the country while offering innovative products and services and committed after-salesservice.Grameenphone has always been a pioneer in introducing new products and services in the localmarket. GP was the first company to introduce GSM technology in Bangladesh when it launchedits services in March 1997.The technological know-how and managerial expertise of Telenor has been instrumental in setting up such an international standard mobile phone operation inBangladesh. Being one of the pioneers in developing the GSM service in Europe, Telenor hasalso helped to transfer this knowledge to the local employees over the years.

 

2.2 Historical Background:

 

November 28, 1996

Grameenphone was offered a cellular license in Bangladesh by the Ministry of Posts and Telecommunications

 

March 26, 1997

Grameenphone launched its service on the Independence Day of Bangladesh

 

November 5, 2006

After almost 10 years of operation, Grameenphone has over 10 million subscribers

 

September 20, 2007

Grameenphone announces 15 million subscribers.

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Grameenphone is now the leading telecommunications service provider in the country with more than 20 million subscribers as of June 2008.Presently, there are about 30 million telephone users in the country, of which, a little over one million are fixed-phone users and the rest mobile phone subscribers. Starting its operations on March 26, 1997, the Independence Day of Bangladesh, Grameenphone has come a long way. It is a joint venture enterprise between Telenor (62%), the largest telecommunications service provider in Norway with mobile phone operations in 12 other countries, and Grameen Telecom Corporation (38%), a non-profit sister concern of the internationally acclaimed micro-credit pioneer Grameen Bank.Over the years, the company has so far invested more than BDT 10,700 crore (USD 1.6 billion)to build the network infrastructure since its inception in 1997. It has invested over BDT 3,100crore (USD 450 million) during the first three quarters of 2007 while BDT 2,100 crore (USD 310million) was invested in 2006 alone. Grameenphone is also one the largest taxpayers in thecountry, having contributed nearly BDT 7000 crore in direct and indirect taxes to the

Government Exchequer over the years. Of this amount, over BDT 2000 crore was paid in 2006 alone.Since its inception in March 1997, Grameenphone has built the largest cellular network in thecountry with over 10,000 base stations in more than 5700 locations. Presently, nearly 98 percentof the country’s population is within the coverage area of the Grameenphone network.Grameenphone was also the first operator to introduce the pre-paid service in September 1999. It established the first 24-hour Call Center, introduced value-added services such as VMS, SMS,fax and data transmission services, international roaming service, WAP, SMS-based push-pullservices, EDGE, personal ring back tone and many other products and services. The entire Grameenphone network is also EDGE/GPRS enabled, allowing access to high-speedInternet and data services from anywhere within the coverage area. There are currently nearly 3million EDGE/GPRS users in the Grameenphone network.Grameenphone nearly doubled its subscriber base during the initial years while the growth wasmuch faster during the later years. It ended the inaugural year with 18,000 customers, 30,000 bythe end of 1998, 60,000 in 1999, 193,000 in 2000, 471,000 in 2001, 775,000 in 2002, 1.16 millionin 2003, 2.4 million in 2004, 5.5 million in 2005, 11.3 million in 2006, and it ended 2007 with16.5 million customers. From the very beginning, Grameenphone placed emphasis on providing good after-sales services. In recent years, the focus has been to provide after-sales within a short distance from where the customers live. There are now more than 600 GP Service Desks across the country covering nearly all upazilas of 61 districts. In addition, there are 81 Grameenphone Centers in all the divisional cities and they remain open from 8am-8pm every day including all holidays.

 

GP has generated direct and indirect employment for a large number of people over the years.The company presently has more than 5,000 full, part-time and contractual employees. Another 100,000 people are directly dependent on Grameenphone for their livelihood, working for the Grameenphone dealers, retailers, scratch card outlets, suppliers, vendors, contractors and others.In addition, the Village Phone Program, also started in 1997, provides a good income-earningopportunity to more than 280,000 mostly

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women Village Phone operators living in rural areas.The Village Phone Program is a unique initiative to provide universal access to telecommunications service in remote, rural areas. Administered by Grameen TelecomCorporation, it enables rural people who normally cannot afford to own a telephone to avail the service while providing the VP operators an opportunity to earn a living.The Village Phone initiative was given the “GSM in the Community” award at the global GSMCongress held in Cannes, France in February 2000. Grameenphone was also adjudged the BestJoint Venture Enterprise of the Year at the Bangladesh Business Awards in 2002. Grameenphonewas presented with the GSM Association’s Global Mobile Award for ‘Best use of Mobile for Social and Economic Development’ at the 3GSM World Congress held in Singapore, in October 2006, for its Community Information Center (CIC) project, and for its HealthLine Service projectat the 3GSM World Congress held in Barcelona, Spain, in February 2007.Grameenphone considers its employees to be one of its most important assets. GP has anextensive employee benefit scheme in place including Gratuity, Provident Fund, GroupInsurance, Family Health Insurance, Transportation Facility, Day Care Centre, Children’sEducation Support, and Higher Education Support for employees, in-house medical support andother initiatives.

 

2.3 Shareholder Profiles:

 

Telenor-Ownership: 55.80%million mobile subscribers worldwide.World’s seventh largest mobile service provider in terms of subscribers.Have operations in 13 countries.Strong subscription growth, particularly in Asian operations.Named the sector leader in mobile telecommunications by the Dow Jones Sustainability Indexes (in which year).Revenues 2009: USD 17.15 bn Workforce 2009: 40000Listed on the Oslo Stock Exchange and headquartered in Norway Telenor as is the leading telecommunications company of Norway listed on the Oslo Stock Exchange with a market capitalization of USD 9.0 bn as of November 12, 2008.In addition to Norway and Bangladesh, Telenor has interests in mobile telephony companies in Sweden, Denmark, Hungary Russia, Ukraine,Montenegro, Thailand, Malaysia. Pakistan and Serbia with more than 150 million mobile subscribers worldwide as of September 30, 2008

 

Grameen Telecom-Ownership: 34.2%

Grameen Telecom is a nonprofit company affiliated with Noble award winning Grameen Bank Operates “Village Phone” program to over 297,079 (Q2. 2010) rural.

Head quartered in Ohaka, Bangladesh. Grameen Telecom (“GTC’) is a not-for-profit company in Bangladesh, working in collaboration with Grameen Bank, winner of the Noble Peace Prize in 2006, along with Professor Muhammad Yunus.

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GE’s mandate is to provide, easy access to GSM cellular services in rural Bangladesh and create new opportunities for income generation through self-employment by providing villagers, mostly poor, rural women, with access to modern information and communication-based technologies

 

 

2.5 Ownership Structure:

 

The shareholders of Grameenphone contribute their unique, in-depth experience in both telecommunications and development.

