Corporate Health Promotion

When your company has this common – and increasingly well-liked – fringe benefit you may 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, several privately owned gyms have been sued – and agreed to expensive 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 companys could also be at risk when the unthinkable happened on company premises while an worker worked out.

SCA is of particular concern. Reason –  Even seemingly healthful, 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 not the same thing as a heart attack. SCA can affect whoever, anywhere, anytime. It occurs more than 600 times every day in the United States, 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 can be rapidly trained to use an AED – you don’t need any medical knowledge to use it. the training can be acquired 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 business with on-site workout equipment should at least investigate an AED purchase and training.

Employees, supervisors and upper 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% 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 workers 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 business and an employee’s family.

Remember –  Prevention 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 may be hidden risks.

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

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

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

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

When push comes to shove, the vendors will protect themselves. Indeed, some attorneys warn that a voluntary plan insurer’s first move when 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 could be turned against you in court –

• the written announcement to tell workers about the new voluntary benefit, and

• getting involved if there’s a dispute between an staff member and the plan provider.

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

• Don’t put the announcement on organizational letterhead

• Put a disclaimer on the description

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

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

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

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

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

Good intentions gone bad

From an ERISA standpoint, the most dangerous voluntary plan design is one that is partially compensated by the business, even when workers pay the bulk of the cost.

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

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

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

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

A recent survey by LifeCare revealed that 93% of employees (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 workers cited for coming to work sick was a belief that they’d be “letting other people  down” when they call out. Almost 30 percent of respondents cited this as their primary 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 employee saves up sick days for childcare/eldercare emergencies (12%), and

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

Many of these rationales are troubling to HR/benefits managers.

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

You have more power than you think to change your corporation culture when the “tough it out” mentality still applies to people  who come in sick. When  upper management is confronted with the real dollars and cents of presenteeism, decling the problem typically 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 decling 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 staff members, 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  beginning – or analyzing  - a wellness or disease management (DM) 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 disease than other groups. the HIV/AIDS population is also disproportionately Hispanic.

Bottom line –  By analyzing  the ethnic breakdown of your worker population, you can set disease management 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. Many times, minority employees receive inferior treatment and health education at the same facilities where others receive top-notch care.

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

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

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

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

Cancer screenings pay off big

Most wellness programs feature health-risk assessments for things like high cholesterol and diabetes. But many overlook the need for early detection of cancer, which could affect any staff member, 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 expensive screenings – like mammograms – are well worth the cost.

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

Smart worker wellness incentives

HIPAA has tricky non-discrimination rules for offering workers 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 lately quit use of tobacco must also be eligible.

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

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

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

Making wellness programs simple

Many firms require employees to work with an individual “health coach” to earn premium discounts or other incentives. Usually, the staff member sets up appointments and reports to the health coach on a regular basis, either by phone or in person.

The good news –  the early results are often encouraging.

The bad news –  Once staff members 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 company spends on wellness, the odds of success depend largely on the example set by top management.

Example –  When your Chief Executive Officer (CEO) is a smoker, chances are few staff members will buy into a use of tobacco cessation program.

Likewise, it’s hard to sell employees on subsidized health club 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 paid for?

Here’s one proven way –  Develop a provider scorecard. Scorecards alone won’t bring down your healthcare costs. But they’ll at least help make certain your company – and workers – 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. Select 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 staff member 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 paid claim and utilization reports?

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

• Employee education. Do your staff members 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 staff members to make healthy lifestyle choices, like tobacco use cessation?

2. Select a workable rating scale

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

Others create 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 objectives are met.

These rating data can be obtained 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 smoking 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, truly  take more sick days than their non-tobacco use colleagues.

And even when 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 use of tobacco ban fit into the cost equation? When the smoker quits, healthcare costs even out.

But if the person only refrains from smoking on the job – but continues puffing away at home – the corporation sees little to no healthcare cost decrease. the research study  found similar patterns for absenteeism.

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

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

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

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

• 17 percent allow workers to smoke offsite, but ban it on all business property

• 39 percent restrict smoking to designated areas outside the building

• 30% allow smoking anywhere outside the building, and

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

Public companys get aggressive

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

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

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

The ban won’t affect current workers, but the county has undertaken smoking 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 employers 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.

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

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

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

Given that employees nationwide are retiring later and the cost of retiree health care is sky high, you could want to keep trying with smoking cessation programs, even for the oldest employees on your health plan.

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

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

Stressed 401(k) importance

How it worked –  on the same day the company’s 401(k) provider sent a plan rep to discuss the retirement plan, the company also arranged for a qualified financial planner to speak to staff members.

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

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

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

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

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

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