It isn’t for substance abuse or depression. Actually, it’s financial in nature. Over the last five years, there’s been a announced 69 percent jump in employee EAP use related to personal financial concerns.

The trend is not all that surprising in this era of salary freezes, high deductibles and cost-sharing of benefits premiums.

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.

A lot of staff members are racking up high credit card debt, make the problem worse.

Troubling trends

Here are some ominous numbers from a recent worker survey –

• 27% of respondents said they were “one major setback away from financial disaster”

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

• 40 percent say their corporation is “insensitive to their employees’ financial needs,” and

• only 6 percent said they felt comfortable with their current financial situation and ability to manage their debts.

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

But should you tackle this issue aggressively or trust your staff members to do the right thing?  Every employer wants to create an environment where staff members feel trusted by management. But there’s also the need to stay protected legally, and it isn’t always easy to balance the two.

The cell phone issue is in particular delicate since most employees carry them nowadays, and improper use at work is a non-issue for the vast majority. But there are always several bad apples in every bunch.

Growing number of complaints

There has been an explosion of lawsuits – and complaints to management – about workers taking inappropriate photos at work with their cell phone cameras.

Most cases revolve around embarassing or expliclit photos of coworkers (sometimes but not always posted on the Internet or e-mailed to others in the office). However, a handful of lawsuits have arisen from staff members taking photos of confidential documents or other internal information.

As most benefits and HR veterans would tell you, the most valuable benefit an organization can offer its workers is a workplace where they feel trusted and valued. In contrast, it only takes one “joke” gone too far to stir up a hornet’s nest of trouble.  And no firm is immune from this risk.

Three options

One step every company ought to take is circulating a memo or having a face-to-face meeting with staff members about the need to restrict camera phone use at work, says labor lawyer William Hannum.

This is the time to answer questions and make clear that the policy is a matter of a legal concern, not a case of Big Brother watching over employees’ shoulders. for added legal protection, you might want to create a formal camera phone policy to be written employee handbooks.

Some businesss have gone so far as to take the step of banning camera phone (or personal cell phone) use at work and prohibiting individuals  from posting personal photos or videos from company computers.

Nevertheless, these policies are difficult to enforce and run the risk of alienating the majority of workers who use the devices responsibly.

As an alternative, several firms that have not banned camera phones have had employees sign a policy that gives managers permission to review photos or videos on the phone when there’s a complaint. When you go down either of these routes, remember –

• The policy ought to be enforced consistently

• your policy must spell out specific steps for filing and assessing  a complaint, and

• The policy should obviously spell out the disciplinary steps for violations.

The enforcement aspect is especially tricky. In cases where the phones are corporation property, companys obviously have the right to control non-work use – which includes requiring employees to turn over the contents stored on the phone in cases of suspected abuse. Employees have no legal expectation of privacy in such cases.  

However, there’s a slippery slope when the phone is an employee’s property.  As a rule of thumb, corporations normally have the right to inspect the contents as they pertain to alleged inappropriate behavior within the workplace.

Where it gets tricky is dealing with behavior that takes places on the employee’s private time, but overlaps with the workplace (e.g., staff members go out socializing at a bar after work, and potentially embarassing camera phone photos get spread around the workplace). Legal specialists caution companys to tread very carefully in these cases.

Where does your organization stand?

Does your organization have – or is considering a policy on employee camera phones? Do you think such policies are workable or even appropriate?

In my conversations with attendees at the SHRM conference in Chicago, HR and benefits managers appear to be divided on the issue.

The more clinically viable the treatment, the less an employee pays out of pocket for it.

Example –  Women over 40 and younger workers with a family history of breast cancer pay less for a annually mammogram than workers for whom the test isn’t as necessary.

Value-based plans often work better than high-deductible plans when used in combination with standard health promotion program features such as health risk (assessment|appraisal}s.

Five target areas

As reported by the May 2008 issue of Simply Well, there are four quality-of-care criteria that have emerged as key benchmarks of the quality of care –  health care management, preventive screenings and treatments, member service and access to care.

Areas of care that are of particular concern –

• Employees’ dependents receiving appropriate and timely childhood/adolescent immunizations

• Breast cancer screenings for female medical plan enrollees, ages 52 to 64

• Diabetic workers receiving hemoglobin A1C and LDL-C testing

• Members receiving proper referrals and treatment for mental health issues (e.g., main care physician refers a patient to a professional to ensure proper prescription and management of an anti-depressant medication)

• Pregnant workers receivig time and appropriate prenatal and postpartum care, and prevention of antibiotic treatment in adults with acute bronchitis.

The quality of care for many of the aforementioned issues can suffer when employees foot too much of the bill out of their own pockets.

The hope for value-based plans is that employees get some cost relief and obtain treatments that will reduce costs in the long run.

Contrary to common belief, the rules – with several key exceptions – apply only to a fraction of the medical information Benefits handles.

As long as the company remains legally “hands off” of employee’s private health information, you can dodge most of the HIPAA bullet.

