A third of millennials have health conditions that reduce their quality of life and life expectancy, according to a new study of medical claims by the Blue Cross Blue Shield Health Index (BCBS Health Index). The report found that millennials had substantially higher diagnoses for eight of the top 10 health conditions than Generation X, and based on their current health status, millennials are more likely to be less healthy when they’re older, compared to Gen Xers. These findings are based off of a study of millennials who were between the ages of 34 and 36 in 2017 and Gen Xers who were 34 to 36 in 2014.
The biggest health differences between the two generations was the higher impact of physical conditions driven by increased cardiovascular and endocrine conditions, including diabetes.
A recent Blue Cross Blue Shield Association (BCBSA) survey found that 83% of millennials consider themselves in good or excellent health, and that 68% of millennials have a primary care physician, compared to 91% of Generation X, which is an important factor in preventative care.
“Based on these findings, we’re seeing that millennials are not seeking preventative care and it’s not only having an effect on their immediate health, but will significantly impact their long-term health as well,” said Vincent Nelson, MD, vice president, Medical Affairs for BCBSA. “With millennials on track to become the largest generation in the near future, it’s critical that they’re taking their health maintenance seriously. Our plan is to address this issue now to ensure millennials, and all Americans, take a proactive role in maintaining their health and wellbeing.”
The Blue Cross Blue Shield, The Health of America Report series, “The Health of Millennials,” examined the BCBS Health Index, a database of de-identified medical claims from more than 41 million commercially insured members of Blue Cross and Blue Shield (BCBS) companies. The findings revealed overall health begins to decline at the age of 27.
Additional findings from the study are:
To identify key drivers of millennial health and how to improve it, BCBS companies will host Millennial Health Listening Sessions across the country. Through these workshops, BCBS companies will hear from millennials, leading health care experts, employers and digital leaders on how to improve the health of millennials. Independence Blue Cross will kick-start the listening sessions by hosting the first one on April 25 in Philadelphia, Pennsylvania.
A millennial is someone who was born between 1981 and 1996, and there are nearly 73 million millennials in the U.S. right now – the second largest generation among commercially insured Americans. Gen Xers were born between 1965 and 1980.
This is the 26th study of the Blue Cross Blue Shield, The Health of America Report® series. For more information, visit https://www.bcbs.com/the-health-of-america.
Cell phones. Video games. YouTube. TV. iPads. Kindles. Online Gaming. Netflix. Hulu. Amazon Prime. Stream, click, stream, repeat.
As the years go on, so too does the list of things to which people become addicted. Emerging front and center as a relatively new but common modern addiction—to which employers are having difficulty responding—is the concept of a digital addiction. A digital addiction, also referred to as a gaming addiction, internet addiction, smartphone addiction, and/or social media addiction, is more than a mindless but incessant checking of one’s cell phone, more than browsing Facebook while taking a break from company-focused work. It is a complete disruption to and dysregulation of the daily life of an individual, due to compulsions to engage in the addictive and cyclical behaviors.
Digital Addictions
Like other, better understood addictions, a digital addiction essentially renders an “addict” unable to perform a major life activity, such as sleeping, eating, or, better yet, working. Although the behaviors themselves (use of electronic devices) may seem more benign than drugs, alcohol, or sex, the personal impact is no less severe.
And perhaps even more concerning is the fact that digital addictions can be hard to spot and even harder to stop: we live in a day and age that virtually necessitates constant and unwavering digital and electronic connection. Behaviors that may be dangerous for a minority of the population with a digital addiction are entirely socially acceptable for the majority of individuals, rendering the line between an addiction and a habit blurrier than ever.
Organizations worldwide have begun conducting investigations and research into the impact of a digital addiction upon both the quality and productivity of life. Despite the fact that these studies are in the early phases, the results ought to be taken seriously, as they mirror those of better understood addictions.
By way of example: a high school student reported being unable to live without his cell phone and used it so frequently that he became hospitalized due to lack of exercise and movement. While in the hospital, he was told he had the lungs of someone nearly four times his age—the direct result of an addiction to his phone at the expense of other, healthier coping mechanisms. Multiple recent deaths in South Korea have been directly blamed on an incessant addiction to gaming, as the victims lost track of the real world and their personal needs. And, for the first time in 28 years, the World Health Organization has gone so far as to revise its International Classification of Diseases. What made the cut? “Gaming disorder,” a sub-type of a disorder arising from behavioral addictions.
Treatment For Digital Addictions
As the prevalence and understanding of digital and gaming addictions rises, so too does an understanding of the disorder and its treatment. Rehabilitation facilities are developing specialized tracks focusing on gaming addictions. One such center is The Edge, located in Thailand, touting its programs designed to break digital addictions, treat the root causes leading to the addictive behaviors, and reprogram and repair relations to the digital world and its technology. A Place of Hope in Washington State boasts another similar program, as do countless centers from California to Florida. Although this addiction is not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), treatment programs are seeing the growing need for programs specifically tailored to digital and gaming addictions.
