Part II of the survey primarily addresses education and prevention, leave policies, plan design and benefit issues. The response rate for Part II was higher than Part I and, by typical e-mail standards, exceptionally high. However, the small number of responses places limitations on the ability to generalize about survey results. Therefore, the discussion to follow is intended to provide meaningful insights into the practices of a limited group of employers rather than to document trends.
Almost all respondents indicate some level of involvement in breast cancer education and prevention. The most frequent reason for being proactive in breast cancer education and prevention is that it is “part of an overall effort to reduce plan costs”. The next most frequently mentioned reason is the real life experience having employees with breast cancer.
By far the most common activity these employers engage in to increase breast cancer awareness is using initiatives in a wellness or disease management program. The next most common activity is to include breast cancer awareness as part of a company-wide health fair. Several respondents indicated they work with community providers to promote breast cancer education or that they provide literature on the importance of early prevention.
Employers also engage in a number of activities to encourage breast cancer prevention. The most common among these is 100% payment for mammograms under the health plan. Other employers also provide time-off without loss of pay for annual screenings and several respondents provide on-site screenings. Some employers also make resources available to employees concerned with breast cancer, such as names of and websites for organizations providing reliable information.
More than 70% of the employer respondents indicate they have provisions in their 401(k) plans to accommodate the financial difficulties of a individual facing a serious illness, such as hardship withdrawals and 401(k) loan provisions.
Employer leave policies are an important area of accommodation for seriously ill employees. The Family and Medical Leave Act (FMLA) requires employers (with more than 50 employees) to provide eligible workers with up to 12 weeks of unpaid leave each year for certain personal circumstances, including the illnesses of employees and their families. Nearly half of employer respondents indicate they have a leave policy for serious illness more generous than that required under FMLA. However, of those who do not have a leave policy more generous than FMLA, none of those indicate that a more generous policy is under consideration.
Employees may be required to exhaust accrued paid leave in the form of sick days, vacation days and paid time off banks before beginning to count the 12 weeks of FMLA. One third of the respondents indicated that use of accrued paid leave was required before the start of FMLA .
One third of the employer respondents track the cost of injectable drugs or breast cancer chemotherapy. However, almost half of the responding employers did not know whether a program to manage these costs was in place.
The insurance arrangement for the plan can influence how the seriously ill individual is guided through the process of making decisions about treatment based on their benefits. Fully insured plans often use a case manager assigned on behalf of certain individuals to act as their advocate throughout the insurance claims process. One third of employer respondents are insured plans. In insured plans, the human resources department often works closely with the individual with breast cancer to review issues such as extent of coverage, out-of-network providers, leaves of absence, etc. before the seriously ill individual makes specific treatment decisions.
The impact of breast cancer claims on plan costs is also related to the plan’s insurance arrangement. For insured plans, claims experience can impact insurance renewal negotiations and result in a change in carrier. Transition to a new carrier may involve taking measures to insure the worker undergoing treatment does not experience any interruption in care as a result of the transition.
For self-insured plans, large claims may impact their stop-loss coverage. Anticipated large claims are typically aggregated during the last quarter of the policy year to minimize the risk triggering the stop loss coverage during the next policy year.
We asked our employers respondents whether they offer critical illness insurance as a voluntary benefit. Payments under critical illness policies are typically triggered by a diagnosis of any one of a number of serious medical conditions, usually including cancer. Payments are in typically made in a lump sum and are not dependent of the type or frequency of treatment. Payments under cancer policies, by comparison, are triggered only by a cancer diagnosis and are issued in increments over and dependent on the course of treatment. Premiums for critical illness insurance and cancer insurance are generally comparable. Since the odds of collecting on the insurance more likely with a critical illness policy, they have become the more “popular” choice. However, an individual undergoing extended treatment under a cancer policy may collect a greater sum of money over the long term.
Other industry surveys show that about one-third of employers currently offer critical illness insurance, up from 25% a few years ago. Twenty-eight percent of our respondents offer critical illness options.
The overall results of Parts I and II of Coping with Serious Illness in the Workplace: Working Women with Breast Cancer reveal concern and initiative on the part of many employers to accommodate workers undergoing treatments for serious illness.
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Part II of the survey consisting of approximately 20 questions was administered by e-mail on September 13, 2005 to the 123 benefit managers or human resource professionals who responded to Part I of the survey. The survey generated 21 responses or a 17% response rate.