• Legal Alert: Complying with the new COBRA extension
• Zapping Fibroids with Heat in Hunt for New Options
• Employees in sheep’s clothing: defining the independent contractor
• Businesses join to educate community on health
• Study finds antidepressants provide no cure for absenteeism
• Employees blind to value of vision benefits
• 90-day supply of meds, e-Rx record initiatives launched
• Diamond in the rough: Hiring increases in February
• Employees say to employers, ‘I’m broke, and it’s your fault!’/A>
• Exercise Corner: Leg Deskercises
• Recipe Corner: Peanut Butter Easter Eggs

The American Recovery and Reinvestment Act of 2009 was signed on Feb.17, 2009 with the announced purpose of providing a massive economic stimulus to the U.S. economy.

ARRA also included temporary provisions requiring employers to provide federally subsidized premium assistance to certain former employees—referred to as “assistance eligible individuals”—who timely elect health care continuation or “COBRA” coverage.

Although ARRA’s temporary premium subsidies were originally set to expire at the end of 2009, they were extended by the Department of Defense Appropriations Act (DDAA), which was signed into law on Dec. 19, 2009.

This article describes the particulars of this extension, and it explains what employers must do to comply.

Background

Under the ARRA’s COBRA subsidized premium assistance rules, each “assistance eligible individual” is treated as having paid the full amount of the premiums for his or her COBRA continuation coverage for a period of up to nine months if he or she pays 35% of the premium.

The employer, plan, or carrier (depending on the nature and source of the health care continuation obligation) must pay the remaining 65% of the cost of the COBRA continuation coverage. The plan, employer, or carrier, as the case may be, recoups the subsidy, generally through the mechanism of a tax credit against employment taxes.

ARRA defines the term “assistance eligible individual” to mean any qualified beneficiary who elects COBRA continuation coverage and (i) whose loss of group health plan coverage is (or was) on account of an involuntary termination of employment other than by reason of gross misconduct; (ii) who is (or was) eligible for COBRA coverage during the period beginning Sept. 1, 2008 and ending Dec. 31, 2009; and (iii) who elects coverage in accordance with the requirements of COBRA and the DDAA.

Defining involuntary

The determination of whether a termination is “involuntary” is based on all the facts and circumstances. Initially, there was some confusion over what constituted an “involuntary termination.”

In Notice 2009-27, the IRS helpfully defined “involuntary termination” broadly as “a severance from employment due to the independent exercise of the unilateral authority of the employer to terminate the employment, other than due to the employee’s implicit or explicit request, where the employee was willing and able to continue performing services.”

Availability of and access to premium assistance is based on “periods of coverage.” Eligibility for the subsidy generally begins as of the “first period of coverage” during which a qualified beneficiary first satisfies the requirements of an assistance eligible individual.

An assistance eligible individual’s eligibility for COBRA premium assistance under the Act ceases 9 months after initial eligibility or, if earlier when the assistance eligible individual is eligible for coverage under another group health plan.

ARRA also provided special election periods for certain qualified beneficiaries who were eligible for a reduced premium but who had not elected COBRA continuation coverage as of Feb. 17, 2009. ARRA established certain notice requirements that were in addition to the general prior law COBRA notice requirements.

These included a “general” notice to be provided in connection with a qualifying event; an alternative notice for use by group health insurance issuers/carriers that offer group health insurance coverage under state mini-COBRA laws; and a specialized notice tailored to assistance eligible individuals. The COBRA premium subsidy under ARRA ended Dec. 31, 2009.

Not only did the involuntary termination have to occur before Dec. 31, 2009, but the assistance eligible individual also had to lose health coverage prior to that date. (Thus, an individual involuntarily terminated in December 2009 who did not lose coverage until Jan. 1, 2010 was ineligible.)

Extension of the COBRA subsidy

The DDAA affected ARRA’s COBRA subsidy in two key ways:

• The subsidy is now available for up to 15 months (a six-month extension from the original nine-month maximum coverage period). 
• The subsidy is available for workers involuntarily terminated who lose coverage on or before Feb. 28, 2010 who elect COBRA (under ARRA, coverage had to be lost on or before Dec. 31, 2009).

