Thousands of California injury claims made by professional athletes
Originally posted Ken Bensinger on September 25, 2013 on https://www.latimes.com
The National Football League’s increasingly visible injury legacy has become a topic of national debate, one that threatens to cast a lasting shadow over the country’s most popular, and profitable, sport.
Far less attention has been paid to the physical woes of other athletes, but a review of injury filings in California suggests that professional athletes of all stripes walk away from their sports with nagging and often permanent injuries.
Over the past two decades, more than 2,500 claims have been filed by former baseball, basketball, hockey and soccer players against their former teams in California’s workers’ compensation system.
In the past six years, more than 940 of them -- among them stars such as two-time baseball most valuable player Juan Gonzalez and basketball legend Kareem Abdul-Jabbar -- have made filings alleging serious brain and head injuries.
The claims were isolated as part of a Los Angeles Times analysis of more than 3 million filings made to the California Division of Workers’ Compensation. Last month, The Times published a searchable database of claims by football players, and now it's being updated will all other major team sports.
Database: workers' comp claims by baseball players
Database: workers' comp claims by basketball players
Database: workers' comp claims by hockey players
Database: workers' comp claims by soccer players
Database: workers' comp claims by women's basketball players
Although the total number of claims from all other sports combined is significantly smaller than those made by football players, which number nearly 5,000, the data are a clear indication of the lasting toll professional sports leave on all athletes.
They also help explain why Major League Baseball, the National Hockey League, the National Basketball Assn., the Women’s National Basketball Assn. and Major League Soccer joined the NFL in a push to pass legislation in California that would seriously restrict such claims in the future.
That bill, AB 1309, easily passed the Legislature this month and is now on Gov. Jerry Brown’s desk. If he signs it into law, it would preclude all athletes who played for non-California teams, as well as many California athletes, from making claims for the most serious types of injuries, incurred over time and known as cumulative trauma.
The leagues, as well as their insurers, say the claims should not be filed in California. However, the players unions in each sport retort that such claims are generally not permitted in other states due to narrow definitions of cumulative trauma or expired statutes of limitations.
Organized labor worries that the measure potentially opens the door for future legislation that could deprive workers in other industries of their ability to file here. Because teams and their insurers pay the entirety of costs of successful claims without a dime of taxpayer money, unions argue that the bill would amount to a huge handout to billionaire owners of professional teams.
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Unlike civil lawsuits, which workers cannot file against their employers for workplace injuries, workers’ compensation awards are strictly limited in size and scope and may include lifetime medical care. Still, spread across thousands of injured players, the costs can mount quickly.
For example, former baseball all-star Cliff Floyd received a $102,500 settlement from the San Diego Padres for injuries to the brain, face, neck, shoulders and numerous other body parts this past April, documents reviewed by The Times show. Floyd, who retired after the 2009 season, now works as a television and radio analyst.
Overall, more than 900 baseball players, including many minor-leaguers, have made claims in California since 1990, The Times’ data show. Of them, at least 460 allege cumulative head or brain trauma, which has been linked to conditions including dementia, chronic traumatic encephalopathyand Alzheimer’s disease.
Since 2006, WNBA players have made 87 filings in the state, while professional soccer players have made 51 claims in that period. Although it’s not known for its jarring physical collisions, an increasing number of soccer players are alleging head trauma.
Among them is former U.S. national soccer team star Eric Wynalda, who filed in 2009 claiming cumulative injuries to a host of body parts including his head. In 2011, he won a $127,500 settlement paid by the Chicago Fire of the MLS and the Charleston Battery of the United Soccer Leagues. Settlement figures do not include attorney fees.
Claims by former stars garner the most attention and tend to be held up by the sports leagues as evidence that California’s system has been too generous to people paid millions of dollars to play sports.
But a substantial majority of the claims come from athletes who never made anyone’s all-star list, enjoying relatively short careers and frequently earning the league minimum. Hundreds more were filed by people who never made it to the big leagues, earning little better than the minimum wage in the minor leagues, including Arena Football, the XFL as well as minor-league baseball and hockey, data show.
Even in professional sports’ lowest levels, however, the contact is hard and the physical toll apparently very real. During his career, defenseman David Cousineau skated for teams such as the Las Vegas Wranglers, Phoenix Roadrunners and Long Beach Ice Dogs, earning just $650 a week toward the end of his five-year career.
The rangy Canadian never saw a minute of NHL ice, but his workers’ compensation filing in California details a string of traumas to his head, shoulders, back and legs. In 2010, Cousineau won a $68,000 settlement from his last two teams, agreeing to permanently forsake all future claims and to cover his own medical expenses in exchange.
Obesity’s disease label could spell trouble for employers
Originally posted by Andrea Davis on https://ebn.benefitnews.com
Earlier this year, the American Medical Association deemed obesity a disease. AMA board member Patrice Harris, M.D., said in a statement that “recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans.”