As with other addictions, a digital or gaming addiction often arises out of feelings of discontent, stress, pressure, anxiety, depression, or other underlying mental health conditions. The co-occurrence of one or more disorder is often present, making the addiction more difficult to treat. Similarly, and as with other addictions, the behaviors (here, gaming or compulsive use of the internet) are but a symptom of a deeper cause; typically, the behavior itself serves to either avoid, ignore, or “numb out” from more complicated inter and intrapersonal issues. In other words, the presentation itself may not be the cause, but the presentation may be the first behavior to “fix.”
What Does This Mean For Employers?
What does this mean for you as an employer? The Mental Health Parity and Addiction Act of 2008 requires health insurers and group health plans to provide parity between its coverage of mental health treatment and medical or surgical care, a dramatic shift that allowed hundreds of thousands of individuals to seek the mental health treatment they so desperately needed. It increased the prevalence of treatment facilities and rehabilitation programs focusing on a variety of mental health issues, as they are now able to receive funding through insurance companies when treatment otherwise would not be covered.
Although a digital addiction may not officially be recognized in the DSM-5, that does not make it any less severe or serious. Furthermore, because individuals often have co-occurring disorders or conditions, it is likely that an individual with a digital addiction may also be suffering from at least one other mental health condition. This, in turn, increases the chance that they would be accepted into a treatment program funded by their health insurance.
In recent years, employers have come to understand their obligations related to mental health issues and disabilities; employees are to be granted reasonable accommodations for mental health disorders the same as they would be for a physical disorder or illness. This includes, when applicable, leave to attend treatment on an inpatient, partial hospitalization, intensive outpatient, or outpatient basis under federal laws like the Family Medical Leave Act or Americans with Disabilities Act, as well as state laws, like the California Family Rights Act and California’s Fair Employment and Housing Act. What, then, is an employer’s obligation if an employee exhibits a digital addiction?
It is prudent to accommodate an individual with a digital addiction the same way you would accommodate any other individual: engaging in the interactive process, and reviewing and discussing any restrictions, limitations, or accommodations that may be needed. While there may be concerns regarding an employee’s ability to return to work in the digital age after receiving treatment for a directly related addiction, this concern cannot be used as a basis to engage in an adverse action against an employee.
This remains the case even if the disorder is not officially “diagnosable.” In other words, an employer must take a digital addiction seriously, even if it does not understand the addiction or personally believe the addiction is legitimate.
Where Do We Go From Here?
For now, there are several best practices employers can use concerning digital addictions. An up-to-date compliant handbook with policies addressing leaves and accommodations goes a long way. A handbook creates the foundation for your policies and procedures. If your handbook is wrong, or if you (gasp) do not have a handbook at all, your internal policies and procedures are much more likely to be problematic and subject to tougher scrutiny.
Your handbook also needs to be acknowledged by your employees. You can use an employee’s acknowledgement to show they were well aware you were more than willing to reasonably accommodate them and welcomed any and all accommodation requests.
Document, document, document. We cannot say it enough: document notice of an employee’s alleged disability; meetings and communications discussing the alleged disability; and requested, offered, or denied accommodations. This helps paint a picture that you took the alleged disability seriously and tried to reasonably accommodate. Without documentation of this interactive process, it may as well have never happened.
Train your managers and supervisors. They can make or break your defense. They typically receive notice of an alleged disability or requested accommodation first. If they fail to take this seriously and begin the interactive process, your defense can be severely undermined. They need to know what constitutes “notice,” that the company has interactive process obligations, and how to handle accommodation requests.
Not so fast…do not be too quick in denying accommodations (even if you want to). The law requires that you participate in a “good faith” interactive process, which means considering each and every possible reasonable accommodation in “good faith.” Document any legitimate reasons why an accommodation may not be “reasonable,” but understand that not everything is “unreasonable.” While employers do not have to provide accommodations that are unduly burdensome, “undue burden” is an extremely tough standard to meet and is looked at primarily in financial terms by courts. So, unless a particular accommodation costs you some serious money, results in a loss of serious money through disruption to your operations, or is a direct threat to the health and safety of others, you are probably going to have to provide it.
Watch the timing of adverse actions. Retaliation claims are on the rise and are currently the number one charge filed with the Equal Employment Opportunity Commission. Retaliation largely focuses on timing – how long after an employee engaged in “protected activity” (like requesting a reasonable accommodation) did they suffer an “adverse action” (like termination). The closer in time, the more retaliation seems plausible. To combat this, make sure you properly manage bad employees, have the documentation to support your story, and terminate as soon as termination is legitimately warranted.
Finally, stay up-to-date on changes in the law concerning digital addictions. A critical part of avoiding future claims is being aware of your ever-changing legal obligations.
Conclusion
The times continue to change, and so too does our understanding of modern addictions. Video conferencing and cloud hosting have begun to replace in-person meetings and file rooms. iPads and tablets have begun to replace notebooks and pads of paper. Cell phones have rendered landlines all but obsolete.