It is a joint venture enterprise between Telenor (55.8%), the largest telecommunications service provider in Norway with mobile phone operations in 12 other countries, and Grameen Telecom Corporation (34.2% ), a non-profit sister concern of the internationally acclaimed micro-credit pioneer Grameen Bank. The other 10% shares belong to general retail and institutional investors.

The technological know-how and managerial expertise of Telenor has been instrumental in setting up such an international standard mobile phone operation in Bangladesh. Being one of the pioneers in developing the GSM service in Europe, Telenor has also helped to transfer this knowledge to the local employees over the year.

 2.6 Vision:

 

We’re here to help (This vision crystallizes customer focus as the cornerstone of everything they do: helping customers get the full benefit of communications in their daily life.

Its official slogan

 

 

2.7 Mission Statement:

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The vision will be achieved by

 

*Connecting Bangladesh with ease and care

*Being user-friendly

*Providing value for money

*Providing simple and timely connections

*Having a right and understandable process.

 

 

Values:

 

Make it Easy; Keep Promises, Be Inspiring, and Be Respectful

 

We’re practical. We don’t over complicate things. Everything we produce should be easy to understand and use. No waste. No jargon. Because we never forget we’re trying to make customers’ lives easier.

 

For our customers, making it easy will be addressing some very fundamental customer needs. They need simplicity. Solutions and services that are easy to buy, easy to use and are built to meet their needs. Solutions and services that work well. Everything we set out to do should work, or if you don’t get it, we’re here to help. We’re about delivery, not over promising – actions not words. For our customers, this will mean they can build trust in us. The solution or service works - if not, we are there to make it work. They need us to deliver on time, to expected levels of quality, and at a fair price. They need us to be strong on action, not on fine words! For employees everywhere, this means… We follow through. We never launch something new before it works as it should work. We arrive on time and we deliver on time. We commit to concrete, realistic promises to our customers – and deliver on our promises

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We are creative. We strive to bring energy into the things we do. Everything we produce should look good, modern and fresh. We are passionate about our business and customers. For our customers, this will mean they will want to engage with us, will appreciate our innovative and modern approach, will appreciate our future proofed solutions and services, and will acknowledge our category leadership. For Telenor employees everywhere, this means… that we live up to the challenge and inspire our colleagues and customers ‘ walk the talk! We must call for creativity at every level, show care, energy and passion. Be fresh and direct, and demonstrate a can-do attitude.

 

We acknowledge and respect local cultures. We do not impose one formula worldwide. We want to be a part of local communities wherever we operate. We believe loyalty has to be earned. For our customers, this will mean each of them can expect to be treated like an individual. Each of them will feel valued, understood and listened to, and their needs acted upon.

 

 

 

Human Resource Planning:

 

Grameenphone Ltd provides ample opportunities growth. Promotion is based both on seniorityand performance. The performance of each employee is reviewed every 6 months and the employee’s worth in the company depends on that. The employee’s designation in the first two years is completely time dependant. However, the employees at the same level can be paid more or less depending on his performance. After the initial two years, the growth of the employee in the company is mostly dependant on his performance. Grameenphone Ltd believes in performance rather than age. People with potential should be at the top rather than being stuck at the bottom because of the lack of seniority. Grameenphone Ltd thinks it is both fair and good for the company as a whole.Grameenphone Ltd arranges various training programs in job related subjects for the development of its employees. This is usually arranged when the employee is not involved in any active project. This helps to utilise the free time and also comes in the best interest of the company and the employee. Grameenphone Ltd also encourages its employees to appear invidious professional certification exams, which the company also pays for. The talent sourcing activities begin with effective human resource planning. This planning is aligned with the business need forecast, overall organizational growth matrix, structure and direction and is done in yearly basis.R& EB (The Resourcing &

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employee branding) department coordinates and evaluates people planning process that eventually approved by board considering the factors:-

 

•Potential/ expected workload and expertise requirements.

•Optimum and effective utilization of the HRM for the entire company, both current and future requirements.

•Possibilities for grater efficiency through reorganization and automation (use of tools &facilities) and making necessary adjustment.

•Employee turnover/employee mobility.

• New business initiatives and project s that require new competence and additionalresources.

•Government legislationHuman resources planning, budgeting and necessary approvals should be taken in the beginningof the year to ensure timely co-ordination and implementation.

 

 

Recruitment & Selection:

 

Recruitment:

The recruitment practice is done mainly on two standard procedure of recruitment. They usually carry out in-house recruitment and/or post online job ad posting. They usually recruit fresh graduates and allow them to grow in the company. Applications received are carefully filtered and usually call a handful of candidates for the post.

 

The Selection Process:

The selection process has two steps – firstly there is a written test. Candidates are tested basically on job related skills and their analytical ability along with some open ended questions relating to their psychological behavior. Selected candidates are called up for an interview within a week. The candidates must appear in front of an interview panel usually consisting of four members: from the HR department as overseen by the MD,

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Chairman, General Manager and AdminManagers. The candidates are tested for their basic knowledge about the subject matter, their interpersonal and communication skills, and their abilities to work in a team environment.Candidates after final selection are offered jobs along with the contract, which they need to sign before joining the job.

 

 

 

 

 

Compensation:

A job is classified according to the skills and experience required for satisfactory performance in the job, the degree of problem-solving involved and the magnitude of the impact of a decision to be taken as an incumbent in the job. The classification is then linked to a salary grade through which a compensation package is made available to the incumbent of a job. Each job makes a contribution to the successful conduct of an activity, which in turn accrues certain benefit to the company. The compensation package, which is an expense incurred by the company, is linked to the benefit derived by the company from the job. Each grade has a minimum level of compensation and a maximum. The minimum is related to them market value of the job and is verified through the availability of suitable candidates who are prepared to join at that level of compensation. The maximum of the grade is the maximum cost the company is prepared to incur for the contribution received from the job

.1.The employee’s performance appraisal will be made as usual.

 

2. Based on the appraisal, performance Bonus will be payable as usual.

 

3. If the performance of the employee who has already reached the top of his grade is “Very Good” or above he will get only one increment for the year. The year in which the performance rating is below “Very Good” the employee will not get any increment. In this manner the employee will be able to go up to 4 steps in Basic Salary beyond his grade maximum and thereafter the basic salary will not increase any further. The allowances that are linked with basic salary will proportionately increase. The allowances that are not calculated as a percentage of the Basic Salary will be paid at the level of the grade maximum.

