That’s especially true for managing the health of employees’ adolescent children. Most of the attention goes to pre-natal and early childhood care. But a host of serious medical issues typically emerge during teenage years.

Physical issues

It’s every bit as important for employees’ adolescent dependents to undergo complete health assessments as it is for employees’ themselves. This is especially true for weight management issues.

There has been an epidemic rise in overweight and obese adolescents, which can contribute to (or worsen) a variety of physical and/or behavioral health problems.

Remember: These issues can create large-scale direct costs (treatments for the teenager) and indirect costs (absenteeism and/or presenteeism by the parent(s) who work for you). Other crucial factors:

• immunizations (shots or vaccines) to reduce the risk of getting diseases such as hepatitis, meningitis, tetanus and mumps
• preventive health counseling and age-appropriate health information (e.g., drug and alcohol abuse, sexually transmitted diseases)
• vision and hearing tests, and
• blood-pressure screening (especially if there’s a family history of high blood pressure).

Psychological issues

Regular physician visits provide an opportunity to discuss emotional changes and other challenges that most adolescents experience. In some cases, it’s also a front-line means of referring teenagers-in-need to behavioral counseling.

Remember: Proactive care greatly reduces the risk of a host of chronic and debilitating conditions. It can even be a life-safer in extreme cases.

One common glitch: some employees enrolled in the old plan fall through the cracks when transferring to the new carrier.

What happens if, for technical reasons, an enrollee is declared ineligible for the new plan? Read the facts and decide – Who won this case?

The facts: A long-time employee was forced to on long-term disability while he battled a usually fatal form of cancer. During the last stages of his lengthy illness, the company switched its supplemental life insurance plan for employees.

The employee passed away, and his family put in a claim for a $150,000 death benefit. The TPA denied the claim, because the plan documents stated that only active employees were eligible to enroll in the new plan.

The employer said: While the situation was unfortunate, the eligibility conditions spelled out in the plan document were crystal clear. Nothing in the plan document stated that exceptions would be made to carry over inactive employees who were inactive due to a pre-existing illness or serious injury.

The employee’s family said: The family was eligible for death benefits under the company’s old life insurance plan. Even after the plan switch, the man was still technically employed by the company. He was placed on long-term paid disability during the final months of his life.

Who won? The employee’s family.

Why: The court said the company, as sponsor of both the old and new plans, had dropped the ball on its ERISA obligations. Simply changing carriers wasn’t enough to release the firm from all of its legal obligations to employees enrolled under the old plan.

Specifically, it was up to the company – before the new policy took effect – to inform anyone who’d soon lose their benefits. It was the firm’s duty to give the man’s family a heads up that, as an inactive employee, he’d become ineligible for the new plan.

After all, the judge said, management at the company knew ahead of time about the employee’s failing health and inability to work.

Cite: Miller v. Rite Aid Corp., Miller v. Rite Aid Corp, 9th Circuit Crt.,
No. 05-35505, 10/11/07.

In order to be effective, the program must meet participants’ individual medical and psychological needs, not to mention your own organization’s need to control long-term health costs.

How wide-reaching should the program be? After all, it doesn’t make sense to pay for services your employees don’t want or can’t use.

Mary Beth Chalk of Resources for Living suggests that obesity programs can be broken down into four tiers of employee need, from which your organization’s return on investment (ROI) can also be measured.

Tier 1: Education

Tier I employees struggle with weight management problems but don’t need a health coach.  Instead, they may benefit from a self-directed program that provides weight-management related materials online, targeted mailing, and/or access to nurse call line.

How to measure ROI: utilization. Do employees click on the Web site? Do they return to the site regularly? Do people use the nurse line? Your program vendor should provide you detailed use stats.

Tier 2: Clinical supervision

If the employee has been diagnosed as obese — a body mass index (BMI) score over 30 is obese, over 35 is clinically obese — he or she would do better working with a health coach in a clinically supervised program.

Three keys to getting maximum results:

1. Periodically have participants rate their relationship with their health coaches. Not everyone clicks, so a change may be in order.
2. Coordinate your disease management care with your employee assistance program (EAP)services. Reason: Inability to control weight is often closely tied with mental health issues — and one can negatively affect the other. The more closely your EAP and obesity program managers work together, the higher the chance for success.
3. Beware of the fade-out effect. Many employees in weight-loss programs get off to a great start and then fall back into old habits. People should re-commit to the program after three sessions, four months and nine months.

To measure ROI, look at utlization, goal achievement and reduced presenteeism. Of course, presenteeism is notoriously difficult to measure with reliable dollar figures. So how can you overcome that problem?

• Start with employees’ salaries. Let’s suppose one participant earns $40,000 per year.
• Ask workers to self-report how energetic and productive they feel on the job, on a percentage scale. Then have supervisors estimate the employee’s productivity and split the difference. For this example, let’s assume it averaged to 50%.
• Collect scores again six months and one year into the program and then multiply the difference by salary. The result is your estimated productivity ROI.