While there is still debate within the medical community as to whether obesity is a disease — the AMA’s own House of Delegates recommended the body not adopt the resolution declaring it a disease — there is speculation the AMA’s decision could open the door to more discrimination claims under the American with Disabilities Act.
EBN spoke to Jay Starkman, CEO of Engage PEO, about the AMA classification of obesity and how it might affect employer decisions.
What are the implications for employers?
Employers need to treat obese individuals like they would anybody else with a disability. … There was always an issue about whether or not an obese person was disabled under the Equal Employment Opportunity Commission guidelines. [Under the] ADA, “disability” is defined as an impairment that substantially limits a major life activity. … but there was always a question about whether or not obesity was one of those things.
One of the issues that existed for a long time was whether or not there needed to be some type of underlying disorder that caused the obesity, whether psychological or physical. By classifying obesity as a disease, it’s pretty clear that whether or not there’s an underlying disorder isn’t going to be a relevant inquiry any more. So that means that employers can’t make hiring decisions — hiring, firing, promotions, raises, compensation — based upon whether or not someone is obese.
Do employers need to consider any changes to their current employee policies?
The first is make sure you have very clear job descriptions — before hiring — that lay out any physical requirements of a position. The second thing is, if somebody is disabled, [because of] obesity or whatever, if it is possible to make a reasonable accommodation for them, that needs to be done.
What else might be important for employers to know?
The definition of “obese” is really in flux right now. A lot of the EEOC cases that existed prior to the AMA coming out with this defined it as “severely” obese or “morbidly” obese. … So nobody is sure what will constitute a disability, because the number of people that are 20% overweight in America is far different than the one for people that are double the standard weight. So I just think that it needs to be a very serious concern in people’s minds.
What You Need to Know about the Small Business Health Care Tax Credit
Originally posted on https://www.irs.gov
How will the credit make a difference for you?
For tax years 2010 through 2013, the maximum credit is 35 percent of premiums paid for small business employers and 25 percent of premiums paid for small tax-exempt employers such as charities.
For tax years beginning in 2014 or later, there will be changes to the credit:
- The maximum credit will increase to 50 percent of premiums paid for small business employers and 35 percent of premiums paid for small tax-exempt employers.
- To be eligible for the credit, a small employer must pay premiums on behalf of employees enrolled in a qualified health plan offered through a Small Business Health Options Program (SHOP) Marketplace.
- The credit will be available to eligible employers for two consecutive taxable years.
Here’s what this means for you. If you pay $50,000 a year toward workers’ health care premiums — and if you qualify for a 15 percent credit, you save... $7,500. If you save $7,500 a year from tax year 2010 through 2013, that’s total savings of $30,000. If, in 2014, you qualify for a slightly larger credit, say 20 percent, your savings go from $7,500 a year to $10,000 a year.
Even if you are a small business employer who did not owe tax during the year, you can carry the credit back or forward to other tax years. Also, since the amount of the health insurance premium payments is more than the total credit, eligible small businesses can still claim a business expense deduction for the premiums in excess of the credit. That’s both a credit and a deduction for employee premium payments.
There is good news for small tax-exempt employers too. The credit is refundable, so even if you have no taxable income, you may be eligible to receive the credit as a refund so long as it does not exceed your income tax withholding and Medicare tax liability.
And finally, if you can benefit from the credit this year but forgot to claim it on your tax return, there’s still time to file an amended return.
Click here if you want more examples of how the credit applies in different circumstances.
Can you claim the credit?
Now that you know how the credit can make a difference for your business, let’s determine if you can claim it.
To be eligible, you must cover at least 50 percent of the cost of single (not family) health care coverage for each of your employees. You must also have fewer than 25 full-time equivalent employees (FTEs). Those employees must have average wages of less than $50,000 (as adjusted for inflation beginning in 2014) per year. Remember, you will have to purchase insurance through the SHOP Marketplace to be eligible for the credit for tax years 2014 and beyond.
Let us break it down for you even more.
You are probably wondering: what IS an FTE. Basically, two half-time workers count as one FTE. That means 20 half-time employees are equivalent to 10 FTEs, which makes the number of FTEs 10, not 20.
Now let’s talk about average annual wages. Say you pay total wages of $200,000 and have 10 FTEs. To figure average annual wages you divide $200,000 by 10 — the number of FTEs — and the result is your average annual wage. The average annual wage would be $20,000.
Also, the amount of the credit you receive works on a sliding scale. The smaller the business or charity, the bigger the credit. So if you have more than 10 FTEs or if the average wage is more than $25,000 (as adjusted for inflation beginning in 2014), the amount of the credit you receive will be less.
How do you claim the credit?
You must use Form 8941, Credit for Small Employer Health Insurance Premiums, to calculate the credit. For detailed information on filling out this form, see the Instructions for Form 8941.