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4. If an employee has not reached the top of his grade yet but his normal increment, according to his performance rating, will take him beyond his grade maximum, he will be able to reach only one increment beyond his grade maximum that year. From next year clause 3 will apply.

It is hoped that employees who get stuck at the top of their grades will seek advice and guidance from General Manager, Corporate Services about how to prepare themselves for higher grades.

 

Festival Bonus:

The company started payment of Festival Bonus to the Management Staff from the year 2000.There will be disbursement of an amount equal to one month’s Basic Salary of the employee on two designated festivals. Management Staffs those are in the employment of the Company for at least three months after their confirmation on the date of the festival will be eligible for the Festival Bonus. The major festivals recognized are the following:

1.Eid-ul-Fitr

2.Eid-ul-Azha

3.Durga Puja

4.Christmas

5.Buddha Purnima.

All  employees of the Company, irrespective of their religion, will draw one Festival Bonus during the time of Eid-ul-Fitr.

The other Festival Bonus will be given to the Muslim employees during the time of Eid-ul-Azha. Employees other than Muslim will receive the other bonus according to their festival mentioned  above.

Festival Bonus will be disbursed in cash and will be paid two weeks prior to the festival date.

 

3.6. Employee Relations:

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The environment at Royal Homes Ltd is extremely friendly. This is very important for a property development firm because most of the work is done in teams. However, if some kind of conflict occurs among employees, the Line Manager usually solves the issue.

 

3.7. Performance Appraisal:

The performance of each employee is closely monitored by their immediate managers. If the broad objectives of the job are clearly understood by the Appraiser and the Appraisee and the Action Plan along with the criterion of assessment is clearly agreed between them, appraisal should be a relatively easy task. If both parties are realistic, pragmatic, fair and objective in their evaluation of performance, there should be very little variation in their scoring and completion of the Performance Appraisal Form. The Appraise has to dispassionately analyze his/her performance and fill in the form with an attitude of trust and fairness in the judgment of the superior. In rating the overall performance, the Action Plan achievements will have 50% weight age. The quality of performance in accomplishing the overall objectives of the job will have the other 50%weightage. The rating for overall performance will therefore have equal emphasis between specific tasks and the general objectives of the job. Management Staff Performance Appraisal Form will be provided in duplicate by the Appraiser to the Appraise. The Appraise will fill in the requisite places on the form and return one copy to the Appraiser. The Appraiser will first complete his part of the form and then fix a date for Appraisal Interview. The interview should be held in a relaxed and congenial atmosphere and the entries on the form should be gone through together item by item. There will no doubt be difference in perception of achievement and of performance on the job but the differences should be discussed in constructive manner so that any misunderstanding is removed and the gap in perception is narrowed down. The Appraiser will have the right to modify his remarks or to change his rating in the light of the Appraisal Interview but his original remarks and rating must remain legible. The Appraiser will then pass on the form to his superior who, if necessary, will revert back or else send the form to the General Manager, Corporate Services at Head Office for review by the Managing Director and consolidation. It is to be borne in mind by the Appraise that the ability to judge his/her own performance fairyland dispassionately, both with regard to the Action Plan as well as the overall performance, will be considered as a good managerial quality called objectivity.

 

He Appraiser, on the other hand, must make a realistic comparison between standards agreed and those achieved; and keep in view unanticipated constraints which could not have been overcome through other initiatives or innovative actions. Needless to emphasis that rating of overall performance is not an exercise in numbers. The external and internal environment in which the job was performed and the threats and opportunities that were encountered should be taken into account while determining the score. Above all, while judging the overall performance both parties must keep in view the performance during the whole year and guard against the fact that recent issues and events may unduly

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influence their judgment. The Appraisal Rating will determine the quantum of Performance Bonus the Appraise will get and the level of Annual Increment of basic salary that will be applicable at the time of salary review in the following July.

 

3.8. Employee Safety & health:

For employee safety and health the company gives medical Benefit for All Permanent Staff:

 

1. In case of hospitalization of the staff, spouse or any dependant child, in any recognized hospital or clinic, the Company will reimburse 50% of the hospitalization charges, which will include bed/cabin rent, doctor’s fees and laboratory tests & medicine required during the period of hospitalization. All other charges will be borne by the staff.

2. In case of surgery, the Company will reimburse 75% of the total operation charges comprising of surgeons fee, anesthetist’s fee & O.T. charges and cost of medicine related to the surgery.

3.Prior approval from the Head of the Business is necessary before hospitalization or surgery. The name of the patient and the name of the hospital/clinic need to be stated while taking the approval.

4.Department Heads will approve advance against surgery for staff on a case-to-case basis.

 

5.Expenses for Delivery under Caesarean Section will be reimbursed as per clause 2.Reimbursement of more than two children will not be allowed. These rules will be subject to modification from time to time at the discretion of the Company.

 

3..9.  Employee Motivation:

 

Profit Sharing:

The most significant employee benefit offered by Grameenphone Ltd is Profit Sharing. The profitsharing takes place once a year: July. Only the senior employees who are around two or moreyears get 20% share of the profit earned. Out of this 20% profit, 75%

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is distributed in terms of seniority and designation and the rest 25% is distributed on performance in that period.

 

Performance Bonuses:

Performance bonuses are given on the basis of performance in a given year. This happens after the yearly appraisal. The reviewer (usually the immediate boss) notes down the performance of the employee on a given set of characteristics and sends it to the MD. The MD then takes thedecision on the performance bonus. However, all decisions regarding performance bonuses by theMD needs to be approved by the Board of Governors.

 

Reward:

This reward system does not have any fixed criteria. This is basically an additional reward system, which provides financial incentives to employees for extraordinary performance in any area of their job.

 

Services Benefits:

Soft Option has a number of service benefits which is typically not found in other companies. Among the benefits are flexible working hour: one can start their office on 8am in the morning and leave by 4pm.-provide transport or transport bills while attending a client meeting

 

-Provide lunch from the office which is prepared in the office.-have provision for the employees to participate in different training programmed as well fund any professional certification exam from IBM, Sun, Microsoft, Oracle, etc at company’s own cost.

Yearly Picnic/Tours:

Grameenphone Ltd bears the expense of one tour/picnic per year for each employee. The company covers all transport, hotel and food expenses. This usually refreshes the employees a lot and makes room for them to interact and know each other better.