In the example above, if the employee earning $40,000 improves from 50% to 75% after one year, the productivity related ROI is $10,000.  

Tier 3: Medical management

At this level, the obese employee needs a higher level of care than a health coach can offer. The employee has chronic health conditions related to obesity — such as diabetes, high blood pressure, and/or sleep apnea — and needs a physician case manager. Specifically, the employee needs to set up regular visits with the doctor and create a treatment plan.

To measure ROI, start with the lower-tier criteria, then track quarterly and year differences in FMLA or paid absences, and prescription drug costs. Then compare it to the per-participant cost of the obesity program.

Tier 4: Morbid obesity

At this level, the employee has been diagnosed as morbidly obese — BMI over 40 — and is considered a potential candidate for gastric bypass surgery.

ROI is measured through ongoing health claims as well as the previous criteria.

Over the last five years, there’s been a reported 69% jump in employee EAP use related to personal financial concerns. The trend is not all that surprising.

Statistics show that, for the first time since the Great Depression, the average American has negative savings — in other words, debt exceeds income — in a typical month. With salaries frozen in many organizations and many employees racking up higher and higher credit card debt, the problem may continue to get worse.

Troubling trends

Here are some ominous numbers from a recent employee survey:

• 27% of respondents said they were “one major setback away from financial disaster”
• 22% say they were “worse off than last year, with less take-home income and more debt”
• 40% say their employer is “insensitive to their employees’ financial needs,” and
• only 6% said they felt comfortable with their current financial situation and ability to manage their debts.

The majority of personal-finance related EAP use arises from concerns over debt management, household refinancing and/or failed investments.

In most cases, employers avoid doing audits either because they’re concerned about the upfront cost (both in terms of money and time), potential privacy law violations or reliance on a third-party adminstrator (TPA) to catch overpayments.

In the long-run, however, audits typically save employers about 4% (either in recovered money or billing credits) on their health plan. What’s more, as plan sponsor, your firm has a right to know if your TPA is handling claims properly.

Most TPA firms expect audits. They have an internal audit system (although odds are none of your firm’s claims will be looked at). They also have a department set up to handle external audits.

Double-check your contract with the TPA. It should have a section on your rights to audit, how often you can do them and any fees charged.

How often you should audit depends on the size of your firm. Most mid-size employers that conduct claims audits do them once a year. Some organizations also do a procedural audit of the TPA and/or a pharmacy benefits audit every three years or so.

Pays to outsource

One downside of audits is they’re time consuming. Another is HIPAA: Unless you have a well-defined compliance policy (including designating a privacy officer and creating a formal system for safeguarding records), it’s risky to get hands-on with employees’ claims.

Most firms – big and small alike – avoid both drawbacks by outsourcing audits to specialists. That way, the claims audits take up very little of HR/Benefits’ time. And reputable audit firms will already have all the needed HIPAA compliance mechanisms in place.

Yes, outsourcing the audits can cost several thousand dollars. But the investment usually pays for itself two ways:

• outsourced audits often produce more substantial savings because specialists know what to look for, and
• there’s no productivity drain.

• health benefits. Although yearly cost increases have slowed, the burden of managing them has grown. Many firms reluctantly raised employee cost-shares again or cut benefits
• profit-sharing programs. Revenue is up at many firms, but profits are down. As a result, employee shares have been affected, and
• retirement benefits. Relatively few employers (less than 2%) have had to scale back annual matching contributions to employee accounts, but it’s an option in extreme cases.

The ruling says that according to state gun laws, employees, contractors and volunteers are allowed to carry guns in their vehicles as long as they’re in possession of a valid license.

The Florida Retail Federation and the Florida Chamber of Commerce said the law conflicts with the U.S. Constitution by violating property rights and is preempted by OSHA. But the court disagreed. Florida employers must allows licensed employees to carry weapons in their vehicles.

Employers aren’t allowed to:

• bar guns in company parking lots
• ask in job interviews whether a prospective employee carries a gun in their vehicle
• take action against a worker based on whether or not they have a gun in their vehicle
• condition employment on whether a person has a concealed-carry permit, or
• terminate or discriminate against a worker who carries a gun in their vehicle.

The court did ban the portion of the law that didn’t allow employers, with permit carrying employees, to ban customers from carrying weapons. They said that portion of the law lacked rational.
I

The IRS recently released the 2009 reimbursement limits for companies that reimburse on a per diem basis.

The new rates are effective as of Oct. 1, 2008.

Increase in standard rate

The standard non-mileage per diem limits for 2009 have been bumped up to $109. The breakdown:

• $70 a day for lodging, and
• $39 for meals and incidentals.