If you are a small business, include the amount as part of the general business credit on your income tax return.
If you are a tax-exempt organization, include the amount on line 44f of theForm 990-T, Exempt Organization Business Income Tax Return. You must file the Form 990-T in order to claim the credit, even if you don't ordinarily do so.
Don’t forget... if you are a small business employer, you may be able to carry the credit back or forward. And if you are a tax-exempt employer, you may be eligible for a refundable credit.
Many expect to retire after 70
Originally posted September 13, 2013 by Paula Aven Gladych on https://www.benefitspro.com
The number of Americans who expect to retire by age 65 has dropped dramatically since 1991, while the number who expect to retire after 70 has shot up, according to a report by the Employee Benefit Research Institute.
One-quarter of workers in EBRI’s 2013 Retirement Confidence Survey said that the age at which they expect to retire has changed in the past year, and of those, 88 percent believe their expected retirement age has increased.
Twenty-two percent of all workers said they would postpone their retirement. The reality, however, is that even though those people want to work longer, health issues and their employers could prevent them from doing that.
In 1991, only 11 percent of workers expected to retire after age 65. Now that number is 36 percent, while 7 percent of those surveyed don’t expect to retire at all, according to EBRI.
The number of individuals who thought they could retire before age 65 also has decreased steadily over time.
In 1991, 19 percent of survey respondents thought they could retire before age 60 and 31 percent thought they would retire between ages 60 and 64. In 1998, those numbers were still high at 24 percent and 25 percent respectively.
By this year, only 9 percent of respondents thought they would be able to retire by age 60 and 14 percent thought they could do it by age 64.
Twenty-six percent of respondents said they expected to retire at age 70 or older, up from 9 percent in 1991 and 7 percent in 1998.
The Employee Benefit Research Institute is a private, nonpartisan research institute based in Washington, D.C. It focuses on health, savings, retirement and economic security issues.
Top 10 Tricks for a Healthier, High-Energy Workday
Originally posted by Whitson Gordon on https://lifehacker.com
Working at an office can be surprisingly unhealthy. Between sitting all day, eating poorly, and enduring never-ending stress, your office can take a few years off your life. Here's how to stay healthy and energetic at the office (and make the day go by faster).
10. Eat Healthy, All Day Long
Ever have those days at work where you just feel exhausted and can't get anything done? There are a lot of ways to solve that problem, but the #1 fix is healthy eating (starting with breakfast). You should eat your most hearty meal in the morning, when you need the most energy, and continue eating healthily throughout the day to avoid crashes during your productive time. Eating lunch away from your desk can help, too.
9. Set Up a More Ergonomic Workspace
It may not seem like it, but sitting at your desk all day can wreak havoc with your wrists, back, neck, and other body parts if done improperly. Thankfully, it's really easy to set up an ergonomic workspace, without spending a ton of money. Most of it is practicing good posture and positioning your keyboard and mouse properly, though a good office chair is a good investment.
8. Get Up and Move
Having an ergonomic workspace isn't enough, though—all that sitting is still killing you. So, to keep yourself healthy and really avoid RSI injury, it's important to take frequent breaks. All you need is five minutes every once in awhile—in fact, we've created a schedule template that'll make sure you get enough time away from your workspace. If you really want to get out of that chair, a standing desk can be a really great solution too—many people, including Lifehacker's own founding editor Gina Trapani, swear by it.
7. Avoid Eyestrain at Your Computer
Ever get eye pain or headaches at the end of the day, but aren't really sure why? It's probably from staring at that computer all day. The aforementioned breaks can help combat eyestrain quite a bit, but a few of us at Lifehacker have also found that computer-oriented glasses likeGunnars can make a big difference, too.
6. Be Friends with Your Coworkers
Coworkers can be distracting and annoying, but being friends with them can actually make work a lot less stressful. In fact, one study even found that people who were friendly with their coworkers actually lived longer. Even if we're just talking productivity, knowing which coworkers will help you in a bind is incredibly useful, and easy to do with a single email. As long as you keep yourself from getting distracted, office friends can actually be good for your productivity and health.
5. Fit More Exercise Into Your Schedule
Getting regular exercise is one of the best ways to stay healthy and keep your energy level up, but getting regular exercise with a demanding job is tough. This 20-minute exercise plan is a good starting point, though you can also work small bouts of exercise into your day without a full "workout." Working out at work is possible, but tough, so it's up to you to try things out and see what works.
4. Cultivate Personal Rituals that Keep You Sane
It may seem silly, but little personal rituals during the day—whether it's a relaxing afternoon cup of tea or kicking back with the funnies—can really improve your mental and physical health. So don't neglect them! You should already be taking a few breaks during the day (see tip #8), so use them to your advantage. Having a good daily routine can go a long way. .