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Chapter: 3

Compensation System Practices in Telecom Industry in Bangladesh One microeconomic factor has been and will continue to be of critical importance within a global economy. That factor is labour costs. Labour cost issues affect the efficiency and even the survival of public and private sector organizations. Long before the advent of a global economy concept, governments in some manner developed various approaches and efforts to redistribute income to the poorer members of their society. It has been recognized that if some kind of subsistence level of income or necessary goods and services is not provided to the poor, a belligerent society develops with constant warfare between the “haves” and the “have nots”. One major method of providing for the poor promoted some kind of welfare payments in the form of money, food, housing, health care services, and even clothing. Another method was for government agencies

Compensation & BenefitsEmployee Benefits

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Employee benefits are optional, non-wage compensation provided to employees in addition to their normal wages or salaries. These types of benefits may include group insurance (health, dental, vision, life etc.), disability income protection, retirement benefits, daycare, tuition reimbursement, sick leave, vacation (paid and non-paid), funding of education, as well as flexible and alternative work arrangements.

The benefits of benefits plansAlthough expensive, there are many intrinsic benefits to providing your employees with a comprehensive benefit plan. For most, it is the ability to find and keep highly qualified staff that is the key driver. With the sector being highly competitive and the number of new employees entering the workforce dwindling, employers are challenged to become even more creative and responsive in the design, timing and generosity of their benefit plans. The more progressive the organization, the more flexible the structure is in response to today’s challenges: i.e. like having four different generations of employees working side by side. Employers who continue to provide the more traditional and limited program, may find it more difficult to find and keep different types of employees.

Here are just a few of the advantages of offering benefits to your employees:

For employers: By providing increased access and flexibility in employee benefits,

employers can not only recruit but retain qualified employees Providing benefits to employees is seen as managing high-risk

coverage at low costs and easing the company's financial burden Employee benefits have been proven to improve productivity because

employees are more effective with they are assured of security for themselves and their families

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Premiums are tax deductible as corporation expense, which means savings for the organization

For employees: Employees can experience a peace of mind which leads to increased

productivity and satisfaction by being assured that they are their families are protected in any mishap

Employees with personal life and disability insurance can enjoy additional protection including income replacement in the event of serious illness or disability

Employees can feel a sense of pride in their employer if they are satisfied with the coverage they receive

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The basics: health & dentalHealth and dental benefits are considered the foundation of any benefit program design. When considering the root issues of all absenteeism from the workplace, most employers agree that health or dental related illness is cited most as the cause. While many have not thought of dental coverage as being a key attraction point, a number of medical reports have been published recently, that indicate that many of our common virus and illnesses are actually related to poor dental health. An organization’s ability to be creative, flexible and generous in providing health and dental coverage can be a key to attracting and retaining top performers as part of the total compensation package.

HealthEven in Canada, where Government plans provide approximately 70% of all healthcare expenses, the remaining gap is still perceived as a major concern for employees and employers. Private healthcare plans are restricted by legislation to expenses not fully covered by government programs.

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Organizational health expense plans are generally permitted in the following areas across Canada:

Hospital room charges in excess of the standard rate to cover semi-private or private accommodation

Hospital charges for emergency treatment outside Canada Drugs, medication and vaccines and other supplies available only by

prescription Professional services of a physician for out-of-country medical

expenses Professional services for private duty nursing Charges for special medical appliances such as crutches, artificial

limbs or wheelchairs Non-emergency ambulance services Dental treatments not requiring hospitalization. Professional services provided by licensed paramedicals, such as

psychologists, massage therapists, speech therapists, podiatrists, physiotherapists, chiropractors, osteopaths, or naturopaths.

Vision care expenses including frames and lenses, contact lenses, fitting and remedial treatment, laser eye correction surgery

This option is one that many employers struggle to provide their employees with as the number requiring vision care is so great, the cost of including this option could raise the employer’s costs by anywhere from 20 to 40%

It is common practice to include many of the above items under a single extended healthcare plan. Most benefit carriers will tailor a plan to include only those features and coverage’s desired. Certain items, however, are often restricted or sold in combination with other coverage’s to contain overall plan costs or to subsidize heavily utilized services.

Extended healthcare plan options should be selected based on the organization’s overall compensation objectives and employee needs. For small organizations, the range of coverage options may be limited if the plans are financed on a fully insured basis. These plans offer restricted

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flexibility to limit the occurrence of high-risk claims. These pre-packaged plans are available to small organizations through affiliation with umbrella organizations such as chambers of commerce, boards of trade, trade associations and professional organizations. For larger organizations, the range of options is mostly limited by cost considerations.

DentalDental plan design is the art of finding a delicate balance between understanding what the foundational priorities are, and allocating sufficient funds, to ensure that the coverage is perceived as being sufficient and appropriate.

Although the type of dental work can differ from person to person, some common elements have been found:

Most employees, their spouses and children, require basic preventative dental care and repair. Therefore, most employers elect to design the plan in such a way as to minimize the cost to employees of basic coverage.

Since major restorative care and orthodontics tend to be more elective in nature and less common in need across the employee group than basic services, most plans do not provide equal coverage in all areas. For example, the plan might pay 100% of basic and 50% of the other two categories. It is also common to find deductibles, co-insurance and benefit maximums for the non-basic services to free up more funds for the necessary preventive ones.

High employee deductibles and co-insurance percentages can help to limit plan disbursements because employees will be paying more of the total costs. The potential problem is that these high employee costs may, in effect, force postponement of needed dental work until the repair bill is even higher. Paying 100% of basic preventative care from day one is the overwhelming choice of employers.

Having the dental plan require a “pre-treatment” evaluation for certain expenses helps control cost levels by ensuring that the plan only

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pays for reasonable treatments. It also avoids any misunderstanding by the employee as to what services are covered and how much he or she is required to pay. It is always preferable to ensure the employee knows what the plan will pay for and what exact dollar amount is their responsibility.

A commonly asked question of benefit administrators is why the dental plan is not optional but compulsory? If the plan is optional, only those employees who are likely to need dental care will sign up. They will almost always use services that exceed their contributions, deductibles and co-insurance. Those who feel that the benefits will not cover their costs will decline. Because of this “adverse selection”, cost per employee will be so high that employers would not be perceived as competitive.

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There are several health care insurance options to choose from if an employer decides to offer health care benefits to employees. Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are the most common types of health care plans offered.