For health insurance portability and accountability act (HIPAA) privacy purposes, your firm is considered “hands off” even when you obtain de-identified personal information, aggregate claims data and routine enrollment info.

Bottom line –  When your organization’s health plans are fully insured and the claims administered through a TPA, the insurance company – not your firm – bears the brunt of the health insurance portability and accountability act (HIPAA) privacy compliance responsibility.

One major exception –  medical cafeteria plans. In most cases, you’ve two compliance choices –

• Process reimbursement requests first through your TPA, with the TPA making sure the claim qualifies below the terms of the cafeteria plan before your firm reimburses it, or

• Develop a written cafeteria plan privacy policy, issue a notice to workers, appoint a privacy officer and amend your plan documents.

Rarely affects FMLA

Many individuals  - including healthcare providers – misunderstand how health insurance portability and accountability act (HIPAA) affects medical certifications for FMLA leave. the key –  health insurance portability and accountability act (HIPAA) only applies to personal information that filters through your health plan, not certifications obtained from a doctor.

Under FMLA, you’re permitted to obtain the minimum information you need to approve and administer leave. In like fashion, health insurance portability and accountability act (HIPAA) doesn’t apply to most workers’ comp, return-to-work notices or disability claims.

Even so, it compensates to be careful how you ask for and use the information. Other state and federal privacy laws often protect the same types of info people  assume falls under health insurance portability and accountability act (HIPAA).

Following procedures

The health insurance portability and accountability act (HIPAA) privacy rules are heavy on paperwork and procedure.

But since your firm follows  the info-gathering process spelled out in your medical plan documents, the HIPAA privacy rules should present few major obstacles.

Generic versions of high-cholesterol drug Zocor have been on market for two years now, but a fair share of business drug store plans have yet to make the switch.

If your PBM gives generic Zocor favored status on the formulary, now’s a good time to remind employees –

• most individuals  on cholesterol-control meds will get the same therapeutic value from generic Zocor as from the label brand and the more potent – and still patented – Lipitor

•  they are able to save $10 to $50 (or more, depending on your drug plan design) on their co-payment by switching, but

•  they ought to ask their doctor first. People  with cholesterol levels over 200 and/or family histories of  ultra-high cholesterol may  be better off staying on Lipitor.

Reason –  It takes four times the amount of a Zocor-type medication  to equal one dose of Lipitor.

As individual states require insurers – and in some cases, companys – to cover or offer coverage of specific individuals  and procedures, similar laws can spread rapidly to other states.

The effect on plan sponsors –  Some mandates can increase your costs by 20% to 45%.

Small firms targeted, too

States are no longer targeting  just the Wal-Marts and other giant corporations anymore. the pressure has increased on companys of all sizes.

That’s specifically true for the new “universal coverage” laws passed in Massachusetts and Vermont.

The Massachusetts law requires every firm with 11 or more employees either to cover or contribute toward everybody’s health coverage, or else pay an annual fee of $295 per employee to a state fund.

Vermont’s similar version sets the each year fee at $365 per full-time equivalent worker. the Vermont law also requires all uninsured, low-income hourly workers to have access to a state-subsidized plan (called Catamount Health) sold through private insurance companies.

It’s up to businesss to deduct the monthly premiums – $60 to $135, depending on the person’s wages – and send it to the state.

There are rumblings in at least 10 states about lawmakers pushing for universal-coverage laws. A few have formed committees to study the Massachusetts law and see when a version may be adapted to their state.

Here are three proactive steps to consider now. These could potentially save money, time and compliance headaches later –

• look into offering mini-med or similar lower-cost programs to satisfy minimum coverage requirements for uninsured workers. Monthly premiums range from about $25 to $200

• educate low-income workers about the earned income-tax (EIT) credit the federal government offers. This could make a mini-med plan free or almost free to eligible workers, and

• use flexible spending accounts to develop a tax savings on premiums for other employees and your firm.

Required procedures

The universal-coverage laws draw national headlines, but far more corporations are currently affected by state laws requiring coverage for certain types of procedures. Three of the biggies –

• diabetes self-management. Nineteen states require your health plan to cover all the steps staff members with diabetes take to control their condition, including nutritional therapy (if prescribed by a doctor)

• in vitro fertilization. This large ticket service adds 3 percent to 5 percent to your premiums, and is now a required benefit in 15 states, and

• cervical cancer screenings. In the last year, four more states have required all employer plans to cover each year cervical cancer screenings for all covered female staff members, spouses and dependents age 18 and older. That brings the sum to 24 states.

The good news about the diabetes management and cervical cancer mandates is they can reduce your  long-term costs, even if they increase them in the short-term.

Here’s a good resource  for keeping abreast of mandatory coverage trends around the country.  The site also features  state-by-state breakdowns of changes in insurance laws  mandating the coverage of different treatments and conditions.

For  instance, this report from 2006 is the most robust coverage-mandate study that I’ve ever seen.

