Health and Wellness
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Will That Knee Replacement Cost an Arm and a Leg?
With more employees enrolling in high-deductible health plans, a nonprofit business group endeavors to pull back the curtain on health costs. In a statement, the Catalyst for Payment Reform pushes for not only more information but also better cost-calculating tools for consumers.
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It’s All in the Wrist—and in the Back
Emphasizing ergonomic workspaces can lead to a healthier workforce, lower costs and a stronger business overall.
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Valuing Value: California Mines New Health Coverage Plan Concepts
SeeChange Health and Blue Shield of California are two San Francisco insurance companies that are stepping up efforts to market value-based insurance design plans to large employers.
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HHS Gives $1.5 Billion in Grants to 11 States to Set Up Health Exchanges
The U.S. Department of Health and Human Services said it is giving $1.5 billion in grants to 11 states to launch or further develop health insurance exchanges. Those states are California, Delaware, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon and Vermont.
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Flu Taking Advisers—and Clients—Down 'Like Soldiers'
The Centers for Disease Control said that this year's flu season, which ramped up earlier than usual and could go on through March, is the worst outbreak in a decade.
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HHS Proposes Rules to Verify Health Care Premium Subsidy Eligibility
Under the proposed rule, administrators of state and federal insurance exchanges must verify whether applicants seeking tax credits to buy health care coverage through an exchange are enrolled or eligible for qualifying coverage in an employer-sponsored health care plan.
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Get Up, Stand Up: Workers on Notice to Re-energize With Movement
Workplace program pushes people to leave their desk and walk around for one to two minutes every 25 to 30 minutes.
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Tobacco Cessation Report Lights Up Coverage Gaps, Confusing Language
Researchers found 'significant variation in how private health insurance coverage works for tobacco cessation treatment' when analyzing 39 insurance contracts in six states.
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Higher Financial Penalties Proposed for Uninsured Massachusetts Residents
In 2012, the maximum penalty for non-compliance was $105 a month, or $1,260 a year. The maximum penalty this year for those with incomes that exceed 300 percent of the federal poverty level will be $106 for each month that an individual is not covered by health insurance, or $1,272 a year.
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Massachusetts Bill Would End Employer Penalty for Not Offering Health Plan
Under the governor's plan, the current annual assessment—known as the Fair Share contribution—of $295 per employee on employers not offering coverage would end on June 30.
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Narcotic Pain Drugs Remain Atop List of Workers' Comp Insurer Concerns
Concern over the long-term implications of prescribing narcotic pain medications to injured workers has grown during the past two years.
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Illegal Immigrants Covered by Nebraska Workers' Comp System: Court
Those courts concluded that denying workers comp benefits to illegal immigrants creates a financial incentive to hire them because it allows an employer to escape liability for worker injuries, giving that employer an unfair advantage over competitors who follow the law, Nebraska's high court said...
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Wellness Programs Can Reduce Worker Medical Costs by 18 Percent: Study
The report said wellness programs could reduce costs for risks such as physical inactivity, smoking, high blood pressure and obesity. If the risk factors were lowered to “theoretical minimums,” health care expenses could be lowered by an average of $650, or 18.
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Workers Indicted for Defrauding Employer-Sponsored Wellness Program
The employees are accused of falsely reporting that they participated in healthy activities in order to earn rewards through a wellness program included in their employee health insurance plans.
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Minnesota, Rhode Island Get OK to Launch Health Insurance Exchanges
The U.S. Department of Health and Human Services has given tentative approval to applications filed by Minnesota and Rhode Island to launch health insurance exchanges in 2014.
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Domino's Pizza Founder Wants Exemption From Contraceptive Mandate
The U.S. Department of Health and Human Services law requires most employers to provide cost-free coverage for birth control prescriptions, sterilization, preventative screenings and other forms of women's preventative care.
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Weighing in on Wellness Incentives
The American Heart Association and American Cancer Society are among the groups providing guidance on how organizations can design outcomes-based incentives programs that don't discriminate against employees.
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Cabinet-maker Among Firms Adding Wellness to Health Care Cupboard
For companies considering healthy programs, it's important to create a wellness culture, one executive says. “If you're doing it just to attack claims, don't do it. It won't succeed.”
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HHS Approves Health Insurance Exchanges for Two More States, D.C.
Kentucky and New York join the District of Columbia in receiving the latest approvals. In all, exchange applications filed by eight states, plus the District of Columbia, have received tentative regulatory approval.