Keep in mind that these rate apply to expenses incurred at “standard” locations, but the feds also have a list of over 400 non-standard locations. The reimbursement limits are higher for the non-standard ones.

Is per diem the way to go?

Per diem reimbursements are just one of many possible methods available for reimbursing employees’ business expenses. But if you’ve never reimbursed this way, it may be worth considering.

According to CFO & Controller Alert, this method offers more opportunities for cost control than many other common approaches.

A recent report found some encouraging trends that may carry over to your health plan renewals:

• point-of-service medical plans without prescription drugs, for active employees and retirees under the age of 65, have declined from 13.7% in 2003 to a projected 10.4% for 2009
• prescription drug trends for active employees is predicted to fall to 9.8% in 2009, down from 2001’s high of 19.7%, and
• trend rates for hospital services are expected to be 10.9% in 2009.

Bottom line: Steering employees toward these cost-effective services and encouraging participation in wellness programs can help to reduce your premium increases.

Are your policy and procedure manuals a lawsuit waiting to happen?

There’s no law that require you provide employees a benefits handbook or manual. But best practice is to have one, so long as you follow some basic rules for what needs to be in there, and what should never be in there. Three sections to review immediately:

• pay policies (especially overtime)
• FMLA, and
• paid leave.

Your choice of wording in these sections could make or break your company’s case if an employee sues. Following are three of the biggest red flags that many firms ignore.

Handbook Taboo #1: Overtime policy violates FLSA

Many handbooks contain the following dangerous statement: “Authorized overtime is paid at 1.5 times the hourly rate.”

From a legal standpoint, that’s the same as saying “Our organization is non-compliant with FLSA’s wage and hour laws.” Under FLSA, if a non-exempt employee works overtime – whether it’s authorized or not – you must pay the overtime rate. No exceptions.

What’s legal is to create policies designed to prevent unwanted OT before employees work it. For example, it’s fine for a hanbook to say, “All overtime must be authorized by your supervisor.”

For such a policy to be effective, however, it’s necessary to have formal procedures for OT-authorization. Your handbook must describe these steps (e.g., written permission from a supervisor), as well as any disciplinary procedures for breaking the rules.

But once the hours are worked, it’s too late not to pay for it. Even if you pay for OT (whether authorized or unauthorized), the mere suggestion in the handbook that you may be withholding pay for unapproved OT could get you sued under FLSA.

Taboo #2 : Vague language on FMLA coordination

Writing FMLA policies in your manuals is one the toughest challenges in creating a compliant handbook.
Federal law says that if you have a benefits manual, you must describe how FMLA overlaps with other company benefits.

Example: Do you require people to use available paid leave and FMLA concurrently? If so, you must include this info in the FMLA section of the handbook.

Otherwise, the employee is entitled to “save up” their 12 weeks of FMLA until after paid time is used up. The result is your organization’s benefits manual accidentally gives away extra family or medical leave that is now protected by the law.

What happens under these circumstances if you terminate an employee for attendance policy violations? Assuming that the excessive leave was the reason for termination, the chances are that court will look at what’s written in your manual and rule in the worker’s favor. 

Taboo #3: Unclear paid time-off policies

Whether you have separate sick time and vacation policies or a single paid time off bank, your manual should be crystal clear on how leave is accumulated, and when and how it may be taken. 

Example: If you expect employees to file written vacation requests signed by a supervisor, but your manual only says “written request” and neglects the need for supervisor approval, a request denied for lack of a supervisor signature may not hold up if the employee challenges it.

When reviewing your paid leave policies, make sure the manual is clear on its descriptions of:

• Eligibility. Do part-timers and/or temps qualify? If so, when?
• Accrual. How do you calculate the banks (e.g., one year of service = 18 PTO days per year)?
• Use. How soon can an employee take leave? Do unused days roll over to the next year or are they calculated on a use-it-or-lose-it basis?

Policies versus procedures

In re-reading any section of your manual, ask yourself, “Is this a policy or is it a procedure?”

Here’s the difference: A policy is where your company stands on a certain issue, such as a policy banning employees from smoking. A procedure is how you get things done. Example: Employees who participate in a smoking cessation program must submit for reimbursement through your Payroll department.

The sections in your manual that describe policies must contain:

• specific descriptions, such as, “Employees may not wear shorts to work,” and
• enforcement details, such as what will happen if an employee violates the dress code?

Meanwhile, sections describing procedures should also be as specific as possible.

For example, compare these two handbook statements for requesting family leave:

1. “If an employee is aware of a need for family leave 15 days or more before it is to begin, the worker must file a request for leave within 15 days of the start date.”
2. “If there’s a foreseeable need for leave, the leave request must be filed ahead of leave within a reasonable time. ”

The first statement is clear and protects your firm if the manual is challenged in court. The latter is open to debate – and possibly lawsuits.