Unlike prior law, under the DDAA, the loss of health coverage by the end date of the subsidy is no longer required. The DDAA determines eligibility for the subsidy based only on the date of the involuntary termination.

The new law requires that individuals who reached the end of the original premium reduction period must be provided with additional time to pay extension-related reduced premiums that were due prior to notice being provided.

The DDAA amendments establish a “transition period” for assistance eligible individuals with respect to any period of coverage beginning before Dec. 19, 2009 to which the subsidy extension applies. An individual’s “transition period” begins immediately after the end of the maximum number of months (generally nine) of premium reduction available under ARRA.

Individuals in a transition period must be provided notice of the extension within 60 days of the first day of their transition period. The notice must include information on the extension from nine to 15 months and the ability to make retroactive payments for certain unpaid reduced premiums.

An assistance eligible individual is deemed to have timely paid a COBRA premium for a transition period if he or she (i) had COBRA coverage for the period of coverage immediately prior to the transition period, and (ii) pays the premium by Feb. 17, 2010 or, if later, within 30 days of receipt of notice of the availability of the transition period.

Any assistance eligible individual who pays an unsubsidized COBRA premium during his or her transition period is entitled to either a reimbursement of the excess paid, or a credit towards future premiums.

There is a special rule for assistance eligible individuals whose eligibility for the premium reduction under ARRA expired, and who thereafter dropped coverage. These individuals are allowed to re-enroll and get the benefit of the additional six months of subsidy, provided they pay the 35% portion of the full premium.
Notice of the extension must be provided:

• By Feb. 17, 2010 to any individual who was an AEI or otherwise experiences a qualifying event relating to termination of employment on or after Oct. 31, 2009; 
• As part of the standard COBRA election package, to any individual who experiences a qualifying event after Dec. 19, 2009; 
• To any individual who did not timely pay his or her COBRA premium during a transition period, disclosing the ability to pay retroactive COBRA premiums and continue coverage, within the first 60 days of such transition period; and 
• To any AEI who paid an unsubsidized COBRA premium during a transition period, disclosing his or her entitlement to either a reimbursement of the excess paid, or a credit towards future premiums.

The DDAA Notice requires that plans notify certain current and former participants and beneficiaries about its changes to the premium reduction rules. The U.S. Department of Labor has issued the following model notices to assist employers and plan sponsors in meeting the DDAA's notice requirements:

Updated General Notice

Plans subject to the Federal COBRA provisions must provide the updated General Notice to all qualified beneficiaries (not just covered employees) who experience a qualifying event at any time from Dec. 19, 2009 through Feb. 28, 2010, regardless of the type of qualifying event, and who have not yet been provided an election notice.

In addition, plan administrators must provide this notice no later than Feb. 17, 2010 to all qualified beneficiaries who experienced a termination of employment and lost coverage on or after Oct. 31, 2009 but were not eligible to begin COBRA until Jan. 1, 2010 or later, have already been provided a COBRA election notice that did not include information regarding the Act, and have not elected COBRA.

In addition, these individuals are entitled to an extended election period of 60 days from the date of the updated General Notice.

Premium Assistance Extension Notice

Plan administrators must provide this notice no later than Feb. 17, 2010 to all qualified beneficiaries who experienced a termination of employment and lost coverage on or after Oct. 31, 2009 and were eligible to begin COBRA prior to Jan. 1, 2010 and who have already been provided a COBRA election notice that did not include information regarding the Act.

Individuals who were assistance eligible individuals as of Oct. 31, 2009 (but who are not in a transition period) must be provided this notice no later than Feb. 17, 2010. Individuals who are in a transition period must be provided this notice within 60 days of the first day of the transition period.