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HHS Gives Tentative Approval to Six State Health Insurance Exchanges
Those six states are Colorado, Connecticut, Maryland, Massachusetts, Oregon and Washington.
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Pharmaceutical Giant Puts Medical-Home Concept to the Test
Working with a nonprofit program, GlaxoSmithKline is giving its North Carolina employees the opportunity to test a medical home's efficiency. The pharmaceutical company will see whether the two-year pilot program could mean cost savings.
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The Medical Home Evolves From Recordkeeping to a Community of Care
A patient-centered medical home practices preventive medicine and helps manage chronic illnesses through a partnership between patients and their primary care physician and other health professionals
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Depression Leads in Top Risk Factors for Employer Health Spending
Annual medical spending for an employee with depression is $2,185 higher, or 48 percent more, than for a worker without depression, according to a new study.
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HHS Proposes Rules on Employee Wellness, Essential Health Benefits
Officials said the proposed rules on wellness programs are designed to give employers greater flexibility to design programs that will positively affect their employees' overall health while providing individuals with enhanced protections against discriminatory practices.
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Fixing Patients the First Time Holding Health Care Costs Down
New York hospitals face steep revenue cuts for readmissions that are preventable.
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Corporate Weight-Loss Initiatives: Motivational or Stigmatizing?
Amid the proliferation of corporate weight-loss efforts, some researchers worry that well-intentioned initiatives can risk employee backlash. Sprint Nextel and O'Neal Steel leaders describe how they strive to marry motivation and results.
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How Whirlpool Boosted Employee Productivity
One organization's data shows that health-related productivity losses cost U.S. employers $227 billion annually. Whirlpool officials are striving to reduce one component, called presenteeism, by providing employees with better mental and physical support at the work site.
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There's No 'I' in 'Team'
Companies are finding that team wellness challenges work better to create behavior change than individual incentives. But team challenges have their limits, too.
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Out of Sight but Not Out of Mind
Employers are tailoring wellness offerings to suit staffs that aren't in the office. Programs must be “highly timely, personalized and relevant,” an expert says.
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Health, Safety Lapses in Lab Tied to Fungal Meningitis Outbreak
Investigators found “serious health and safety deficiencies” at the compound pharmaceutical lab tied to the fungal meningitis outbreak, according to a preliminary report released Oct. 22.
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Get Healthier or Pay Up
That's the approach some new wellness ventures and employers are embracing to inspire employees to kick bad habits.
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Integrating Wellness Programs With Incentives
A company that sees itself as a 'universal remote' for wellness programs aims to help employers and their workforces see all of a program's offerings in one place.
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Benefit Tech Tools Aim to Turn Employees Into Smart Shoppers
Health care consumerism—a movement to empower employees with information to help them choose plans, providers and treatments—is giving rise to online decision-support tools that assess the best benefit plan for their needs.
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Court Rules Employer Does Not Need to Pay for Employee's Gastric Bypass
On the doctors' advice to lose weight, Melinda McKenzie underwent unauthorized gastric bypass surgery in 2006 and eventually lost 241 pounds, records show. However, MCI denied authorization and payment for McKenzie's procedure.
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Medicare Heats Up Biden-Ryan Debate
The Medicare segment of the debate included some of the most frequent interruptions by both Vice President Joe Biden and Republican vice presidential candidate Rep. Paul Ryan (R-Wisconsin) in a testy debate as each took turns bashing the other side's impacts on the program.
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Illinois Politicians Back Health Insurance Co-Op Applicant
Gov. Pat Quinn, fellow Democrat Richard Durbin and Republican Mark Kirk have written letters of support on behalf of SimpleHx, a co-op proposed by a group of people who met last year while pursuing their MBAs at Northwestern University.
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Employees Get Creative When Calling in Sick
Thirty percent of workers called in sick during the past year even when they weren't ill, according to a CareerBuilder survey. In addition, the survey found the holiday season tends to be the busiest time for sick calls.
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Romney Reform Repeal Would Mean More Uninsured: Commonwealth Fund
Under Romney's plan, 30 percent or more of the under-65 population in nine states—Arkansas, California, Florida, Louisiana, Mississippi, Nevada, New Mexico, South Carolina and Texas—would be left uninsured by 2022, which the report says would increase the number of uninsured in every...
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Most Risky Day of Week to Drive to Work? TGIF
A Columbus, Ohio-based insurance company determined its members have the highest average number of claims per day on Fridays—at 4,664. Wednesday came in second with an average of 4,197 claims, followed closely by Thursday, Monday and Tuesday.
