Nearly 80 percent of businesss provide staff access to flu shots, either onsite or at a local clinic.  And 72 percent cover some or all of the cost (typically compensating between $10 to $20). But -

o  At 89% of firms, fewer than half of personnel actually get a flu shot

o  At 38 percent of businesses, fewer than 25 percent of staff members participate

o  only 6 percent of firms can easily get at least 75 percent participation

o  87% of survey respondents said  they never measure absenteeism during flu season, and

o  75% never tracked whether personnel who get flu shots are actually absent less often.

The firms that get best results are those that actively educate personnel, track flu-related absenteeism and send sick personnel home.

Over the last five years, there’s been a stated 69 percent jump in employee employee assistance program use related to personal financial concerns.  The trend isn’t 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 average month.

With salaries frozen in many companies and many staff members 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 staff member survey -

o  27 percent of respondents said they were “one major setback away from financial disaster”

o  22 percent say they were “worse off than last year, with less take-home income and more debt”

o  40 percent say their company is “insensitive to their employees’ financial needs,” and

o  only 6 percent 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.

A recent survey found the average worker has three unused vacation days at the end of the year. But 33% admit that they sometimes take “unofficial” vacation days of a half-day or more.

Not surprisingly, the day after Thanksgiving, Christmas Eve day and December 26 rank among the highest “presentee” days among corporations (specifically in the white-collar realm) that remain open on those days.

In terms of the broader question of presenteeism, what’s keeping people  from using their vacation time as it’s intended?  Top answers -

o  supervisors frown on workforce taking vacation time

o  There’s too much work to make up after using vacation time, and

o  people  want to “reserve” time in case of an emergency.

On the flip side, many folks who take vacation time have trouble leaving work behind. One staff member in four admits to checking work e-mail and/or voicemail while on vacation.

And 29% say they have trouble forgetting about work-related stress, even when they’re using compensated time off.

Among all industrialized nations, USA staff members receive the fewest yearly vacation days â.” 14 on average.

Seventy-one% of personnel lack basic knowledge of standard benefit programs, as reported by a new study by the American Payroll Association (APA).

Low participation rates

The ASA study  focused on personnel knowledge of their company’s pre-tax benefits. While nearly three quarters of personnel say they live paycheck to paycheck, and would like to stretch their current salaries -

o  52 percent don’t participate in available flex spending accounts (and 6 percent of had never even heard of an FSA)

o  17% didn’t know their business offered a health savings account or health reimbursement arrangement (46% of those alert to the benefit still don’t participate), and

o  18 percent are unaware of existing transportation benefits or subsidies their organization offers.

That’s all changed, with the rules established earlier this year by the DOL and U.S.  Treasury Department.  The rules themselves haven’t changed, but they’ve been clarified. Here’s what you need to know -

â..Participation incentives’ are fine

As long as you structure incentives as rewards for wellness participation, the new rules provide a lot of freedom. All of these are fine under health insurance portability and accountability act (HIPAA) -

o  reimbursing all or a portion of the cost of health club membership

o  financial rewards for undergoing health risk appraisals so long as the reward is based on participation rather than test results

o  encouraging preventive care by waiving co-pays or deductibles for these services (i.e., well-baby visits or prenatal care)

o  reimbursing workforce for the cost of use of tobacco-cessation programs without regard to the result, and

o  offering rewards tied to personnel attending a monthly health education seminar or working with a wellness Coach.

Conditional rewards OK ifâ..

But what when you want to make the reward conditional on participants meeting specific health goals? Example - Staff Members who achieve a cholesterol count under 200 get a 20% reduction in the cost of their health plan contributions pending results of an annual cholesterol test.

The feds say it’s OK under health insurance portability and accountability act (HIPAA) to do this, too, but your plan must meet five additional requirements -

o  The reward can’t exceed 20 percent of the cost of employee-only (or, if you allow dependents to participate, employee-plus-dependent) coverage under your health plan.

o  The standards must be reasonable (e.g., you can’t limit rewards to folks who can run a marathon).  The rewards also can’t be used as a backhanded way to adversely single out certain personnel (e.g., rewards for all non-diabetics).

o  Participants must’ve the opportunity to qualify for the reward at least once each year (e.g., a smoker who fails to quit this year gets another chance next year).

o  Rewards ought to be available to all “similarly situated person.” In other words, you can’t make a company-compensated weight control program available to certain staff but not others.