Source: EmployeeBenefitNews.com, February 12, 2010

They're a bane of that decade or two before menopause, growths in the uterus called fibroids that cause bleeding, pain or other problems in nearly a third of women - and they're the No. 1 cause of hysterectomies.
The latest attempted alternative: Insert a tiny electrode through a small hole and zap, an experiment to see how well the heat of radiofrequency energy shrinks fibroids.
"Women still feel they need more options, justifiably so," says Dr. Erika Banks of New York's Montefiore Medical Center, which is among six health centers nationwide testing the new RF ablation method.
There's also news for women trying to decide among already-approved alternatives to hysterectomy. A separate major study aims to determine which of two options - a longtime method named uterine artery embolization or a newer one called focused ultrasound - works better for which women.
"Patients are maybe surprised there is no research that has definitive answers at this point on which procedure is best for their predominant symptom," says Dr. Estella Parrott of the National Institutes of Health, which is funding the comparison study at the Mayo Clinic and Duke University.
For something so common, fibroids bring a lot of mystery. No one knows what causes these noncancerous tumors, although the hormone estrogen plays a role in their growth. At least 30 percent of women experience symptoms from fibroids - severe pain, heavy bleeding, bladder or bowel dysfunction, infertility or pregnancy complications - mostly in their late 30s and 40s. Many more harbor them - two-thirds or more of all women by age 50 - without reporting problems. Black women, also for unknown reasons, are at increased risk.
Tiny fibroids usually cause no symptoms, but they can grow to cantaloupe size. Even not-so-big fibroids can cause serious bleeding if they're in the wrong spot in the uterus.

Source: www.ahiphiwire.org, February 22, 2010

Employers that have disguised employees as independent contractors to save on wages and benefits could get slaughtered by monetary penalties as the government seeks to close tax loopholes.

In its proposed 2011 budget, The White House has proposed funneling $25 million into a “Misclassification Initiative” to help the Labor Department’s Wage and Hour Division combat the practice of employee misclassification as “independent contractors." In addition, Sen. John Kerry (D-MA) introduced a bill in December to close a tax loophole that he claims has facilitated the practice.

“By and large, most workers are properly classified as employees by most employers,” says James Coleman, partner in the Fairfax, Va., office of national employment and labor law firm Constangy, Brooks & Smith. “Moreover, there are many different legitimate independent contractor classifications. However, many lawmakers at both the federal and state level are concerned that some employers may be overreaching in attempting to classify individuals who should be employees, as independent contractors.

“One motivation for using the independent contractor classification is that it saves an employer money on employment taxes, employee fringe benefits, insurance premiums, and administrative costs. Of course, if taxes are being saved by employers, that means that tax revenues are being reduced at both the federal and state levels, and this provides the motivation for lawmakers to attempt to tighten up statutes to make it more difficult for employers to use the independent contractor classification, and more costly if they attempt to do so, and get it wrong."

Currently, determining whether an individual is an employee or independent contractor is defined under Fair Labor Standards Act, whose protections for workers can also be triggered by definitions under the Internal Revenue Code, and most other federal employment laws, as well as most state tax and employment statutes, which all similarly address the issue, though with some discrepancies, of when an employer-employee relationship arises.

Under these various federal and state statutes, penalties can be severe and can include back wages and back overtime, back taxes for failure to withhold income and employment taxes, liquidated damages and significant penalties under the Internal Revenue Code.

“Some of the criteria that are out there are how much direction an employer gives the particular individual, whether the employer is concerned with how the job is done versus the overall outcome of it,” Coleman explains. “[In other words,] if the employer is dictating how the job is to be done, when the job is to be done, where the job is to be done and getting down to that level of detail, those are all factors that tend to weigh on the side of an employer-employee relationship. If [companies] have people defined as independent contractors who are doing largely identical work to those classified as employees [over the long term] that should be a red flag.”

In an effort to regain what they see as lost taxes, legislators are taking a hard line on the issue. It’s important to know the definitions of an employee-employer relationship under all codes and statutes and to adhere to them strictly, especially if the money comes pouring in to tease out these relationships from those with an independent contractor. “Now would be the time to double check [interdependent contractor] qualifications,” advises Coleman.

Source: Employeebenefitnews.com, February 11, 2010

The Whirlpool Corporation and other community organizations in the Benton Harbor/St. Joseph, Michigan area are taking steps to control health care costs for their employees and the greater community with a pilot project, known as Communities of Health.

The group of employers, health stakeholders, educators, political and faith leaders, brought together by Whirlpool Corporation, the Consortium for Community Development and Cigna, is hoping to identify and break down community and social barriers that affect the health of local residents.

By broadening the conversation to go beyond the traditional scope of health care payment and access, they hope to improve the health and overall wellness of the population at large, including their employee population.

After all, as employees live and breathe in a greater community beyond the work space, their health is significantly affected by that environment, which can carry over to employer health and productivity costs.