3. Get Better Sleep (or Sneak In a Nap)
You already know lack of sleep is bad for your work and health, but few of us actually do something about it. Well, it's time. Try sneaking in a nap at work if you can't force yourself to get enough sleep at night. Even a short power nap can keep you productive and creative. Justmake sure your nap isn't too short (or too long) and you'll be on your way to a more productive workday.
2. Work Smarter, Not Harder
Working yourself to the bone can create stress and really weigh on your health. If you're a regular reader of Lifehacker, you know our main philosophy is to work smart, not hard: that means using your time efficiently, doing your most important work during your body's high-energy hours, and avoiding the "cult of busy." The smarter you work, the less time you have to spend stressing out over everything you have to do.
1. Go Home
Building off the above: more hours does not equal more work. Ask yourself: how many hours do you work a week? Most research shows that if it's over 40 hours, you're hurting your productivity, your health, and your income (since you're working fewer hours for the same pay). The key? Stop working and go home at night. It's more challenging than it sounds, but it's well worth it.
7 Ways To Keep Your Employees Happy (And Working Really Hard)
Originally posted September 8, 2013 by Karsten Strauss on https://www.forbes.com
It doesn’t matter what you build, invent or sell; your organization can’t move forward without people. CEOs, company founders and managers all over the world know that keeping the teams beneath them moving forward together in harmony means the difference between winning and dying.
Prof. Leonard J. Glick, Professor of management and organizational development at Boston’s Northeastern University, teaches the art of motivating employees for a living. He let FORBES in on a few tips for entrepreneurs and managers looking to keep their people smiling and producing.
Build Ownership Among Your Crew
You’ve got to get employees to feel that they own the place, not just work there. “One of the principles of self-managed teams is to organize around a whole service or product,” Glick explained. In other words, make sure company personnel feel responsible for what the customer is buying.
One way to inspire that feeling is to have each member of a team become familiar with what other team members are doing, allowing them to bring their ideas for improvement to the table and have input in the whole process. If the roles are not too specialized, have your people rotate responsibilities from time to time. “It all contributes to a feeling of ‘it’s mine,’ and most people, when it’s theirs, don’t want to fail, don’t want to build poor quality and don’t want to dissatisfy the customer,” said Glick.
Trust Employees To Leave Their Comfort Zones
Few employees want to do one specific task over and over again until they quit or retire or die. Don’t be afraid to grant them new responsibilities—it will allow them to grow and become more confident in their abilities while making them feel more valuable to the organization.
Though managers might feel allowing their people to try new things presents a risk to productivity or places workers outside of their established place, it heads off other issues. “To me the bigger risk is having people get burnt out or bored,” explained Glick.
Keep Your Team Informed
Business leaders have a clearer perspective on the bigger picture than their employees do. It pays to tell those under you what’s going on. “Things that managers take for common knowledge about how things are going or what challenges are down the road or what new products are coming… they often don’t take the time to share that with their employees,” Glick said. Spreading the intel lets everyone in on the lay of theland and at the same time strengthens the feeling among workers that they are an important part of the organization.
Your Employees Are Adults—Treat Them Like It
In any business there is going to be bad news. Whether it’s to do with the company as a whole or an individual within the organization, employees need to be dealt with in a straightforward and respectable manner. “They can handle it, usually,” said Glick. If you choose to keep your people in the dark about trying times or issues, the fallout could be a serious pain in the neck. “The rumors are typically worse than reality. In the absence of knowledge people make things up.”
You’re The Boss. You May Have To Act Like It Sometimes (but be consistent)
Though this issue is affected by an organization’s overall culture, there are going to be times when you have to make a decision as a leader, despite whatever efforts you may have made to put yourself on equal footing with your personnel. “Ideally they have an open relationship but not necessarily are peers,” Glick said of the manager-employee relationship. “I think the worst thing is to pretend you’re peer… it’s the inconsistency, I think, which is the bigger problem.”
Money Matters (But Not As Much As You Think)
Compensation packages are a big deal when employees are hired, but once a deal has been struck the source of motivation tends to shift. “The motivation comes from the things I’ve been talking about—the challenge of the work, the purpose of the work, the opportunity to learn, the opportunity to contribute,” Glick explained.
When it comes to finding a salary that will allow your employees to feel they’re being paid fairly, don’t bend over backwards to lowball them. If you do, they will eventually find out and not be happy. “If the salary were open, is it defensible?”
Perks Matter (But Not As Much As You Think)
Some companies (we’re looking at you Google GOOG +0.96%) have received attention for offering lavish perks to their personnel – massages, free gourmet lunches, ping pong tables, childcare facilities – but, like money, these things tend to be less powerful motivators for workers than in-job challenges and the feeling of being a valuable part of a quality team that will recognize their contribution. A manager needs to understand that though those perks are great and release burdens from employees’ shoulders, they are not a substitute for prime sources of professional inspiration.