Answer –  Both groups worry equally about their out-of-pocket medical costs, as reported by a PNC Services Group survey of 1,485 employees. Almost 52 percent of all respondents – regardless of income -cited the unpredictability of medical expenses as their No. 1 financial-planning concern.

Other common financial-planning fears that affect staff members of all salary levels –

• eldercare. Over half the respondents with kids were afraid their offspring can be forced to pay for the parents’ long-term care, and

• financial stability. 47 percent of mid- to high-salary employees said they were concerned about sustaining or increasing wealth.

How? Well, roughly 75 percent of staff member lawsuits happen because of accidental disconnects between an corporation’s internal policies and procedures, and what’s written in the plan documents.

Here are two areas where some the costliest errors lurk, and three steps your fim can take to catch and correct the mistakes before you’re ever sued.

1. Policy/coverage discrepancies

A lot of firms’ written benefits policies and plan documents are like siblings who begin to drift apart as they grow up.

In the benefits realm, however, the plan sponsor has the “parental” power – and legal responsibility – to make certain written policies and plan documents remain close as they grow and change.

As a routine practice, firms should be certain changes in their benefits policies are also written into the formal plan documents, according to benefits attorney William Wright.

When push comes to shove in court, any inconsistency with plan documents can prove fatal for the corporation. Example –  Upper management passes a new rule that staff members must work 30 hours a week to be eligible for the health plan.

Benefits and HR then write the new coverage policy into employees’ benefits  handbooks and hold meetings with staff members to explain the change.

Now suppose an worker drops to part-time status. Are you legally protected if the worker challenges the loss of benefits?

Not necessarily. for the policy in  the handbook to stand up in court, the plan documents must also say there’s a 30-hour-a-week eligibility requirement.

Same thing goes for disputes over run-out coverage.  Suppose it’s your firm’s policy to carry over coverage for a cancelled employee during the COBRA election period, but the requirement was never written into the plan document.

Several weeks later, the staff member has a major health claim. the TPA denies it, saying coverage had expired. Reason –  the plan document says “active employees” are covered, but doesn’t specify that the insurer pay claims until the end of the month.

The likely result –  the ex-employee sues, saying the company is liable for the mistake.

2. Coordination of benefits

Watch out for cases where an employee’s claim may  be covered under two or more policies (e.g., your firm’s plan and one from a spouse’s employer).

Be sure there’s a clear-cut coordination-of-benefits policy in all of your plan documents. Normally, when a plan contains no instructions for coordination of benefits, it’s expected to pay first. Two key areas to check –

1. Make sure there’s a statement that says only the amount actually compensated by each plan will be charged against the maximum benefit, and

2. Make certain that the order of benefits determination spells out which plan pays first for a covered child when the worker is divorced from his or her spouse.

Similarly, if your firm offers domestic partner coverage, be certain there’s a coordination-of-benefits statement for dependent and non-dependent partners.

Three best practices

On an ongoing basis, you can cut your lawsuit risk by 75 percent if you –

• gather all materials related to specific plans into a binder, including renewal letters from vendors and materials distributed to employees

• perform a yearly self-audit, checking to see if plan-document wording matches your current policies, and

• pay special attention to keeping benefits descriptions up to date.

Reminder –  If you don’t have a formal plan document, your contract with the vendor legally serves as the “control document” for the plan. By law, all workers must have access to the plan document and be notified in writing of any alterations, including minor ones.

However, the same study found that only 21% of those employers believed their workers had a strong understanding of the workings of their own benefits.  and 5% believed that their workers didn’t know anything about their benefit choices.

Implication –  the greater emphasis placed on staff member education, the more likely staff members understand the role of benefits in sum compensation.

Like most organizations, insurance carriers rarely keep perfectly up-to-date records on their clients.  As a result, plan sponsors often get charged for individuals  who shouldn’t be covered on the health plan. Here are two areas to watch –

Claims versus enrollment

It’s common to have cancelled staff members still in the carrier’s claims eligibility system – even after they’ve been taken off your enrollment list.

Reason –  A lot of carriers use separate computer systems for tracking enrollment and claims – and the two systems use different technologies that don’t “talk” to each another.

Carriers have no incentive to upgrade their systems, as reported by CSG president Eric Raymond, because doing so would cost the insurers money.

Leaving things as is, carriers simply charge clients when they put through claims for ineligible staff members and dependents.

That’s why an annual claims audit is a must –  That way, you won’t get charged fees for claims the carrier accidentally put through.

Even if your firm outsources the work (it’s a rather time-consuming task when performed in-house), you’ll typically see several percentage points of savings on your total health care costs.

Dependent eligibility

Poor carrier record-keeping also could be the cause for employees’ ineligible dependents not being taken off the enrollment files.

Few carriers have systems that automatically integrate with your Payroll department and your current enrollment forms (including the electronic “employee self-service” kind). Instead, data entry people  employed by the carriers input the information in the vendors’ system.

Human error by the carriers’ workers costs plan sponsors another several percentage points. Solution –  annual dependent audits.