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Connecting Wellness-Program Participation and Incentives
Many companies offer incentives and tie them to plan design, specific health outcomes or apply surcharges when employees don't take part in particular programs.
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Specialty Drugs Appearing as the Next Wave of Health Care Costs
The Midwest Business Group on Health and other organizations aim to educate employers about the cost of biologics, which treat serious illnesses such as cancer. Their cost is expected to rise to 40 percent of employers' total drug costs by 2017.
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South Dakota Declines to Set Up Health Insurance Exchange
South Dakota joins several other states, including Texas, whose governors said they will not set up the exchanges.
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Group Health Care Spending Up in 2011: Analysis
For those covered by employer plans, spending on health care services increased by 4.6 percent to $4,547 per plan enrollee. By contrast, in 2010, costs rose an average of 3.8 percent, according to the Health Care Cost Institute, an independent Washington-based health research organization.
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Sutter Health Seeks Approval to Offer HMO in California
Under California's Knox-Keene Health Care Service Plan Act, health plans must obtain a license from the Department of Managed Health Care to operate as HMOs in the state.
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Obesity-Related Conditions Could Add $66 Billion Annually to Medical Costs by 2030: Study
The state-by-state analysis of obesity-linked disease rates and associated medical spending projects that obese individuals could account for 44 percent of all American adults by 2030 if obesity rates nationwide continue to grow at their current pace.
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Consultancies Are Eager to Enter Private Health Exchanges
For employers, an exchange ideally will expand health benefits choice for workers while holding down their health costs, advocates for the concept say.
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Poor Health of Employees Can Drag Down Productivity: Study
Workers' poor health and its drag on productivity costs U.S. employers $576 billion annually. The costs include those spent on group health policies for employees, short- and long-term disability, workers' compensation, illness absence, and presenteeism.
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Group Health Insurance Premiums See Moderate Increase in 2012: Survey
The survey of more than 2,000 employers found that the premium for family coverage rose an average of 4 percent, increasing to $15,745 this year.
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Seriously Injured Stripper Not Entitled to Workers' Comp Benefits: Court
The split 2-1 ruling in LeAndra Lewis v. L.B. Dynasty Inc. upholds a workers compensation commission finding that she was a contractor and not an employee when she was shot in 2008 while dancing at the Boom Boom Room in Columbia, South Carolina.
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Treatment Guidelines Help Reduce Amount of Services Used for Low Back Injuries: WRCI
In a report released September 5, Cambridge, Massachusetts-based WCRI studied Texas medical treatment guidelines that were implemented by the state in 2007. The study looked at how the guidelines affected workers with injuries of the upper back, lower back, neck, knee and shoulders.
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Health Care to Take Center Stage at DNC
The night of September 4 will feature some of the highest-profile defenders of the law, including first lady Michelle Obama and HHS Secretary Kathleen Sebelius.
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Global Push for Wellness
Health programs get off the ground internationally, but local conditions can create challenges.
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Health Care: A Real Fixer-Upper
Employers are helping to rebuild the health care system with a do-it-yourself approach that takes picking the right tool. The new options include value-based design, workplace clinics and direct primary care.
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Rochester Business Alliance Fosters the Links for Health Care
The Rochester Business Alliance Health Care Initiative brings together business and community leaders to find ways to improve the health care system and patient outcomes.
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Employer Violated ADA by Requiring Employee's Psychological Evaluation: Court
According to the August 22 ruling in Emily Kroll v. White Lake Ambulance Authority, in 2008 the ambulance service became concerned about the behavior of Kroll, an emergency medical technician, after she became romantically involved with one of her co-workers.
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Injured Worker Entitled to Benefits for Related Mental Illness: Court
A trial court ruled that along with benefits for his physical injuries, Stephen Vowell was entitled to medical benefits for treatment of related severe depression.
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Worker's Loss-Of-Consortium Tort Claim Cannot Proceed: Court
The wife of a California worker cannot pursue a tort claim against his employer for injuries that prevented him from performing "necessary duties as a husband," the California Supreme Court said August 20.
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Analysis: Transforming the Mobile Workplace While Keeping an Eye on Ergonomics and Underlying Health Risks
While mobile device use in and outside of the office is still too new to know the long-term impact on employees, this reality holds true: Workplace injuries can leave your company at a competitive disadvantage.
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More Workplaces Dig Farmers Markets to Cultivate Employee Health
Although the exact number of workplace farmers markets is unclear, there's a bumper crop of such marketplaces nationwide, with more than 7,000 as of mid-2011, the U.S. Department of Agriculture says.