“I don’t think people work harder, work better because of those things,” said Glick. “It may make it easier for them to come to work, I understand that.”
Open Enrollment Tips Under Health Care Reform
Originally posted September 6, 2013 on https://www.thestreet.com
This year's open enrollment season for selecting workplace benefits comes just before some of the biggest changes of health care reform go into effect.
Never before has it been more important to pay attention as you choose a health plan for you and your family.
"You really need to do your homework this year," says Carol Taylor, an employee benefit adviser with D & S Agency Inc. in Roanoke, Va.
Here are 5 tips for open enrollment this fall.
1. Understand the health care reform individual mandate: You must have coverage.
Starting in 2014, federal law will require virtually everyone to have health insurance or face a tax penalty. So if your employer doesn't offer health insurance for next year or your company's health plan doesn't meet certain minimum standards, you'll need to shop for health insurance on your own. Your employer must let you know by Oct. 1 whether its health plan meets "minimum standards," says Taylor, a member of the National Association of Health Underwriters National Legislative Council.
To meet the minimum standards under health reform, employers must offer coverage at the "bronze level," which is one of the four levels of coverage defined under health reform provisions. The other three are silver, gold and platinum. They are based on actuarial value, which measures the amount of financial protection the policy offers, or the percentage of health costs a plan would pay for an average person. For a bronze plan, the insurance would cover 60 percent of all health care costs for an average person. Enrollees, on average, would be responsible for paying 40 percent of the costs.
If you're shopping for an individual health plan, you can buy one from an insurance company directly or through your state's new health insurance marketplace. The online health insurance marketplaces, sometimes called exchanges, are scheduled to open for business Oct. 1. Coverage can begin Jan. 1.
If you're not eligible for coverage through an employer or your employer's plan doesn't meet government standards, then you might qualify for a tax credit to save money on premiums when you buy a marketplace plan. People who earn up to 400 percent of the federal poverty level -- that's $94,200 for a family of four in 2013 -- will be eligible for premium subsidies in the form of tax credits. People who earn up to 250 percent of the federal poverty level will be eligible for lower deductibles and copayments.
2. Don't assume your family will qualify to save money in the new marketplaces.
Think you can get a better deal in the new marketplace than what your employer is offering? Maybe not. If you and your family have access to affordable employer-sponsored health insurance that meets minimum standards, then you and your dependents are not eligible for premium tax credits or help with cost-sharing - which includes aid in paying deductibles, copayments or co-insurance -- in the new marketplaces. You can shop there, but you'll pay full price.
"Affordable" means you pay no more than 9.5 percent of your household income toward the coverage for yourself. The amount you pay for your dependents to be covered on the employer-sponsored plan isn't factored into the equation. So even if you have to pay a bundle to keep your dependents on the employer plan, they're still not eligible for subsidies in the marketplace if the portion you pay to cover yourself is deemed affordable and they have access to the employer plan.
That could put a lot of moderate-income families with a sole breadwinner in a financial bind, says Mindy Anderson-Wallis, president of Employee Benefit Solutions of Indiana in Lafayette, Ind.
3. Compare benefits and health insurance plan networks.
Check out the provider networks of the plans you're offered to make sure your doctors and preferred hospital system are included, especially if you have a serious or chronic condition and are undergoing treatment. Given all the standards that must be met, one way health plans may cut costs is to cut the provider networks, Taylor warns.
You pay substantially more out of pocket to see providers outside the network with a preferred provider organization (PPO) plan. Except in special circumstances, you typically pay for the full cost of services for providers outside the network with a health maintenance organization (HMO) plan.
4. Understand that your employer doesn't have to offer coverage in 2014, and it won't have to offer coverage to your spouse.
Starting in 2015, the Patient Protection and Affordable Care Act will require employers with at least 50 workers to provide affordable health insurance for workers and their dependents or pay a penalty. The so-called employer mandate was supposed to go into effect in 2014, but the Obama administration delayed implementation for a year.
Still, most employers are gearing up for the mandate, and there's one tricky technicality you should know. The federal government will define dependents as children, not spouses. So even when the employer mandate goes into effect, your workplace won't have to offer coverage to your spouse.
Nobody knows yet how this will play out, but Anderson-Wallis says she doesn't think the definition of "dependent" will have much impact.
"I don't think we'll see large employers not continue to cover spouses," she says. "Benefits are seen as a way to attract and retain employees."
If your spouse isn't eligible for employer-sponsored coverage, then he or she will qualify for a tax credit to save money on a health plan in the new marketplace if your household income is less than 400 percent of the federal poverty level.
5. Crunch the numbers and pick the health insurance plan with the best value.
Compare the out-of-pocket costs of each health plan if your employer offers a choice of plans. Your costs include:
- Deductible.
- Doctor visits, urgent care and emergency room copayments.