Should You Offer Employees Health Care Benefits? What Type of Health Care Benefits Should You Offer Your Employees? Consider Health and Medical Savings Accounts as an Employee Benefit

Read more about Managing the Workplace »Health care benefit choices are numerous, and employers will want to carefully examine the different aspects of insurance options available. Health insurance plan types include health maintenance organizations (HMOs, traditional fee-for-service indemnity insurance, preferred provider organizations (PPOs), and major medical policies. The popularity of health savings accounts (HSAs), is steadily growing as a health care benefit option. Dental and vision care insurance can also be provided as a separate health care benefit by employers.Health care reform. The enactment of the Patient Protection and Affordable Care Act and related legislation in 2010 heavily regulates the insurance industry, instituting benefit and coverage mandates. Except for grandfathered plans, it mandates that by 2014, all qualified health benefit plans offer at least an "essential health benefits package" as defined by the Secretary of Health and Human Services.

Health Maintenance Organizations (HMOs)

Health maintenance organizations, better known as HMOs, have arguably become the most prevalent type of health care offered by employers today. They

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are popular because they are relatively lower in cost than traditional fee-for-service plans and offer broad health coverage. They have, however, been criticized on the grounds that the cost-cutting comes at the expense of patient care.

The insurance company or managed care company contracts with physicians, both general practitioners and specialists, and hospitals to provide care to its insureds. Sometimes the doctors have their offices together, in sites selected by the HMO; sometimes the doctors maintain whatever offices they like, in small groups or individually, and see patients from within and without the HMO.

The people who are insured under the HMO are required to choose a general practitioner from the list of doctors that the HMO has contracted with. Patients who use the services of doctors outside the HMO network will not be covered by the insurance for those services. Whenever a person insured under the HMO has a medical problem, he or she must go to the chosen general practitioner, known as the person's Primary Care Physician (PCP). The PCP will either treat the patient or refer the patient to a specialist who is also under contract with the insurance company.

If the patient tries to get medical care from a doctor other than the PCP or does not receive a referral from the PCP to see a certain specialist, the insurance company will not pay for any of the costs except in cases of life-threatening emergency. If the patient follows the rules and sees his or her PCP and gets referrals to approved specialist and hospitals, he or she will generally only have to make a small copayment to the doctor for each visit. The average copayment is normally around $10 per visit.

So, if you're only paying $10 per visit, how are the doctor and the HMO making any money? There are two ways: volume and capitation.

Patient volume. Many HMO doctors have more patients than they know what to do with. Many physicians have so many patients from HMOs that they can no longer accept new patients, and it is often difficult for current patients to get a timely appointment. So, sheer patient volume is one way that doctors make money on HMOs.Capitation. Capitation refers to the financial arrangement between the doctor and the insurance company. For each person that chooses a certain doctor as his or her PCP, the insurance company will pay the doctor a certain fee each month, whether that patient sees the doctor during that month or not.If Dr. Makewell has 150 patients from the HMO and his capitation fee is $20 per patient per month, he'll receive $3,000 per month from the HMO. If patient Y and patient Z both have Dr.Makewell as a primary care physician, and patient Y sees Dr. Makewell five times during the month, and patient Z doesn't see the doctor at ll, Dr.Makewell is still going to get $20 for each patient.

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This arrangement has been criticized because some charge that in order to maximize profits, the doctors are motivated not to see patients and care for them as often and as well as they should. Furthermore, some arrangements have also been set up to penalize doctors financially for referring patients to specialists because the referrals add to the costs for the insurance companies.

Regardless of how you feel about HMOs, they are a pretty good deal, on the whole, if they are available in your area. Their major drawbacks are rigid rules and lack of free choice in physicians and medical facilities. However, they offer a vast array of coverage and even offer different copayment levels to help strike the right balance in cost-sharing between you and your employees. They often cover preventative care, and the cost out of the employee's pocket is generally affordable.

Which employees will like HMOs? Generally, people who hate claims forms and recordkeeping will be happier with HMOs. Rarely are employees even billed for services — it's all taken care of by the doctors and the insurance company. HMOs are also a good value for employees with a large family to cover. Employees who have special, on-going medical needs are less likely to like an HMO because they may not be able to see a doctor with whom they have established a relationship.If you want more choice in terms of physicians, be prepared to pay more than you will for an HMO. Fee-for-service plans provide freedom of choice but at a high cost. However, some plans try to blend the cost cutting measures of HMOs and still allow you to make choices in your health care. Those plans are known as preferred provider organizations (PPOs).

Fee-for-Service Health Insurance

Fee-for-service plans, also known as indemnity plans, are traditional insurance plans that give employees absolute freedom in choosing physicians and medical facilities. In return, insurance companies require patients to fulfill a yearly deductible and, after that deductible has been fulfilled, the insurance company will pay at a certain coinsurance rate. Generally the coinsurance is 70 percent/30 percent or 80 percent/20 percent, where the insurance company pays the higher percentage and the employee pays the lower.

Fee-for-service plans are the dinosaurs of the health insurance world. Some employers still offer them because they want to give their employees the freedom to choose their medical services, unfettered by networks and copayments. However, these plans still require the use of patient claim forms and reimbursement checks. The insurance company pays the claims using usual, customary, and reasonable charges (UCR) for covered services, a fixed

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schedule of fees (for example, a fixed dollar amount per day for hospital care or a schedule of payment by procedure), or both.

The death-spiral. Another interesting trend has emerged over the years for some fee-for-service plans. They are the most expensive health insurance plans because they have few managed care or cost control measures in them. As the price of indemnity plans started to rise, many of the relatively young and healthy people left to join PPOs or HMOs, leaving the people generating the most cost in these indemnity plans.  This causes what is known in the industry as "adverse selection" or a "death spiral."When an indemnity plan goes into a death spiral, only the most ill individuals with the most expensive medical needs are left in it. They stay because they have serious medical needs and do not want to have to change doctors in the middle of treatment. As the costs for the care continue to exceed what the insurance company is collecting in premiums, the price of the indemnity plan rises and rises. At a certain point, these plans become cost prohibitive; so much so that neither the employee nor the employer can afford to pay their share of the premium.

Who will like fee-for-service plans? As an employer paying premiums, you will most assuredly like fee-for-service plans. Individuals with serious medical conditions that need frequent treatment (who want to go to their doctors) and employees who are well-paid and can afford the higher deductibles and premium payments will like fee-for-service plans because they have complete freedom of choice to see whomever they wish, whenever they wish.Another way to maintain freedom of choice as to physicians and treatment, while keeping your costs down, is to choose a major medical plan, or compromise with a preferred provider plan (PPO).

Preferred Provider Organizations (PPOs)

Preferred provider organizations, known as PPOs, are a cross between regular fee-for-service plans and HMOs. They are a compromise for people who don't want to pay for traditionally expensive fee-for-service coverage, but want more choice than an HMO offers.