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Direct Primary Care: Medicine for the Masses or an Unused Gym Membership?
For less than $100 a month, direct primary care provides patients with unlimited doctor's visits for routine services. Critics question the plan's economic viability for healthy patients paying a monthly fee for services they don't always use.
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Memphis Opens Health Clinic for City Employees, Retirees, Dependents
The clinic offers diagnostic services and non-emergency care for a range of conditions, including sinus, urinary tract and upper respiratory infections, cold and flu symptoms, muscle sprains and minor cuts and burns.
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Opinion: Business Leaders Have a Chance to Step Up and Fix Health Care
In the marketplace, employers' relationship with health care must be guided not only by the compassion of human resources but by the hard-headedness of finance and risk management.
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Cisco Systems Takes Telemedicine From Coast to Coast
Using its own system, the California technology company takes care of employees at its headquarters and in North Carolina. In India, employees at four locations can access care through the Bangalore office.
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Hello, Doc? With Telemedicine, Medical Help Is Just a Phone Call Away
Companies and employees are finding that the service offers benefits: Employers can cut health care costs, and workers can get issues addressed quicker. But telemedicine isn't a substitute for a face-to-face doctor visit.
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Ohio State University Takes a Stand Against Sitting for Too Long
Researchers have long advised that workers shouldn't sit too much because they say the inactivity can be a factor in such conditions as heart disease and cancer.
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More Companies Linking Rewards, Penalties to Wellness Program Results
Fifty-eight percent of employers offering wellness incentives pegged rewards to completion of lifestyle modification programs such as weight loss, smoking cessation and physical fitness.
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Doctor-Owned Group Launches Medical Home in NYC
The goal of the program is to reduce readmissions and improve health outcomes for its patients.
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Is Patient Health Taking a Hit Under High-Deductible Plans?
High-deductible health plans have been touted as a savvy behavioral tool to motivate enrollees to more closely scrutinize the price tag of imaging tests, brand-name drugs and more.
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On-Site Wellness Programs See Growth, Gain Support of Senior Executives
For a majority of employers, the lack of ROI data has not stemmed incremental expansions in the types of services offered at the on-site centers.
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Employers Play Key Role in Educating Workers on Health Plan Choices
'People who were confused about what was covered [outside of the deductible] were more likely to cut back on care,' one researcher says.
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NFL Creates Wellness Program for Current, Former Players
The league is being sued by thousands of former professional football players who say the league misled them about the dangers of concussions.
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Employers Are Caught Up in the Five Stages of Health Care Reform Ruling
While many employers have achieved acceptance, a new survey shows they do not have a strategy for complying with the law's 2014 provisions. One 'sleeper' issue: Medicaid expansion.
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Will Walgreen Suffer Side Effects Even After New Express Scripts Deal?
Express Scripts, like other PBMs, are third-party middlemen that negotiate prices with pharmacies and drugmakers on behalf of corporate clients and processes their claims.
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Program Helps Long-Term Disabled Workers Return to Work by Crossing Finish Line
Insurance giant Cigna Corp. partners with a New York health organization to put long-term disabled workers on the track to good health and re-entry into the workforce.
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Cop Who Shot, Killed Suspect Ineligible for Workers' Comp
Brandon Bentley was treated for anxiety and depression after the shooting, and a psychiatrist and psychologist deemed him unable to work. He filed for workers' comp benefits in March 2010.
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Substance-Abuse Intervention Works Best When the Boss Steps In: Study
A new study reveals supervisors must go past detection and aid in enforcement of substance-abuse policies to deter use of alcohol and drugs on the job.
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Health Care Job Growth Slows in June
For the 12 months ended in June, health care has added 324,500 jobs to a workforce of 14.4 million, amounting to a 2.3 percent annual growth rate.
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Supreme Court Upholds Health Care Reform Law
The U.S. Supreme Court ruled that the Patient Protection and Affordable Care Act is constitutional, handing President Barack Obama a major election-year victory and shunning 26 states that had sought to overturn the reform law.
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Brain Training Is Becoming the New Push in Employee Wellness
Not only is employee well-being an essential component of overall wellness efforts, researchers say a healthy brain is crucial to employee engagement.
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Health Care Reform Takes Center Stage at SHRM Event
Typically, SHRM's conference agenda reflects the economic, political and other realities of the workplace, and this year is no different. Several sessions are scheduled on the topics of health care reform, social media, aging workers and domestic partner benefits.
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The Last Word: Actually App-etizing
If a company is debating the merits of apps and games in the hopes of enabling employees to learn, track, measure, compete and possibly get healthy, get in the game before it's game over.