- Co-insurance -- the percentage the health plan pays after you satisfy the deductible.
- Prescription drug copayments or co-insurance.
- Your portion of the premium.
Consider how often you go to the doctor, the medicines you take and what services you might need in the next year. Run some scenarios to see how much each health plan would cost, and choose one that meets your unique needs.
"Don't just roll the dice without calculating," Anderson-Wallis says.
Cost savings attributed to self-funding, wellness
Originally published September 6, 2013 by Tristan Lejeune on https://ebn.benefitnews.com
Dianne Howard has understandably made a number of changes during her tenure as director of risk and benefits management with the School District of Palm Beach County, Fla. - after all, she's been there for 18 years. One change in particular six years ago paved the way for many other beneficial ones: The district went self-funded. It's a shift that may not be an option for many employers, but Howard - winner of the 2013 Benny Award for Benefits Leadership in Health Care - says it allowed her to be more hands-on with internal policies and institute real, lasting improvements.
"I'm a big believer in self-insurance," Howard says. "I think you can buy excess insurance to protect yourself, you know, specific and aggregate. You can't be too small, but for groups of 1,000 or more, it's the way to go. You can control things, you can subcontract, you can get in there and say, 'Well, why is this costing us so much money?'"
She recalls an incident where MRIs - hundreds of them in total - were being paid for without having the deductible applied. Providers never informed them of this until the district took the reins themselves; they had just assumed that hospital stays were involved.
"And it was just a mistake - I'm not trying to throw anybody under the bus - but because we looked at it, we could fix it and change it so that the design as we negotiated [it] was in there, and we're getting the savings that we thought we would get," she says.
After going self-insured, the district used a data warehouse to analyze its claims and find ways to control costs. Estimated savings? At least $4 million. It also added a tobacco surcharge to insurance plans and helped write the Florida law banning smoking on school property. But the initiative Howard is most eager to talk about is one that has been widely embraced even as its financial efficacy has been increasingly questioned: wellness.
Not an easy sell
Many who have tried it will tell you that initiating a wellness program is not the easiest sell to an employee population. Just ask Howard: "People don't like being told what to do," she says, and she saw quite a bit of resistance. That's normal enough for a private company, but Howard's position comes with extra challenges.
"We're a public entity, so noise gathers," she says. "It doesn't just come to me and my staff. It goes to me, to my boss and maybe to our school board. You just want to be able to defend your position, get it well-communicated and get the unions on board to help you communicate. We told them, 'If it works and we keep our rates down, maybe we won't need rate increases every year.' And for 2014, we're not going to need a rate increase."
Marilyn Boursiquot, benefits manager for the district, agrees that wellness was not exactly a welcome change for employees, but she says the work is paying off.
"Our culture is slow, and some folks are still being dragged along kicking and screaming, but we can truly say that we're starting to see the light of creating a culture of wellness, which is really exciting," Boursiqout says.
Howard's "tenacity" and her "willingness to be on the edge" has helped steward the district through year after year of change, Boursiquot says. And she thinks that's what makes Howard worthy of her Benny Award.
"When we look at other school districts, and just other employers in general, they're willing to go to a point, but then when the rubber hits the road ... it's not always easy to introduce programs like this," Boursiquot says. "You take flak for it. And to actually keep moving forward in spite of all that - that's what I really admire about her."
Medical trends
The School District of Palm Beach County boasts an average five-year medical trend of 6% - 4% below the industry median of 10%. It also shed 1,000 dependents (estimated long-term savings: $4.4 million) after an audit found them ineligible - one of many reviews made possible through self-insurance.
Howard, however, believes the wellness program has been helping keep costs down for the district, which has 20,000 full-time employees. It was a slow road, she says, and the program "evolved" from weak to strong.
"We started out by saying, 'Here's a health assessment you could do.' In a district our size, we got 25 people to do it, and we gave gift cards at the time," she says. "And that really was poor. So about four or five years ago, we started talking with the unions, and we found a different way to negotiate with them and said, 'Let's bargain something two years out,' and that gave them time to think and to plan.
"We wanted to get to the point where employees have to get blood work, so they know their condition, and get a physical. ... More than half our employees never saw a doctor. So we said, 'OK, preventive stuff is what we should do,' so we had talks with our carrier about what's important, and we figured the health assessment was very important."
The district upped the reward for HRA completion substantially to a $50 premium reduction per month. "And that number," Howard says, "really was motivating to our employees." In its first year, the new program saw 85% compliance. And now, as she says, health insurance costs won't rise for workers next year. This, too, is a bigger deal for a public entity.
"We're government employees," Howard points out. "We haven't had raises in a few years."
Of course, even wellness programs' biggest proponents will admit they can only get you so far; the district has had to do its share of belt-tightening. Copays and premiums have risen in recent years, and there are newly designed pharmacy tiers, too.
