Worksite health promotion programs are an essential component of systematic efforts to reduce health care costs. A comprehensive worksite health promotion program, as defined by Healthy People 2010, contains five elements: health education, supportive social and physical environments, integration of the organization’s worksite program into its structure, programs like employee assistance programs and other programs to help employees balance work and family, and worksite screening programs (U.S. Department of Health and Human Services, 2000).

This labor-management health insurance committee facilitation guide was authored by Gregg Gascon for Ohio school districts and educational service centers. The School Employees Health Care Board (http://sehcb.ohio.gov/) has endorsed it “as a resource for use by public school district benefits or insurance committees to encourage collaborative efforts and recognize the shared interests of labor and management in the negotiation and procurement of health insurance benefits.” Completion of training on this text and its accompanying presentations is offered through the Ohio Education Association and the Ohio Association of Public School Employees (http://www.oapse.org/). Upon completion of the training program through OEA or OAPSE, a CE credit worth 1.6 credits of continuing education (24 classroom hours) will be granted to successful trainees. This certification is recognized by two- and four-year accredited colleges or universities through the National Labor College and George Mason University.

A health care and insurance glossary for Labor-Management Health Insurance Committees.

Prescription drug insurance plans can arise as a component of a traditional medical insurance plan, as part of a managed care medical insurance plan, or as a stand-alone plan.” The benefits and costs of such plans in the 2012 school district market are described in this document.

In 1986, the U.S. Congress passed the Consolidated Omnibus Budget Reconciliation Act (C.O.B.R.A.) to provide newly unemployed workers with temporary health insurance coverage. Under C.O.B.R.A., private sector employers of more than 20 employees and all state and local governments that offer health insurance must provide temporary continuation coverage to covered employees, their spouses, their former spouses, and their dependent children when coverage would otherwise be lost to a ‘qualifying event’.   

Each year, the School Employees Health Care Board (SEHCB), in conjunction with the State Employment Relations Board (SERB), distributes a survey instrument concerning health insurance benefits and costs to public employers.

The 2011 report includes general information on health insurance (employee coverage, eligibility and participation), formal procurement processes, health insurance brokers and consultants, consortia, labor-managment health insurance committees, and worksite wellness programs); medical insurance plans (best practices, medical plan choice, designs, enrollment, take-up rates, loss financing, market share of companies, and premium/funding levels); prescription drug plans; dental insurance plans; vision insurance plans; and flexible spending accounts.

In 2010, Congress passed legislation to address health insurance reform through two pieces of legislation. The first, the Patient Protection and Affordable Care Act (PPAC) (P.L. 111-148), was signed into law by President Obama on March 23, 2010, expanding Medicaid eligibility, providing incentives for employers to provide health insurance, providing certain employees and employers with support for health insurance premium payments, prohibiting the denial of coverage for children on the basis of pre-existing conditions, establishing health insurance exchanges and providing additional support for medical research, among other things. A week later, President Obama signed the Health Care and Education Affordability Reconciliation Act (HCEAR) (P.L. 111-152) into law, which made several technical changes to PPACA, also included a rider on financial aid for college students.

Section 403(b) plans represent a defined contribution approach to retirement funding for employees of nonprofit organizations such as schools, colleges and universities. In such a plan, employer and employee contributions and earnings accumulate tax-free. Distributions (withdrawals) from plans to employees in retirement are taxed as income. If money is withdrawn before the employee reaches the age of 59 ½, a 10 percent penalty is applied. When employees contribute to section 403(b) plans on a regular basis over the years, they can increase their retirement savings while lowering the amount of taxes they pay annually.

Section 457(b) plans represent a defined contribution approach to retirement funding for employees of state and local governments and non-government organizations exempt from tax under Internal Revenue Code Section 501. In such plans, employer and employee contributions and earnings accumulate tax-free. If the plan is eligible, deferred income and earnings accumulate tax free until the assets are distributed to the employee after separation from service when they are taxed as income. The advantage of a 457(b) plan is that no penalty is applied for withdrawals that occur prior to age 59 ½. Moreover, 457(b) plans are portable, allowing employees to move plan assets into a new employer's 457(b), 403(b) or 401(k) if the plan accepts such transfers, or into an IRA; generally, however, rollovers are not encouraged for a variety of reasons, including the fact that the 10 percent penalty for withdrawals prior to age 59 ½ would be lost.

Part of H.B. 1 (2009) included a number of changes applicable to health insurance coverage in the Ohio public school market; among them, continuation coverage.  At issueare the changes made for dependents that participate in an employer’s health insurance program and are subject to a termination date by policy, contract or agreement.  For more information, see the Ohio Department of Insurance webpage http://www.insurance.ohio.gov/Consumer/Pages/HealthCareReform.aspx.

On October 3, 2008, the United States Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.  The law requires that medical insurance plans that provide mental health or substance use disorder benefits offer full parity between medical and mental health and substance use disorder benefits. 

Health Reimbursement Accounts (HRA) represent a defined contribution approach to health expense funding that relies upon employer contributions alone, either through regular contributions or a compensated leave buyout program.  Employers do not pay FICA taxes on their contributions while earnings grow tax-free for employees. Distributions are not included in an employee’s gross income so long as they are made for qualified medical expenses and made by the employee, the employee’s spouse and dependents.

Health Savings Accounts (HSA) are tax-exempt trusts or custodial accounts for the payment of qualified medical expenses. Eligibility is restricted to those persons who are enrolled in a high-deductible health plan (HDHP) that meets IRS requirements.  An employee’s contributions to an HSA must be made in cash, and contributions are deductible in determining adjusted gross income.

Studies conducted on the prevalence of health conditions have found that over half of all Americans wear corrective lenses.  Nearly all people have a need for vision care at some point in their life, though the need for vision services increases with age. Currently, the American Optometric Association recommends examinations every two years for asymptomatic or risk free patients aged 18 to 60 and annually for asymptomatic or risk free patients over age 61; those who are at risk are encouraged to have examinations every one to two years from age 18 – 60 and annually or as recommended after age 61. 

Dental insurance covers the cost of care for teeth and gums associated with dental care from dentists, orthodontists, periodontists, and oral surgeons. It is a widely held benefit due to the importance of preventative dental care to sound oral hygiene. Employer-based dental insurance plans are provided not only to cover the costs associated with dental care, but to encourage the regular use of preventive care. 

In health plan financing, five medical health insurance designs are generally available in the marketplace: Base medical and major medical (Base), comprehensive major medical (CMM), preferred provider organization (PPO), point of service (POS), and health maintenance organizations (HMO).  Additionally, while not strictly a form of medical plan insurance design, high deductible health plans (HDHP) feature a network, and deductibles and out-of-pocket fees are indexed for inflation and are guaranteed to increase in the future. 

School Employees Health Care Board (SEHCB) best practices to which each Ohio school district and educational service center health insurance program must adhere to are detailed herein. 

Flexible spending accounts (Section 125 plans) provide a vehicle for funding health care and dependent care expenses in the context of an employee benefit program. If the employer requires employee premium contributions, a flexible spending account should be offered to employees. A number of expenses can be paid for through such accounts. In the context of health care expenses, this may include dental services, hospital services, insurance premiums, prescription drugs, dental services, travel expenses to receive medical care, and vision care, to name a few. Qualified medical expenses are updated each year in IRS publication 502; IRS publication 503 details expenses that are qualified annually for dependent care expense reimbursement.