One participant at a December 2008 meeting explained that “as goes Whirlpool, so goes the community…And as goes the health of the community, so goes Whirlpool,” says Daniel Hopp, senior vice president, Corporate Affairs, and general counsel for Whirlpool Corporation.

Since the pilot began two years ago, the Communities of Health initiative has succeeded in educating citizens about a surrounding’s affect on health and have begun setting measurable goals for inhabitants in the Benton Harbor area.

“Our strategy is to move individuals to take a personal responsibility for their health, [which means] trying to help them understand their present health conditions, while moving them toward preventive care, [building] a personal relationship with a physician in the community and understanding how their surroundings affect their health,” says Susan Pavlopoulos, manager, global medical management at Whirlpool.

Pavlopoulos stresses that Whirlpool would not be able to meet the same goals if they were relying on their company’s health care plan design on its own. By utilizing resources in the larger community along with partnering with other business, faith, and health care leaders in the area, they will be able to cover a great deal more ground than if they went it alone.

“From an employer standpoint there hasn’t been a lot of connection between employer plans and the home, the community itself,” observes Pavlopoulos.

To change this antiquated relationship, the Communities of Health recently hosted a Town Hall two day event, which brought together 500 community participants to learn how their community affects their health. The following day, a group of health stakeholders and faith leaders drafted a plan of action. One idea is to have faith groups set and measure a BMI goal for their congregants.

Source: EmployeeBenefitNews.com, February 25, 2010

Feeling blue about skyrocketing costs coming from short-term disability, lengthy absences, or lost productivity? It may be the other way around for your employees. Even with antidepressant treatment, employee depression severity levels positively correlate with the length and cost of short term disability leave, according to a new Thomson Reuters study.

Despite antidepressant treatment, patients with depression still had significant productivity deficits, including longer absences and higher STD costs, which exceeded the costs of diabetes, among other chronic diseases.

For the study, Thomson Reuters analyzed insurance claims and employee health and productivity data for more than 34,000 patients diagnosed with depression and treated with antidepressants.

Among treated depressed patients, mean annual STD costs were $1,038, as compared to $325 among the control group. For those diagnosed as severely depressed treated patients, the mean annual STD costs were $1,685, versus $340 among their controls.

After the study authors controlled for demographic and employment characteristics, treated patients with depression had STD costs that were $356 higher per patient and those with severe depression had costs that were $861 higher. The marginal impact of treated depression on absenteeism was $377.

When compared to other chronic diseases’ effect on annual STD cost of patients, those associated with depressed individuals ($1,038 for patients with depression and $1,685 for the severely depressed) exceeded the STD costs for hypertension ($66), diabetes ($118), chronic obstructive pulmonary disease ($197), and rheumatoid arthritis ($851), based on estimates by a study by Carls et al. using the same data source standardized to the same year.

In terms of days lost, 18% of patients with depression used short-term disability leave, while only 7.2% of the matched control group took advantage of the leave. Depressed patients also took more than 30 absentee days, approximately four days more on average than among matched controls. Associated costs to these days off were also disparate, with $3,925 associated with depressed employees and $3,360 with the control group.

The survey concluded that patients treated for their depression with antidepressants brought much in the way of lost time and high costs to their employer. They survey authors suggest that “therapies that can better manage depression may provide opportunities for savings to employers.”

These findings are in line with other similar reports, one of which, conducted by National Institute of Mental Health Sequenced Treatment Alternatives to Relieve Depression (STAR*D), found that only one-third of trial participants reached full remission after one treatment trial and over 90% of participants who achieved remission had at least one residual symptom of depression. The productivity deficits found in the Thomson Reuters study, the authors hypothesize, were likely the result of patients not realizing full remission from depression and/or still experiencing symptoms even after reaching remission.

“Improved care for workers with depression could help reduce the costs of absenteeism and short-term disability,” explains Suellen Curkendall, director of outcomes research at Thomson Reuters. “Employers can help [their employees] by ensuring that employees have access to the care they need. One problem is poor adherence to treatment. Out-of-pocket cost may be a barrier to adherence. Also, patients often need to try more than one antidepressant before they find the one that works best for them. So, continuity of care is important,” she advises.