Estimating in 2010 that diabetes accounted for 20% of its health claims, the district implemented a diabetes health plan. In its first year, the plan reduced total net costs by 9%, or around $2.9 million.
In another "self-funded only" gain, the district now gets 100% of its pharmacy rebates, which not only helps its coffers but also future plan design.
"Our rebates are approaching $5 million a year, and that's money that goes right back into the health plan," Howard says. "We had no idea it was so much money - only self-insured employers do."
Schools run mini-programs
But Howard again credits the district's wellness plans for starting long-term change. Schools, she says, can be excellent incubators for mini-programs that could work just as well at businesses with multiple locations. In addition to administrative offices, the Palm Beach County district runs some 180 locations, serving approximately 176,000 students.
"We had what we called 'wellness champions' at each school," Howard says. "What we said we would do is give them some resources so that they could run a program for their school - if they wanted to run a class on exercise or Weight Watchers or whatever. We have two big meetings a year with them, we give them a $500 stipend out of our health budget and for that they have to do a certain number of programs at their school. ... We went from 30 to 170 [wellness champions] in four years. And each of those people can [reach out] to the 200 to 400 people at their school and they know them."
Employees might be more amenable to such programs when they're initiated by a friendly co-worker and not some distant HR office. Making it personal and fun helps, too: In a different effort, called the Apple-a-Day Program, participants can submit photos of themselves eating apples while walking, reading medical care info or doing other healthy things. Howard says vendors donated prizes for the best photos, and local orchards even donated some apples. It's definitely a program she plans to repeat.
Kimberly Sandmaier, Palm Beach County wellness coordinator, admires Howard for her dedication and knows the district health plan is in good hands. "She's worked so hard with all our programs," Sandmaier says, and positive results are coming in on all fronts.
"I've always looked up to her and seen her as a leader. Whether it's meeting with a vendor or the unions, she gets a lot of respect from them. I think she does a great job, and she handles everything with grace."
As for what lies ahead, Sandmaier says, "We're trying to be proactive. We're trying to figure out the best thing out there to reduce our health care costs, especially in light of everything that's happening with health care reform and some of the additional charges that we may see in the future."
In the next phase of evolution, Howard plans to make her wellness programs results-based. Though she concedes it "may be not quite as successful," she remains optimistic.
"I think people are going to do it. I mean, you're taking the blood work anyways," she says. "Ideally people will say 'I've been doing the blood work for three years, I've had high blood pressure for three years - why don't I do something about it?' But that might not happen."
Whether self-insured or not, whether public or private, Howard recommends employers commit to wellness. "I really believe that you need a wellness component and work toward having your population having a little accountability in your health care," Howard says. "Don't give up when the noise gets a little loud. Use your data to show people, 'Look, this is what happening.' I just really believe in it; it's been good for us."
The numbers
Here are just a few of the results achieved by the School District of Palm Beach County under Dianne Howard's leadership:
2007: Switch to self-funded plan.
0: Cost increase in 2014 for self-funded medical plan.
6%: Average five-year medical trend.
100: Percentage of pharmacy rebates now received.
$4 million: Savings achieved from using a data warehouse to dig into claims to see where the school district was spending the most money and analyze what could be done to control those costs.
1,000: Number of dependents moved off the health plan thanks to a dependent eligibility audit.
$4.4 million: Estimated savings from dependent eligibility audit.
80%: Average participation rate in the wellness program.
$2.9 million: Estimated savings from the implementation of a diabetes health management program.
$600: Annual tobacco surcharge.
195: Number of wellness champions, up from 16 a few years ago.
IRS struggles to combine PPACA reports
Originally posted September 6, 2013 by Allison Bell on https://www.benefitspro.com
The Internal Revenue Service is still trying to figure out how to combine two new Patient Protection and Affordable Care Act reporting programs.
One of the new programs requires a carrier to tell the IRS and consumers whether it’s providing minimum essential coverage.
The other requires a large employer to tell the IRS whether it’s meeting the “shared responsibility” requirements -- the employer mandate -- by offering full-time workers affordable coverage with a minimum value. An employer that violates the mandate rules could have to pay a penalty of $2,000 per affected worker.
The IRS will publish the PPACA Section 6055 MEC reporting requirement and PPACA Section 6056 shared responsibility reporting requirement draft regulations in the Federal Register on Monday.
It’s been suggested before that the IRS combine the two programs. But doing so would be complicated, because the programs apply to different entities and will generate different types of information, IRS officials said.
In some cases, the IRS may let large employers use information reported on Form W-2 and information reported to meet the Section 6055 MEC reporting requirements to meet the Section 6056 shared responsibility requirements, officials said.
The IRS is considering letting employers meet the Section 6056 shared responsibility reporting requirements by using a code on the W-2.
Also in the draft, officials:
- Declined to let employers with fiscal years other than the ordinary calendar year to base Section 6055 or Section 6056 reporting on the fiscal year. Consumers need the coverage information early in the calendar year, officials said.