Although new technology may be initially feared, with time comes understanding. This age-old maxim holds true with respect to digital and gaming addictions, as well: although it may not be well known as of present, awareness begets recognition, and recognition begins understanding. Patience, an open mind, and a good labor and employment attorney will take care of the rest.
Despite a 10 percent overall drop in the number of charges of employment discrimination, the EEOC recently reported that sexual harassment charges filed with the agency jumped by 13.6% from the previous year. The 7,609 sexual harassment charges received clearly demonstrate that the #MeToo movement is in no way slowing down. What do employers need to know about this development?
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We have awaited to see where the U.S. Department of Labor would land with its much anticipated revised “overtime rule” and late yesterday the agency delivered. The USDOL released its long-awaited proposed rule which, if adopted, would set the minimum salary threshold at $679 per week, or $35,308 per year. For now, the proposed rule does not include an automatic update provision (which many were concerned would simply serve to periodically inflate the threshold level), nor does it revise the duties test that accompanies the rule.
Once published in the Federal Register, the public will have 60 days to submit comments regarding, among other things, the proposed minimum salary threshold.
Proposed Rule In A Nutshell
A federal judge in Washington D.C. sent shockwaves through the employment law community late on March 4th by reinstating a revised version of the EEO-1 report, which is now once again set to gather compensation information from employers across the country. The resurrection of the controversial revisions, which had been cast aside by the White House shortly after President Trump took over, will almost certainly be challenged by an appeal and could also lead to further agency maneuverings. While we have not yet seen the final chapter of this controversy, employers need to prepare for the possibility that their pay practices could soon be placed under a federal microscope like never before.
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As has been reported in various news outlets, new rules issued last year now require hospitals to post their standard charges for various services on their websites. This is part of a move toward greater hospital pricing transparency in the health care provider market. The requirement to post these amounts comes from the Affordable Care Act.
However, the posted prices are likely to be of limited use. First, the amounts on their websites are the “full price” amounts, sometimes referred to as “rack rates” or the “chargemaster”, but almost no one actually pays these prices. Insurance companies and third-party administrators negotiate discounts off of these prices. Furthermore, consumers who are covered by insurance may only pay a portion of these rates through copayments or coinsurance. Even uninsured consumers may negotiate discounts off of these prices.
In many cases, the items or services listed on their websites are given highly technical, often confusing names. Even an experienced health care professional may have trouble understanding them. Additionally, a single hospital procedure may involve multiple services and therefore include several listed amounts, so the total charge for a procedure or visit may require some sleuthing around on the website to figure it out.
The Takeaway
It seems unlikely that most employees will get much use out of these posted hospital prices. However, to the extent employers receive questions from their employees, the employers should be prepared to respond. Specifically, employers should point out that the charges on the website do not reflect the discounts negotiated by their insurance carrier or TPA.
If an employee wants to know what he or she will be charged for an item or service, the employer should suggest that they contact the carrier with their questions. Many carriers are also offering price transparency tools that reflect the discounts of the employer’s plan. If those tools are available, the employer may want to mention that as well.
Employers that participate in E-Verify, the government’s electronic employment eligibility verification program, have until Feb. 11 to create and enter cases into the system for all hires made during the 35-day partial government shutdown.
U.S. Citizenship and Immigration Services (USCIS), which manages the program, announced that E-Verify has resumed operations, but patience will be required from users as the service is restored.
“Expect delays due to the sheer volume of past E-Verify cases that need to be created, in addition to the fact that employers continue to hire every day and that adds to the queue of cases being created,” said Montserrat Miller, a partner in the Atlanta office of Arnall Golden Gregory. “Employers, you only have a little over two weeks to bring yourself into compliance with the E-Verify requirements given the Feb. 11, 2019 deadline.”
Miller reminded HR professionals that “a case needs to be created for all employees you hired for whom a Form I-9 was completed but you could not create a case in E-Verify because the system was offline due to the shutdown.”
USCIS instructed that employers use the hire date from the employee’s Form I-9 when creating an E-Verify case. If the case creation date is more than three days following the worker’s start date, select “Other” from the drop-down list asking for an explanation and enter “E-Verify Not Available” as the reason.
“Any pending tentative nonconfirmation (TNC) that you and/or your newly hired employee were not able to resolve due to the shutdown needs to be resolved at this time,” Miller said.
If an employee has received a TNC and notified HR of his or her intention to contest it by Feb. 11, employers must add 10 federal business days to the date on the worker’s “Referral Date Confirmation” notice. That’s the date by which the employee must contact the Social Security Administration or Department of Homeland Security to begin resolving the TNC.
Federal business days are Monday through Friday and do not include federal holidays.
There’s no need to add days to the referral date for TNC cases after E-Verify resumed operations. “If your employee decided to contest the TNC when E-Verify was unavailable, you should now refer the employee’s case and follow the TNC process,” Miller said.
Federal contractors should contact their contracting officer for more information about the impact of the government shutdown on their operations related to E-Verify.