Source: EmployeeBenefitNews.com, February 16, 2010

Almost half of U.S. employees are not fully taking advantage of their vision benefits, potentially putting themselves at greater risk for costly eye problems and systemic diseases. In fact, 24% of U.S. workers do not enroll in their employer’s vision plan, and 30% of those who do enroll do not use their coverage to receive a comprehensive eye exam for themselves, according to a new survey from Transitions Optical, a manufacturer of photochromic eyeglass lenses.

“While all employees surveyed reported access to a vision benefit through their employer, they were less likely to enroll in vision than medical and dental benefits,” says Pat Huot, director of managed vision care at Transitions Optical. “This is a serious lost opportunity for employers to help lower potential health care costs and boost productivity.”

One of the most common reasons that workers cited for not enrolling in an employer-sponsored vision plan was not having vision and eye problems (22%), showing a lack of understanding of the importance of preventative eye care for overall health and eye health. Among the employees who enrolled in a vision plan, only 21% indicated diagnosis and management of chronic diseases as a reason.

Effective benefit communications could help to improve employees’ understanding and encourage enrollment in vision insurance. At least 30% of all employees felt their employer did not take the appropriate steps to make sure that employees understand their vision benefits. Additionally, half of all employees were not sure what eyeglass lens options were included in their vision coverage, but survey responses showed that having a greater understanding could increase enrollment and utilization of the benefits. Among the workers whose employer communicates about vision benefits, only about 25% said their employer includes information about the importance of eye health.

“Employers have a lot of concerns on their minds when it comes to promoting the health and productivity of their employees, and [they] may take for granted that their employees understand the full value of their vision benefit, especially when it comes to vision wear,” Huot says. “Today’s eyewear can do a lot more than correct vision, with features to protect the eye by blocking UV and reducing eyestrain and fatigue by blocking glare.”

The survey results also demonstrated some ethnic and racial differences in behavior and attitudes toward vision insurance. Asian Americans were more likely than whites to enroll in their employer’s vision insurance. African Americans and Asian Americans were more likely than whites to say they did not enroll because their eye or vision problems could be addressed by their primary care physician, or that their employer did not explain the vision coverage well enough. Hispanics were more likely than African Americans to cite providing eye care for their family as a reason for enrolling in their employer’s plan.

Source: EmployeeBenefitNews.com, February 4, 2010

Pharmacy-retail chains Walgreens and CVS Caremark recently rolled out programs aimed at improving medication adherence and care coordination for their pharmacy customers.

The Walgreens’ initiative will have its pharmacists working with doctors, insurers, employers and managed care organizations to allow for a 90-day supply of prescription drugs, instead of 30 days, for chronic conditions. CVS Caremark, on the other hand, will allow its customers with a personal health record operated by Microsoft Health Vault to download their prescription information into the record.

“By enabling patients to download their prescription information directly into their personal [health] record, we are helping them access and maintain a more complete view of their medication history, one that can easily be shared and discussed with the health care providers who are managing their overall health,” says Helena Foulkes, executive vice president at CVS Caremark. The program aims to help consumers take better control of their medication plans, thus ensuring better coordination of care with their doctors.

Walgreens’ officials report that there is about a 15% increase in adherence to medications for patients receiving a 90-day retail prescription versus those receiving a 30-day supply. “We can positively impact adherence by encouraging our patients to receive a 90-day supply for their chronic medications. This program will lead to improved outcomes for patients and payors,” says Greg Wasson, Walgreens president and CEO.

He explains that each 90-day prescription fill equals three times the volume of a 30-day fill, more than 24% of the company’s Medicare Part D beneficiaries’ prescription volume and 47% of its prescription savings club members’ medication volume are filled as 90-day supplies at the pharmacies.

Source: EmployeeBenefitNews.com, October 5, 2010

Employers might need to redefine their human capital strategies as glimmers of a recovering economy emerge. Data show more organizations taking on new employees in February, although benefit package and wage levels for new hires remain flat.

While experts predict unemployment will remain problematic in coming months, job seekers fared better in February 2010 than in the same month last year. The Leading Indicators of National Employment survey conducted by the Society for Human Resource Management found that a net of 30.3% of companies in the manufacturing industry will hire in February, a slight gain from one year ago. For those companies in the service sector, a net 23.5% will add jobs in February, compared with a net of 4% that hired a year ago.