- Declined to create a safe harbor from penalties for coverage issuers or employers that violate reporting rules because other parties cause problems. Another provision already offers issuers and employers relief for any errors that are corrected in a timely manner, officials said.
- Said that the insurer that insures a group health plan, not the group plan sponsor, is responsible for meeting the Section 6055 MEC reporting requirements for the group plan members.
9 items to tackle ahead of the Oct. 1 deadline
Originally posted September 6, 2013 by Dan Cook on https://www.benefitspro.com
Enrolling employees for the 2014 company health plan will put plan managers to a test like they’ve never seen before. Those that haven’t already immersed themselves in the details are going to be working some very late nights in the next couple of weeks.
John Haslinger, vice president for strategic advisory services at ADP, helped BenefitsPro.com compile a list of the essentials that must be executed in order to comply with the law and avoid sanctions.
Haslinger strongly advises that companies take these requirements seriously. He said the government’s decision to delay the corporate plan sanctions piece of the PPACA until 2015 doesn’t let anyone off the hook as far as meeting all the other requirements by Jan. 1. And many items must be completed by Oct. 1.
Here, then, are nine items you need to check off your 2014 checklist to stay out of the PPACA’s woodshed.
1. Notice of coverage or exchange notification: It’s up to employers to notify every employee, covered by a company health plan or not, of the health care options available to them through the insurance exchanges created by the Patient Protection and Affordable Care Act. This notification must be in an employee’s hands no later than Oct. 1. Employers hired after Oct. 1 have to be notified within 14 days.
Suggestion: If you haven’t started this process, hire a third-party administrator with knowledge of the process to do it for you.
2. The Transitional Reinsurance Fee: This is the $63-per-covered-employee fee that plan sponsors and insurers must pay. The money goes to fund insurance for high-risk individuals. Employers and insurers have to report their enrollment numbers to the feds by Nov. 15. You’ll get an invoice back in a month, if all goes as planned, and the bill will come due a month later.
Suggestion: Set aside a good chunk of dough now to cover the cost.
3. Essential health benefits: This section of the PPACA requires non-grandfathered health plans to cover 10 essential health benefits as follows:
(1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services;(9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.
For newly hired full-time employees who come on board after Jan. 1, coverage must be made available no longer than 90 days after hire.
Suggestion: State EHBs may vary, so make sure you know the requirements where you live.
4. Defining and counting your eligible full-time employees: The PPACA has redefined full-time employees for purposes of healthcare coverage. Now, employers must offer coverage to anyone who works an average of 30 hours a week. Calculating the 30 hours can be tricky, so you need to know the details. For instance, hours an employee is paid to work aren’t the only ones you count. You need to include the hours you pay someone not to work, such as vacation time, and hours of unpaid leave, such as jury duty. Having a good fix on who your eligible employees will be come Jan. 1 is critical to meeting the requirements of the law. To provide good data to the feds when they ask for it in 2015, employers will have to start tracking hours beginning this Oct. 1.
Suggestion: If you have put this exercise off because of the delay for sanctions until 2015, start counting now. You’ll need data from 10/1/13. Just because you don’t face sanctions doesn’t mean it isn’t essential to have a handle on this number.
5. 90-day waiting period: Under the PPACA, a group health plan or health insurance issuer offering group health insurance coverage must offer health coverage to new employees within 90 days of their hiring. No more “we’ll get you covered if you survive six months here.”
Suggestion: You might want to test potential hires out as contractors to make sure they’re a fit before you’re committed to coverage after 90 days.
6. Preventive services must be offered without cost-sharing: This requires group health plans to cover recommended preventive services without charging a deductible or co-pay/coinsurance. Grandfathered plans are generally excluded from complying with this provision. Among these services are immunization, well-woman visits, screening for gestational diabetes, screening for sexually transmitted diseases, well baby visits, and others.
Suggestion: If your benefits package includes a wellness program, you’ve got more assignments to complete before Oct.1. The idea behind these new rules is that all employees, regardless of their physical condition, should be able to meet the incentives built into wellness programs. Among the requirements:
7. Reasonable accommodations: Some employees, for various reasons, cannot meet the requirements established by wellness programs, so there must be options available for them built into the system.
8. The program must be designed to promote health or prevent disease: Wellness program goals must be tied to direct health benefits. Also, the goals established must not be “overly burdensome.”
9. Rewards must be available to all similarly situated employees: Again, because employees present a range of medical conditions, including some that may thwart them from achieving a reward, the conditions present in a given workplace have to be considered when designing the incentives and goals. Notice must be given to these employees of the options available to them.
Suggestion: Have a wellness program professional review your program to make sure that it is fair to all, truly promotes better health and includes incentives that any employee making a reasonable effort can hope to enjoy.