How does a PPO work? The insurance company, as they do in HMOs, contracts with certain physicians and provides a "preferred provider" network of doctors and specialists that people insured under the PPO plan can choose to go to. However, unlike HMOs, patients do not have to go to the doctors in the preferred provider network, and they don't have to get referrals from their primary care physician to see a specialist.

However, patients are encouraged to use the preferred provider network because cost control and managed care measures can be used to keep costs down for the patient and the insurance company.  If they do, patients pay for

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services with copayments, as they would in an HMO, or they receive a higher coinsurance amount than they would if they used a doctor not in the preferred provider organization.

Patients who used a doctor in the PPO network might get 90 percent coinsurance, so they would only have to pay 10 percent of the cost of the medical service, and they would have a low deductible (the part that the patient must pay first before the insurance company starts paying anything).

Generally deductibles are lower for patients who use the PPO network. A patient who didn't use the PPO network might only have 60 percent coinsurance and a higher deductible. That would mean that the patient would have to pay the higher deductible and would have to pay 40 percent of costs incurred after that.

Which employees will like PPOs? PPOs are a good choice for employees who want to have some flexibility in their choice of physician. They are also good for people who have built a relationship with a certain physician and want to continue that relationship. They may use preferred providers for other services and keep seeing that one certain specialist who is not in the network for an on-going problem they have. PPOs are also good for people who know they will exceed the deductible amount. People who will not exceed the deductible will see less value in their insurance because the deductible amount must come out of the employee's pocket first before the insurance payments start kicking in.

Major Medical Plans

Major medical plans are a special type of fee-for-service plan. They are designed to provide protection against long-term chronic or catastrophic illness or injury. These plans cover a broad area of health care services and are designed to protect against large medical expenses only.

Despite the high deductible, the coinsurance requirement, and the ceiling on the amount of benefits, major medical plans have several advantages over basic benefit plans:

Instead of covering only certain enumerated expenses, major medical plans cover all personal medical expenses (with a few exceptions) whether incurred on or out of a hospital. Major medical plans reimburse virtually all patients according to the same formula, regardless of the specialties of the attending physician, the location of the treatment, the drug treatment used, or the diagnostic techniques employed.

Unlike many basic plans, major medical plans do not encourage unnecessary or prolonged hospitalization by covering medical service only if it is rendered in a hospital.

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The maximum amount of benefits payable is much higher under a major medical plan than under a basic medical plan, particularly in the areas of physician and surgeon fees.

Partially reimbursing medical expenses has the combined effect of having a deductible and coinsurance in major medical plans and has three advantages over basic plans that provide full reimbursement:

It discourages over-utilization of services and unnecessarily expensive treatment and facilities; both of which raise costs for you and your employees.

It gives plan participants an incentive to police their own medical fees and keep costs down.

It eliminates the payment of many small claims, thereby reducing administrative costs and saving money that would otherwise be spent on higher premiums to offset the additional administrative costs.

Types of major medical. There are two types of major medical plans: comprehensive plans that coinsure all covered medical expenses exceeding the deductible and supplementary plans that coinsure expenses in excess of the deductible and expenses in excess of those covered by another plan. Both supplementary plans and comprehensive plans place ceilings on the amount of benefits payable for each insured person. Comprehensive plans. Comprehensive major medical plans provide

coverage for the same types of services covered many other plans. Comprehensive plans also include deductibles and copayment requirements but may provide first-dollar coverage (full coverage with no deductible) for emergency accident benefits or waive out-of-pocket expenses for certain benefits.

Supplemental plans. These plans act as a supplement to another health insurance plan. Supplemental major medical plans cover most medically necessary services excluded under basic insurance plans, as well as charges that exceed the primary plan's limits. Covered services typically include inpatient and outpatient hospital care, special nursing care, outpatient prescription drugs, medical appliances, durable medical equipment, and outpatient psychiatric care. Supplemental major medical plans set deductibles, require copayments, and often limit total benefits.

Who will like major medical plans? Major medical plans may be popular with low-wage earners if they are healthy because the cost is lower than some other, more comprehensive plans. In fact, the premiums are usually lower than they would be with an HMO. Low-wage earners with health problems will not like them because of the deductibles involved.Dental and Vision Care Plans

Standard health care insurance policies typically cover dental and vision care if the expenses are related to an accident, injury or illness. Coverage for expenses

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such as dental preventative care and annual eye exams are not part of many health care plans.

Dental Care Plans

Dental care can sometimes be purchased in addition to basic medical care, or it can be purchased as a separate policy from a separate provider. Generally, there are two dental plans available: an HMO plan and an indemnity plan. These plans usually cover only basic dentistry services, not orthodontics (like braces) or surgical procedures.

HMO-type plans. These dental plans operate in the same way as an HMO health plan. Employees choose from a list of doctors under contract with the insurance company and then pay a copayment when they visit. Sometimes these plans include free exams and teeth cleaning once or twice a year for insureds, as well.Indemnity plans. Like a fee-for-service health plan, these plans allow you to go to the dentist of your choice. The employee must fulfill the deductible before the insurance company will start paying. They also have a usual, reasonable, and customary (UCR) fee schedule that they pay from. Any covered costs that exceed the UCR limit must be paid by the employee.

Vision Care Plans

Vision care plans are most often offered as an additional feature on HMO or PPO plans. However, they can be purchased separately as well.

What do vision plans cover? Most vision care plans cover the cost of a yearly eye exam (or require only a small copayment) by an approved optometrist under contract to the plan. Some also allow a certain discount for a pair of glasses or contact lenses.

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Health PlansTypes of PlansTwo types of plans participate in the FEHB Program: fee-for-service plans and health maintenance organizations (HMOs).Fee-for-Service PlansThese plans reimburse you or your health care provider for the cost of covered services. You may choose your own physician, hospital, and other health care providers. Most fee-for-service plans have preferred provider (PPO) arrangements. If you receive services from a preferred provider, you usually have lower out-of-pocket expenses (i.e., a smaller copayment and/or a reduced or waived deductible). All fee-for-service plans require precertification of inpatient admissions and preauthorization of certain procedures.Fee-for-service plans include:

The Governmentwide Service Benefit Plan, administered by the Blue Cross and Blue Shield Association on behalf of Blue

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Cross and Blue Shield Plans, and is open to everyone eligible to enroll under the FEHB Program.

Plans sponsored by unions and employee organizations. Some of these plans are open to all Federal employees who hold full or associate memberships in the organizations that sponsor the plans; others are restricted to employees in certain occupational groups and/or agencies. Generally, the employee organization requires a membership fee or dues paid directly to the employee organization, in addition to the premium. This fee is set by the employee organization and is not negotiated with OPM.