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Q&A With Jay Krueger: Evaluating Medical Marijuana Policies
Jay Krueger is chief strategy and client services officer at PMSI Inc., providing overall strategic direction for the Tampa, Florida-based provider of pharmacy benefit management services, medical equipment, home health care and case settlement services.
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Lingering Personal Burdens Prompt Employers to Add Alternative Benefits
Easing personal stress is among the goals for adding free or low-cost legal services. One study indicates that workers who do not hire an attorney to help with legal issues are nearly three times as likely to spend five to 10 hours at work dealing with those problems than those who do hire counsel.
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Apps for Social Wellness Programs
If you're considering launching a social wellness program, get ready to sort through an ever-growing list of services and applicatiions.
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Starting a Social Wellness Program
Social wellness tools won't do much if you don't establish objectives and a time frame for meeting them, says Jennifer Benz, a San Francisco-based employee wellness communications consultant.
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Can Social Media Produce Wellness Results?
To win at employee wellness programs, companies are turning to online fitness challenges and Facebook-style social networks to boost workers' options, improve engagement and cut costs.
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After Workplace Violence Incident, Mental Health Resources a Must
Employers also should work to make sure employees are trained in techniques that can help them prevent or escape violent scenarios.
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Pharmacy Benefit Managers Cite Employees' Unhealthy Behavior as Biggest Challenge: Study
In the past five years, the percentage of plan sponsors who list the breadth of coverage offered to employees as a top priority for their plans has fallen 14 percent from 57 percent at the end of 2011.
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Wellness Isn't Such a Foreign Concept to American Express Employees Overseas
The New York-based financial-services company has taken on such issues as food safety and prenatal care as part of a broader global wellness effort it launched in 2009.
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Essential Health Benefit Packages Under Health Care Reform Have Employers Wary
Large and small employers have banded together to form the Essential Health Benefits Coalition to voice concerns in Washington and statehouses around the country on the issue.
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Health Care Adds 19,000 Jobs in April, 7,000 Fewer Year Over Year
U.S. unemployment held steady last month at 8.1 percent as the overall economy added 115,000 jobs. Hospitals added 4,100 jobs in April for growth of 0.1 percent to bring total hospital employment to 4.8 million. For the year that ended in April, hospital employment grew by 95,100 jobs, or 2 percent.
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Humana Pharmacy Solutions Has New Offerings for Self-Insured Employers
The new options include the Wal-Mart Rx Network, which directs employees to fill prescriptions at the international retailer; and the Rx4Value formulary, which swaps certain name brand drugs for generic.
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Going Mobile: On-Site Clinics Hit the Road for Employee Health Screenings
Mobile clinics, a relatively new phenomenon, offer an alternative for employers who might not otherwise be able to reach geographically scattered workers.
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Dodge Ball Anyone? When Work Becomes a 15-Minute Playground
Recess at work programs are becoming an important element in an overall employee wellness package. ‘When you talk to people about wellness, it's not really that fun.
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Injured Worker's Depression not Compensable Because She did not Return to Work
A doctor found that Delores Roxbury's depression was caused directly by her 2004 work accident, and prevented her from returning to her former position. However, an independent medical expert contended that Roxbury suffered from mild depression, and was not totally disabled by her mental condition.
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White House Suggestions on Funding Contraception Coverage Called 'Unworkable'
Under one administration suggestion, TPAs could fund the coverage through rebates they receive from drug manufacturers that the TPA is not contractually liable to forward to the affiliates.
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Will New Claims and Appeals Procedures Change Case Law?
Health care reform regulations that took effect for the 2011 plan year require non-grandfathered self-insured and insured group health plans to make changes to their internal appeal procedures and offer external reviews of denied claims.
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Administration Lays Out Annual Dollar Limits on Student Health Care Plans
Centers for Medicare and Medicaid Services said student health insurance policies must provide annual coverage limits for essential benefits of at least $500,000 for policy years beginning on or after Sept. 23, 2012, but before Jan. 1, 2014.
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Health Reform Law to Slightly Lower Number of Employer Plan Enrollees: CBO
The health care reform law will have only a modest impact on the number of people covered in employer plans, but it will significantly reduce the number of uninsured, according to a congressional analysis.
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Obesity Problems Weigh on Workers' Comp
Not only are obese workers comp claimants likely to miss more work days than healthy-weight co-workers with similar injuries, obese workers are likely to have higher medical costs and are more likely to become permanently disabled, research has shown.
