The topic of health insurance is everywhere: In the news, in casual conversation, at the union meetings and jobsites, and probably at your home.
Health and welfare.
What can you do and how can you contribute to ensure we have the best health and welfare possible for all members? There’s one simple answer – something anyone could control no matter what they are faced with.
Be a good steward.
I’m not talking about a jobsite steward. I mean be a good steward of our health and welfare plans, such as making good decisions on how and when you use your insurance or actively managing your insurance and your health.
It’s important to understand that insurance is a cost-sharing endeavor, not a pay-it-for-me solution. We all go to work and for our labor the contractors pay our negotiated wage and benefit package. A certain amount of our benefits are sent to an administrator that deposits that money into various accounts. Most of the money stays there and as you all should know some of the money is reciprocated back to others’ home funds.
We have various accounts that hold our money. Trustees, consisting of an equal amount of union members and employers, work with various administrators, attorneys, actuaries, and money managers to manage and provide the best benefit possible for the money we collectively accumulate.
Although your insurance card may say Blue Cross & Blue Shield, United Health Care, Cigna or any other name of an established health care provider, the insurance that we have is a self-insured plan managed by your fellow members and our employers. We pool our money together and when one of us has a medical expense, we pay a portion of that expense out of that pool of money.
It’s a self-funded cost sharing…not a pay-it-for-me solution.
How can each of us help to protect the solvency of these insurance plans, which we depend on for help when faced with the burden of medical expenses? We can be good stewards. We can participate in selfimposed wellness and if you’re a trustee, work toward enhancing wellness programs within our plans.
When we abuse or take advantage of a benefit that is offered, we spend money that could be spent on a medical necessity for someone who truly needs help. This type of behavior can be devastating to a self-funded plan. For example:
- Individuals have their eye doctor prescribe sunglasses so they could abuse the benefit and get free sunglasses.
- Doctors are asked to prescribe large doses of ibuprofen so the participant can get a prescription and take one pill instead of purchasing ibuprofen at the drug store and taking two or three pills.
- Members get prescription pain medication when an over-the-counter drug might be all that is necessary.
- Using urgent care facilities versus family care practitioners. Although your co-pay may be the same, the price charged to our plans is often higher.
Ask your doctor questions. Look at all the options. Use the benefits wisely. Make good decisions. If it’s not a medical necessity don’t take advantage of a benefit offered just because you found a way around or through the system. You may someday need a benefit that was cut due to financial stress on our fund caused by abuse.
Human Capital and Wellness Programs
The ability to function and perform at a high level consistently is greatly enhanced by our members’ wellness and our organization’s image and influence in the industrial community. Productivity relates to an employee’s ability to work for longer periods of time while effectively concentrating on the task at hand. A healthy workforce also leads to reduced absenteeism and lost time. It can also positively affect employee turnover.
Being well means you are in good physical and mental health. It is the process of becoming aware of and making choices toward a healthy lifestyle, including physical, mental, and social well-being. Wellness is achieved as the result of deliberate effort.
According to information supplied by the Wellness Council of America, a fund gains an average of $5.81 for every $1.00 invested in health-management programs. These programs reduce sick-leave absenteeism by an average of 26.8%, and insurance claims cost by 32%.
The potential savings are impressive. If 60% of our 5,000+ members participated in wellness programs and slightly reduced our insurance claims cost, our funds could save about $1.6 million annually. Wellness programs include health risk assessments, early detection screenings, programs on tobacco cessation, diet, exercise, diabetic management, weight management and many other topics.
I hope I have captured your interest in being a good steward, abstaining from abusing our programs, and participating in a self-imposed wellness program. If you’re a trustee on one of the Health and Welfare Funds our members participate in, be active, search for ways of improving the programs, adapt as many wellness benefits as possible and encourage good stewardship. There are many great wellness benefits offered by our plans. Take advantage of them, make good educated decisions, and make choices toward a healthy lifestyle. The gains could be enormous for us all.
Remember, we supply labor to our contractors. The end users choose our contractors because they perform well and bring value. The better we prepare ourselves to deliver safe, professional, productive labor the more marketable we become. Being prepared to deliver on the jobsite will allow all of us to have a better opportunity to provide for our families, who are the number one reason we go to work.
- Smokers generate 31% higher claim cost than non-smokers.
- People with unhealthy weights have a 143% higher hospital inpatient utilization than those with healthy weights.
- Individuals with just a few risk factors cost much less than those with numerous risk factors.
- Wellness programs can help with every issue listed, above.