Health Maintenance OrganizationsHealth Maintenance Organizations (HMOs) provide or arrange for comprehensive health care services on a prepaid basis through designated plan physicians, hospitals, and other providers in particular locations. Each HMO sets a geographic area for which health care services will be available, called its service area. This area is described in the plan's brochure. You may join a particular HMO if you live within its service area. Some plans also accept enrollments from employees who work in the area even though they live elsewhere. If you have questions about whether you live or work within a HMO's service area, you should contact the plan before you enroll in it.Generally, you must choose a primary care physician and have all care coordinated through that physician. Your physician is responsible for obtaining any pre-certification required for inpatient admissions or other procedures.The three types of HMOs are:

Group Practice Plans. These plans provide care through groups of physicians who practice at medical centers.

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Individual Practice Plans. These plans provide care through participating physicians who practice in their own offices.

Mixed Model Plans. These plans are a combination of Group Practice and Individual Practice plans.

Point of ServiceSome fee-for-service plans and HMOs offer a point of service product. This gives you the choice of using a designated network of providers or using non-network providers at an additional cost to you. If you don't use network providers, you must pay substantial deductibles, coinsurance, and copayments.High Deductible Health PlansThe HDHP features higher annual deductibles and annual out-of-pockets limits than other insurance plans. Depending on the HDHP you choose, you may have the choice of using in-network and out-of-network providers. There may be higher deductibles and out-of-pocket limits when you use out-of-network providers. Using in-network providers will save you money.Some fee-for-service plans and HMOs offer a high deductible health plan (HDHP). When you enroll, your health plan establishes for you either a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA). The plan automatically deposits the monthly "premium pass through" into your HSA. The plan credits an amount into the HRA.Consumer-Driven Health PlansA consumer-driven plan provides you with freedom in spending health care dollars the way you want. The typical plan has common features: member responsibility for certain up-front medical costs, an employer-funded account that you may use to pay these up front costs, and catastrophic coverage with a high deductible. You and your family receive full coverage of in-network preventive care.BACK TO TOP

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Description of PlansGuide to Federal BenefitsEach year prior to Open Season, OPM publishes a Guide to Federal Benefits for distribution through employing offices to enrollees and eligible persons. The Guide lists all participating plans in the FEHB Program, the premiums required, and other information, including quality indicators. You can also access the Guide to Federal Benefits from the FEHB home page.BrochuresThe benefits, cost, exclusions, limitations, and other major provisions of each participating plan are described in the brochure for that particular plan. You can get copies of the brochures for the various plans that you are eligible to join so you can make an informed choice among them. You can access all plan brochures from the FEHB home page. You can also get brochures from your employing office, and by contacting the plans directly at phone numbers listed in the Guide to Federal Benefits. You need to keep your selected plan's current brochure as a continuing source of information on the benefits that your plan provides.Participating Provider DirectoriesEach HMO and each fee-for-service plan with preferred provider arrangements publishes a participating provider directory that lists its participating physicians, hospitals, and other providers. Before you enroll in a plan, you should review its participating provider directory. Every year during Open Season, you should ask for an updated directory and contact your chosen providers to see if they will continue to participate in the plan. Many plans have their provider directories on their websites. These can be accessed directly or from the FEHB home page.

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Providers sometimes cease participation during an FEHB contract year; if you enroll in a fee-for-service plan, you should verify the provider's participation status before you receive services.The continued participation of any provider with a health plan is not guaranteed. You are not eligible to change plans outside of an Open Season or other qualifying event solely because a particular health care provider stops participating with your plan.Participating PlansBefore each Open Season begins, OPM provides agencies with an updated list of the names, addresses, and telephone numbers of all fee-for-service plans and HMOs that currently participate in the FEHB Program.BACK TO TOP

Coordination of BenefitsIf you or a covered family member are entitled to benefits from a source other than your FEHB plan, such as a spouse's health insurance coverage, Medicare, Medicaid, or no-fault automobile insurance, coordination of benefits will take place. You must disclose information about the other source of benefits to your plan's Carrier.Coordination with health care furnished by Uniformed Services Facilities (USF) and the Department of Veterans Affairs (DVA)These Government agencies are entitled to seek reimbursement from FEHB plans for certain services and supplies furnished to you or a family member. Generally, FEHB benefits are payable for (1) inpatient hospital costs at a Uniformed Services facility, and (2) services and supplies provided by a DVA facility for treatment of a non-service connected disability.

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Coordination with TRICARE (formerly CHAMPUS)TRICARE provides health care for active-duty military personnel whose orders do not specify a period of 30 days or less, and their dependents; retired and former military personnel currently entitled to retired or retainer pay, or equivalent pay, and their dependents; and dependents of deceased military personnel. If you are covered by both an FEHB plan and TRICARE, the FEHB plan pays benefits first as the primary payer and TRICARE is the secondary payer. (All provisions applicable to CHAMPUS now apply to TRICARE.)BACK TO TOP

Coordination with MedicareBasic Medicare ProvisionsMedicare is generally for persons age 65 or over. It has two parts:

Part A (Hospital Insurance) helps pay for inpatient hospital care, skilled nursing facility care, home health care, and hospice care. You are entitled to Part A without having to pay premiums if you or your spouse worked for at least 10 years in Medicare-covered employment. (You automatically qualify if you were a Federal employee on January 1, 1983.) A percentage of your salary, up to a maximum determined by the Social Security Administration, is deducted from your pay for this coverage.

Part B (Medical Insurance) helps pay for doctors' services, outpatient hospital care, x-rays and laboratory tests, medical equipment and supplies, home health care (if you don't have Part A), certain preventive care, ambulance transportation, other outpatient services, and some other medical services Part A doesn't cover, such as physical and occupational therapy. You must pay premiums for Part B, which are withheld from your monthly social security payment or your Civil Service Retirement System (CSRS) annuity.

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You should contact the Social Security Administration for detailed information on Medicare eligibility and benefits. You may also find information on the Medicare website at www.medicare.gov  (external link) .FEHB Plans and MedicareGenerally, plans under the FEHB Program provide protection against the same kind of expenses as Medicare, plus all FEHB plans provide prescription drug coverage, routine physicals, and a wider range of preventive services than Medicare.Whether your FEHB plan or Medicare is the primary payer depends on your current employment or health status, as shown in the following table.Medicare always makes the final determination as to whether they are the primary payer.

