I realize, in this economy, that a lot of people have lost their jobs through no fault of their own.  And I have no problem with them receiving unemployment benefits while they look for a job.  And, for example, in Ohio (where I live), you are supposed to be forced (ongoing) to look for a job and submit spreadsheets to the State in order to qualify for unemployment benefits.

But in the same breath…I could tell you 1M stories about people I know who never submitted the necessary reports to the State of Ohio and never looked for a job, but still received their unemployment benefits.  And I could tell you 1M stories about people who heard that the Government was extending unemployment benefits and said, “Well, I guess I’ll just sit at home for a longer period of time now.”  Bottom line – that is just not right.

Unemployment, just like worker’s compensation, should be for the ones that really need it.  Not for the people who want to “sit at home.”  And it seems like various branches of the Government are set on continuing to extend it – thinking they are helping the people who have been laid off – and to some extent, they are.  But they’re also encouraging this same group to not look for work, especially if their state of residence is set up like Ohio – with no accountability.  More and more of my HR colleagues seem to think it’s the latter these days.  So in an economy where you’re supposed to be able to recruit top-notch talent – you find more and more people putting their job searches on hold.  And then…because employment isn’t up, unemployment is extended.  Ah, the circle of life…

As an HR Professional, and the one who works the most with our broker to shop and design the insurance plans, I have come to expect that even if we have a spectacular year with our claims, we’re going to see some sort of increase.  That’s normal, even if it’s a percent or two.

However, with that being said, I thought you might find today’s HR Morning story  interesting.  They’re following-up on a Wall Street Journal  story from last Friday on the same topic.  Interestingly, in both reports, the message from the Government was clear – insurance companies that try to raise premiums now and blame it on the reform will have problems later.

But the immediate concern becomes…hopefully companies won’t have to suffer long while the IRS (who will be overseeing the health care reform) hires the auditors, agents and investigators they need to police any retaliatory actions by the carriers.  For everyone’s sake, I hope the auditors are out on the street sooner than later…

“After nearly three months of behind-the-scenes maneuvers, a bipartisan summit and numerous speeches, the final vote by Congress on health care reform legislation appears imminent.  According to House Speaker Nancy Pelosi, D-Calif., the vote could come as early as Saturday, March 20, 2010, which at least one observer said was setting up a showdown of “epic proportions.”  If you’re a SHRM member, you can read the full article here.

Admittedly, it’s been interesting to hear the arguments on both sides leading up to this.  Personally, I have gone on record as saying that I don’t think the final legislation will look like what’s being proposed now.  And I cannot imagine an insurance world where people can pick up coverage and/or drop it at any time without being responsible for any back-premiums or pre-existing conditions.  So needless to say, this weed could be historic and I, for one, will be curious to see what happens…

I think the answers to all three are yes, although in my mind, the latter can be very dangerous.

Check out this blog post that Porter Wright published through their Employer Law Report.  They discuss a situation where a company terminated a woman’s long-term disability benefits due to some pictures they observed on her Facebook page.

This is a very interesting debate.  You’ll have to decide if Facebook should have come into play or not.  Personally, I have always preached – if you don’t want someone to see it, never put it online!

First, let’s clarify what a TPA is.  They are third party administrators.  You could also be talking about a broker – if you’re in the insurance world.  Other examples of TPA’s would be in dealing with your pension, 401(k) or worker’s compensation plans.

So let’s walk through a few situations…

First, let’s talk about insurance brokers.  I can’t tell you how many times I’ve heard about a CFO asking the HR person, “Why do we need a broker?”  The answer is simple.  And it’s so simple that typically your by-the-book CFO doesn’t get it.  The company does not pay the broker directly and they are a tremendous resource.  Yes, that’s right; it is not an operating expense.  They are paid a commission directly from the insurance carrier.  The broker is the one you call if you have escalated issues.  They normally have back-door relationships with the carriers and have direct access to decision-making liaisons.  They are also the ones that go out and competitive-shop your plans every year.  This is where their relationships are key – they can give pushback and help lower your rates.  They can also create plan designs that will help your company save money and still be able to put a plan you’re proud of in front of your employees.  One broker I continue to recommend has helped companies save millions of dollars year after year.  So ask me again why you should hire a broker?  It’s a no-brainer.  They fight the battles that you can’t fight with the insurance companies.  And they have the ability to maneuver better than you because they’re in a position to send or not send business to the carriers.  I once saw a broker walk into a situation and get a 6% (increase) quote on an insurance renewal, whereas the previous broker (that had just been fired) received a 60% quote.  The company was much happier with 6% obviously.

Second, if you’re talking about worker’s compensation, the term is TPA’s.  Now, I will tell you that you will have to pay for this service.  But my experience has been that it is an all-inclusive one-time payment – no matter how many claims or how much they have to do for you – it’s all covered and based on your claims experience.  Anyway, here’s why you should hire a TPA.  Worker’s compensation is an elaborate labyrinth and mess of paperwork.  They keep it all stright for you.  They file your claims and appeals.  They hire the attorney and send them to your hearings (most TPA’s include the hearing fees as a part of their yearly retainer fee).  Keep in mind that a TPA can also attend a hearing on your behalf, but normally, it would be advised to send an attorney, because the practice of law definition usually hinders the TPA from participating in every aspect of a hearing (i.e. cross-examination).  TPA’s can also work with their actuary to help decide if financially, you should settle a claim or if a claim is eligible for handicapped reimbursement.  I once had a TPA discover a $25,000 error that the Bureau of Worker’s Compensation had made regarding a reserve on a claim.  They also can advise you on how to handle a claim real-time, whereas an MCO has to take more of a neutral stance.

This post turned out to be a little longer than I had originally planned, so we’ll turn it into a multi-part series.  In Part II we’ll talk about what you should be doing to make sure that your TPA and broker are doing what they should be doing.

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