February will be the eighth consecutive month that hiring will outpace layoffs in manufacturing (42.8% will hire, 12.5% will reduce their workforce), and it is the tenth straight month this has happened in the service sector (35% will add jobs, 11.5% will cut jobs). It is also the fourth consecutive month that hiring has improved on an annual basis in both sectors.

Many companies have taken advantage of high unemployment and a large pool of job seekers in the market by reducing the wages and benefits they are offering new hires in an ongoing effort to control costs. Those trends might be reversing somewhat.

In the manufacturing sector, 2.5% of employers said they would increase new-hire wage and benefit packages in January, while 1% decreased compensation, a small rise from January 2009 and the first time that the index has increased on an annual basis since September 2008. In the service sector, 3.6% increased compensation, though 2.8% decreased it. That is a sharp decline from the 10.1% of service companies that increased new-hire compensation in January 2009.

Though potential employees may be willing to accept lower wages and benefit offerings now, this may not be the case in the near future, experts predict. Those employers who are building on their compensation package will ultimately win the talent war when it comes.

SHRM’s monthly survey of private-sector human resource professionals included more than 500 manufacturing and 500 service-sector companies. Together, these two sectors employ more than 90% of the nation’s private-sector workers.

Source: EmployeeBenefitNews.com, February 5, 2010

Americans are not doing well financially. No surprise there, right? However, what may surprise you are numbers from a Harris Interactive poll that show a decent-sized share of adults are blaming their money woes on … you.

Now, that’s not to say employees think employers are completely to blame — they saved that distinction for Congress (72%) and Wall Street (71%). Another large chunk of adults point the finger at large corporations (63%), state government (60%) and local government (47%).

Then, the kick in the gut. For all your efforts to provide competitive pay and benefits amid the most severe economic downturn since the Depression, 33% of workers age 18-32 and 16% of workers age 64 and older say they blame their employer for their financial situation. I guess it’s true no good deed goes unpunished.

Horrifyingly, in true American fashion, adults say those least to blame for their financial situation are their families and themselves. A full 85% don’t blame their family and 61% don’t blame themselves. To me, this sounds a little like blaming McDonalds for obesity.

But, perhaps you have a different – and more forgiving – view. What do you think of workers blaming you in part for financial troubles? Who do you credit/hold responsible for your company’s financial situation?.

Source: EmployeeBenefitNews.com, February 2, 2010

Sit On Air

Strengthen your weary, neglected legs as you have a "seat." If you have a wall and two to four minutes, try this exercise once a day. You'll definitely feel the results!

Stand with your back against a wall and feet apart and about 16 inches from the wall. Lower yourself into a seated position, keeping feet flat on the floor, and hold for 15 to 30 seconds. Return to standing and relax for 30 seconds. Repeat three times. Do not bend your knees beyond a 90-degree angle.

Ballet Bends

Weak or tight leg muscles often lead to back problems, which can make sitting for long periods uncomfortable. Legs are the foundation of good posture, and keeping them properly stretched prevents misalignment in the upper body.

Stand with your feet comfortably apart, your toes turned slightly outward. Hold the back of a chair if you need support. Keep your back straight and slowly bend your knees over your toes. (It’s important not to extend your knees beyond your toes in order to avoid stress on the knees.) Straighten, by pushing up through your feet.

Ingredients
• 1 (16 ounce) package confectioners' sugar
• 1 cup creamy peanut butter
• 1/4 cup butter
• 1 tablespoon milk
• 8 (1 ounce) squares semi-sweet chocolate
• 1 tablespoon shortening

Directions
1. In a mixing bowl, combine confectioners' sugar, peanut butter, butter and milk (if needed for moisture) until blended. Shape mixture into two 1/2 pound eggs or make a bunch of smaller eggs. Freeze eggs for 1 hour.
2. While the eggs are freezing, cut semi-sweet chocolate into small pieces and place in top of double boiler with shortening. Melt over medium heat, stirring frequently until smooth. Stick a long-tined fork in top of each peanut butter egg, dip it in melted chocolate to cover then drain on waxed paper. When the eggs are cooled and set, decorate the eggs to suit your fancy.

Source: allrecipes.com