The following chart illustrates whether Medicare or the FEHB Plan should be the primary

payer for you according to your employment status and other factors determined by

Medicare. It is critical that you tell your plan if you or a covered family member has

Medicare coverage so they can administer these requirements correctly.

A. When you - or your covered spouse - are age 65 or over and have Medicare and you...

The primary payer for the individual with Medicare is...

1) Have FEHB coverage on your own as an active employee or through your spouse who is an active employee

FEHB Plan

2) Have FEHB coverage on your own as an annuitant or through your spouse who is an annuitant

Medicare

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A. When you - or your covered spouse - are age 65 or over and have Medicare and you...

The primary payer for the individual with Medicare is...

3) Are a reemployed annuitant with the Federal government and your position is excluded from the FEHB (your employing office will know if this is the case) and you are not covered under FEHB through your spouse under #1 above

Medicare

4) Are a reemployed annuitant with the Federal government and your position is not excluded from the FEHB (your employing office will know if this is the case) and ...

FEHB Plan

You have FEHB coverage through your spouse who is an annuitant Medicare

5) Are a Federal judge who retired under title 28, U.S.C., or a Tax Court judge who retired under Section 7447 of title 26, U.S.C. (or if your covered spouse is this type of judge) and you are not covered under FEHB through your spouse under who is an active employee

Medicare

6) Are enrolled in Part B only, regardless of your employment status Medicare: for Part B servicesFEHB Plan: for other services

7) Are a former Federal employee receiving Workers' Compensation and the Office of Workers' Compensation Programs has determined that you are unable to return to duty

Medicare

B. When you or a covered family member...

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A. When you - or your covered spouse - are age 65 or over and have Medicare and you...

The primary payer for the individual with Medicare is...

1) Have Medicare solely based on end stage renal disease (ESRD) and... It is within the first 30 months of eligibility for or entitlement to Medicare due to ESRD (30-month coordination period)

FEHB Plan

It is beyond the 30-month coordination period and you or a family member are still entitled to Medicare due to ESRD

Medicare

2) Become eligible for Medicare due to ESRD while already a Medicare beneficiary and... This Plan was the primary payer before eligibility due to ESRD

FEHB Plan: for 30-month coordination period

Medicare was the primary payer before eligibility due to ESRD Medicare

C. When either you or a covered family member are eligible for Medicare solely due to disability and you...

1) Have FEHB coverage on your own as an active employee or through a family member who is an active employee

FEHB Plan

2) Have FEHB coverage on your own as an annuitant or through a family member who is an annuitant

Medicare

D. When you are covered under the FEHB Spouse Equity provision as a former spouse

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A. When you - or your covered spouse - are age 65 or over and have Medicare and you...

The primary payer for the individual with Medicare is...

1) When you are covered under the FEHB Spouse Equity provision as a former spouse

Workplace health promotion

Benefits

Proper attention to workers' health and safety has extensive benefits:

healthy workers are productive and raise healthy families; thus healthy workers are a key strategy, i.e. goal, for overcoming poverty.

workplace health risks are higher in the informal sector and small industry which are key arenas of action on poverty alleviation, where people can work their way out of poverty;

safe workplaces contribute to sustainable development, which is the key to poverty reduction;

the processes of protecting workers, surrounding communities and the environment for future generations have important common elements, such as pollution control and exposure reduction;

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much pollution and many environmental exposures that are hazardous to health arise from industrial processes, that may be influenced by occupational health and safety programmes;

occupational safety and health can contribute to improving the employability of workers, through workplace (re)design, maintenance of a healthy and safe work environment, training and retraining, assessment of work demands, medical diagnosis, health screening and assessment of functional capacities;

occupational health is fundamental to public health, for it is increasingly clear that major diseases (e.g. AIDS, heart disease) need workplace programmes as part of the disease control strategy.Benefits of Workforce Health Promotion

To the organization To the employee

a well-managed health and safety programme

a safe and healthy work environment

a positive and caring image enhanced self-esteem

improved staff morale reduced stress

reduced staff turnover improved morale

reduced absenteeism increased job satisfaction

increased productivityincreased skills for health protection

reduced health care/insurance costs improved health

reduced risk of fines and litigation improved sense of well-being

These benefits are greater for low-paid workers in high risk occupations and settings, and in this way occupational health interventions can reduce inequities. Efforts made by WHO and its partners to strengthen key aspects of occupational health focus on increasing the coverage of workers in under-served countries and regions with basic occupational health services.Workplace health promotion - What is it?The European Network for Workplace Health Promotion has defined workplace health promotion as the combined efforts of employers, employees and society to improve the health and well-being of

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people at work. This vision of workplace health promotion places particular emphasis on improving the work organization and working environment, increasing workers' participation in shaping the working environment, and encouraging personal skills and professional development.Workplace health promotion focuses on a number of factors that may not be sufficiently covered in the legislation and practice of occupational health programmes, such as the organizational environment, the promotion of healthy lifestyles, and non-occupational factors in the general environment. Non-occupational factors include family welfare, home and commuting conditions, and community factors which affect workers' health.

Workplace health promotion supports a participatory process to help promote a stronger implementation of occupational and environmental health legislation. It suggests tools for maintaining or strengthening a national healthy workplace initiative, such as an awards system as an incentive for participating enterprises, and creation of healthy workplace networks. To be successful, workplace health promotion has to involve the participation of employees, management and other stakeholders in the implementation of jointly agreed initiatives and should help employers and employees at all levels to increase control over and improve their health.While some health promotion activities in the workplace tend to focus on a single illness or risk factor (e.g. prevention of heart

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disease) or on changing personal health practices and behaviours (e.g. smoking, diet), there is a growing appreciation that there are multiple determinants of workers’ health. In addition to person-focused interventions, workforce health promotion initiatives have moved toward a more comprehensive approach, which acknowledges the combined influence of personal, environmental, organizational, community and societal factors on employee well-being. A health-promoting workplace recognizes that a healthy workforce is essential and integrates policies, systems and practices conducive to health at all levels of the organization. Rather than a series of projects, workforce health promotion is an ongoing process for improving work and health. Effective health promotion assists employers to adopt appropriate administrative procedures and workers to use safe working practices. Occupational health personnel benefit from training and education in health promotion to enable them to implement it as a part of their occupational health practice.Experience in workplace health promotion has shown that competitions and awards are valuable in engaging enterprises in occupational health and safety activities. Firms and enterprises achieve valuable publicity and a boost in staff morale through competing to become the most healthy and caring company.

http://iasir.net/AIJRHASSpapers/AIJRHASS13-306.pdf

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