When, for medical reasons, it’s unreasonably difficult for an individual to satisfy conditions that are otherwise reasonable, you have to offer an alternative. Example -  A pregnant employee may not be able to meet certain standards, so you have to offer her an alternative.

Negative incentives violate health insurance portability and accountability act (HIPAA)

So what’s not permitted under HIPAA’s non-discrimination rules? Anything that punishes individuals  for their health conditions or health risks.

The rules prohibit companys from charging different premiums, contributions, co-pays or deductibles based on personal health factors such as obesity or smoking. Notwithstanding, it’s OK to reimburse these expenses based on someone’s participation in your health promotion program, without regard to success.

In addition, the feds have added an important new non-discrimination rule - Employers’ heath plans can’t deny benefits for treatment of injuries resulting from a health condition, even when the condition wasn’t diagnosed before the injury.

For example, some healthcare programs have a “suicide exclusion” that denies payment for treating self-inflicted wounds from a suicide try. Now let’s suppose the staff member suffers from clinical depression. Even if the depression was undiagnosed prior to the suicide try, it’s illegal for your plan to deny benefits to this staff member.

Best practice - Develop a records retention policy as your first step. A host of federal and state laws specify how long you must retain pay- and benefits-related documents.

Compliance is essential when a current or former employee sues or the DOL, IRS or the state audits your records.

Here is a records-retention schedule advised by employment lawyer Jacqueline McManus -

o  Retain for two years employee personnel files, including performance reviews and training.

o  Hold these for three years -  wage records, including time cards, base pay and overtime wage-rate calculations and records explaining wage diferentials for workforce performing the same job, and hold I-9 forms for three years from hire date or one year after termination, whichever is later.

o  Keep these four years -  all Payroll documents, including - home address records, and all wage records, including weekly OT earnings, straight time pay, deductions, bonuses, pay period designations and payment dates.

o  Use a five-year retention window for staff member health info such as medical and first-aid records from on-the-job injuries, and drug and alcohol testing records.

o  Keep this benefits data for six years (or one year after plan termination) -  elections and enrollment forms, benefit change documents, and COBRA notices.

o  Retain 401(k) files indefinitely.

There’s a common misbelief that the IRS considers gift cards worth $20 or less de minimus benefits and, therefore, they’re tax free. Regrettably, that’s not true.  With few exceptions, the IRS considers almost anything with cash value a taxable form of compensation.

Practically speaking, the IRS is unlikely to go after your firm or an employee over several small-value gift cards for which you withheld no taxes. But they could, namely if your firm regularly hands out gift cards.

At some firms, those $5 to $20 cards can add up to several thousand dollars worth of uncompensated taxes in several years. Each $15 gift card would usually require about $5.55 withheld.

To be safe, you can use gift cards sparingly and pay the tax for the recipient. Or else you can educate folks proactively that Uncle Sam requires you to take out for taxes.

Read the fine print

Gift cards can be money-wasters or or morale-killers when staff have a bad experience attempting to redeem them. Read the fine-print before you purchase. Three common pitfalls to watch -

o  expiration dates. Some retailers offer cards that last forever. But many have expiration dates, rendering the cards worthless after a period of time

o  dormancy fees. A $50 card can end up worth only $40 at stores that deduct “dormancy fees” after a certain period of time, and

o  redemption fees. Some stores charge a fee for redeeming cards that can be used in multiple locations.

The good news -  There are some good deals out there. Corporation use of gift cards has doubled since 2001, and related sales bring in $20 billion a year to retailers. With such fierce competition, it compensates to shop around.

If your organization is weighing self-insurance â.” or has already taken it â.” here are three pitfalls that can develop unexpected costs.

1. Unfavorable worker mix

It’s impossible to completely eliminate the risk of unexpected, high-dollar health claims. But here’s a guideline to reduce your risk. Health claim stats suggest the “ideal” staff member population for a self-insured plan is predominately young, non-tobacco use and male.

Be aware that stop-loss insurance carriers often “laser” those staff members considered higher risk. Lasering means that your organization would’ve to pay out much more in claims for these staff members before the stop-loss coverage kicks in.

2. Loss of network discounts

Some firms learned after the fact that going the self-insurance route caused them to lose providers’ network discounts they previously received under fully insured plans. When evaluating  plan vendors’ administration-only options, ask -

o  Will the vendor’s network alliances work in your best interests, cost-wise?

o  Will the vendor only oversee claim payments or negotiate to build the best provider network, quality-wise, for your employees.

Bottom line -  You should get the same kinds of plan designs, networks and discounts as a fully insured plan.

3. Wasteful reinsurance contracts

When the language of your reinsurance contract does not match your health plan’s summary plan description, you could be compensating for coverage you don’t need and can never use.

It’s also key to be sure your firm has enough money in reserve to cover run-out claims and other costs that may occur before reinsurance will cover payments. Best practice -  annual audits of your financial reserves.

The key -  Using these treatments in addition to â.” not instead of â.” conventional medicine may prove more cost-efficient in the long term.

What the latest research says

Do these five common complimentary treatments belong on your health plan? Here is what recent research suggests -

1) Chiropractic care. Studies suggest these treatments might help cut absenteeism for personnel with uncomplicated lower back pain, in particular for people  who’ve had it for less than a month.

2) Acupuncture. Studies show acupuncture can help relieve osteoarthritis, chronic migraines, post-operative pain, low-back pain, fibromyalgia and carpal tunnel syndrome. There’s less evidence about its effectiveness as a tandem treatment for other conditions.

3) Acupressure. There’s no meaningful research to show this needle-free variation of acupuncture (a therapist applies pressure to specific points on the body) has the same medical benefits.

4) Biofeedback. As reported by the Mayo Clinic, there’s now some research to suggest this treatment can help with some kinds of chronic pain, namely tension headaches and muscle pain.

Just how it works -  Monitors display a patient’s heart rate, breathing patterns, body temperature and muscle activity. A therapist then teaches the patient how to lower these readings via relaxation.

5) Aromatherapy.  As yet, there’s no evidence of direct medical benefits. While it may be a relaxing treatment to reduce stress, few firms - if any - foot the bill on employees’ behalf.

In some cases, it’s your firm that ends up on the hook â.” both for workers’ comp and for other people ’s injuries caused by misuse of a prescription drug.

Situations such as these raise three questions that even HR/benefits pros have trouble answering. Precisely how are you â.” or supervisors â.” supposed to know what meds individuals  are on and whether they’re taking them as directed by their physicians?

In most cases, you won’t.

Can you determine without violating health insurance portability and accountability act (HIPAA) or other laws?

You can’t, unless the worker volunteers the info or a doctor notes the effects of medication being the reason for the accident.

So if you won’t know and can’t find out, how on earth can your firm be held responsible after the fact?

It all depends on the circumstances. Three key danger signs -

o  A supervisor already has knowledge of an employee’s medical condition, if not the meds themselves. Example -  the staff member requested a schedule change and said it was as a result of a particular medical problem

o  The person has a history of erratic behavior that management suspects is medication-related, and/or

o  The employee’s job involves potentially dangerous situations.

Spotting possible danger

A Florida case (Johnson v. Rentway) is a classic example of the two of the three big danger signs.

1.  The supervisor knew an worker had insulin-dependent diabetes.

2.  The staff member was under doctor’s orders to take insulin at specific times, which required the corporation to adjust the employee’s schedule.

But as a result of short staffing, the employee was often forced to work shifts that overlapped with times he was supposed to take injections.

What’s more, the employee worked a potentially dangerous job (he was a expert truck driver).

Lastly, the inevitable happpened.  The employee suffered a diabetic blackout at the wheel, causing a serious crash that injured himself and another driver.

The staff member filed for workers’ comp, and the injured driver sued the business.  The firm fought â.” and lostâ.” both cases. Total cost -  $5 million.