Author: Site Staff

California Gov. Arnold Schwarzenegger has announced a $32 million public-private partnership with state educators aimed at boosting the number of health care support workers, whose ranks are far thinner than national averages.

Called the Allied Health Initiative, the partnership is intended to increase the numbers of workers that directly support physicians or nurses—occupations such as pharmacists, medical lab technologists and radiation technologists. California is estimated to have less than 75 percent of the per capita national average number of each of those job areas.

The state is supplying $16 million to the partnership, including $8 million from California’s slice of funding in the stimulus bill. The rest of the funding for the partnership comes from financial or in-kind contributions from several organizations: the California Community Colleges System, the University of California and California State University systems, and the California Hospital Association.

The initiative is being led by the state Labor and Workforce Development Agency, and will begin this fall when 25 community colleges will enroll an additional 700 allied health workers in classes. The agency estimates that the state will need to educate more than 206,000 additional health care professionals in the next six years.

Filed by Joe Carlson of Modern Health Care, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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Employers with employees living in New York are receiving bills from the state’s Department of Health requiring them to pay in a lump sum a retroactive increase in a special supplemental health care-related assessment.

The covered-lives assessment on employers with employees living in New York is used to help fund a state pool used to pay for graduate medical education.

Earlier this year, New York legislators approved a budget bill that boosted that assessment by about 13 percent, according to calculations by benefit consultant Mercer. For example, the annual assessment for employers with employees in New York City climbed to $613.56 from $543.20. That increase was retroactive to January 1 and was reflected in the bills sent to employers the next month.

In the same budget measure, legislators also retroactively boosted the size of a special supplemental six-month assessment that expired last month.

Under the original special assessment, which was in effect from October 2008 through March 2009, employers with employees in New York City, for example, paid an additional $22.60 for each employee choosing single coverage and $74.58 for those choosing family coverage. One-sixth of the assessment was paid each month over that six-month period.

The budget legislation jacked up the special assessment rates by about 170 percent. For example, the assessment on employers with employees in New York City opting for single coverage rose to $61.31 from $22.60, while the special assessment for family coverage climbed to $202.32 from $74.58.

Because the state didn’t update its electronic reporting system at the time the legislation was approved, employers now are being billed for the entire difference in the original special assessment and the new special assessment, according to Mercer. That difference will have to be paid by May 10 before penalties accrue.

Separately, another budget measure signed last week by Gov. David Paterson increased, effective April 1, to 9.63 percent from 8.95 percent the surcharge that is imposed on bills incurred in New York hospitals. The surcharge is used to help fund indigent care.

Filed by Jerry Geisel of Business Insurance, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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Only 13 percent of U.S. workers said they were very confident about having enough money for a comfortable retirement this year, down from 18 percent and 27 percent in 2008 and 2007, respectively, according to EBRI’s 19th annual Retirement Confidence Survey, released Tuesday, April 14.

The survey, conducted by the Employee Benefit Research Institute and Mathew Greenwald & Associates, also found that 28 percent of workers changed their expected retirement dates in the last year, with 89 percent of them postponing retirement with the goal of increasing their financial security.

More workers this year also said they plan to work after they retire: 72 percent versus 63 percent in the 2008 survey.

“After a very poor performance in the stock market and overall economy, workers have become very concerned about their ability to finance a comfortable retirement, and many are looking toward working longer,” Craig Copeland, EBRI senior research associate, said in an interview.

Workers also said they have more than twice the level of confidence in banks than they do in investment companies. In response to a question asked for the first time in this year’s survey, 77 percent said they were at least somewhat confident in banks, compared with 37 percent who said they had the same level of confidence in investment companies.

The survey also said that 67 percent of the workers were at least somewhat confident in insurance companies, while 59 percent had a similar level of confidence in the U.S. government.

The survey was conducted in January and was based on randomly selected telephone interviews with 1,257 people age 25 and older.

EBRI is a nonprofit research institute. Mathew Greenwald & Associates is a survey research firm.

Filed by Doug Halonen of Pensions & Investments, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

Major U.S. health insurers and managed care companies earned sharply lower profits in 2008, some nearly half of 2007 results, as poor stock market performance and lower interest rates chiseled away at their investment portfolios.

The downturn in results may lead some insurers to try to increase premiums, though they will likely meet stiff resistance from employers, some analysts say.

Insurers also were hurt by a shrinking commercial market, while underestimation of the cost stung those that dived headlong into the Medicare Advantage plan business, analysts said.

If U.S. unemployment continues to rise, health insurers are likely to see group enrollment fall further, even after taking into consideration the effects of the 65 percent COBRA subsidy made available under the American Recovery and Reinvestment Act of 2009, analysts said. Despite help from the federal government, COBRA premiums may be too expensive for the jobless who are living solely on unemployment insurance benefits, they noted.

Meanwhile, planned cuts in federal funding of Medicare Advantage programs will affect the performance of insurers with a sizable portion of that market after 2010, analysts warned.

While health insurer profit margins hovered in the 9 to 10 percent range in 2007 after several prior years of similar good performance, margins of the top 10 health insurers dropped to about 5 to 6 percent in 2008, where they are expected to remain for the near future.

“We typically look at the sector as being fairly strong. But we had said for several years the 9 percent and 10 percent margins weren’t sustainable,” said Bradley Ellis, a director at Fitch Ratings in Chicago.

Poor investment results were a major contributor to the lower margins.

“Interest rates are down. Since health insurers have a shorter duration in their investment portfolios than life insurers, they’re replacing higher-returning investments with lower-returning investments,” Ellis said.

The decline of the financial markets was particularly problematic for Oakland, California-based Kaiser Foundation Health Plan Inc., which reported a net loss of $794 million for 2008, compared with a net gain of $2.2 billion in 2007.

Although Kaiser was the only one of the top 10 managed care companies to post a net loss for 2008, Stephen Zaharuk, vice president and senior credit officer at New York-based Moody’s Investors Service Inc., said the rating agency has placed a negative outlook on the entire sector.

“A number of things happening in the health care space are unsettled,” Zaharuk said, pointing to the Obama administration’s call for national health reform, cuts in federal funding of the Medicare Advantage program and enrollment losses due to increasing layoffs.

“Earnings were not as good in 2008,” said Sally Rosen, managing senior financial analyst with Oldwick, New Jersey-based A.M. Best Co. Inc. “But there were other issues besides investment returns. Each one of the companies seemed to have independent issues.”

For example, “in the winter of 2007 going into 2008, the flu season was worse in several areas of the country than it had been in several years,” she said. “There does not seem to be an increase in medical cost trend, but there is an increase in utilization. We’re also seeing an increase in high-dollar claims and claim severity.”

Minnetonka, Minnesota-based UnitedHealth Group Inc., for example, cut its full-year 2008 outlook by 10 percent due to unusually high flu costs and reduced investment income. For the year, UnitedHealth’s net income fell 36 percent to $2.97 billion from $4.65 billion in 2007.

Indianapolis-based WellPoint Inc., which reported net income of $2.5 billion in 2008 versus $3.3 billion in 2007, changed its financial forecast several times last year.
“They had an issue with systems migration,” said Wayne Kaminski, a financial analyst at A.M. Best.

Rosen said WellPoint had several legacy claims systems that had to be merged after a string of acquisitions in 2007 and 2008.

Other insurers “had issues with product design and pricing, mostly Medicare-related. The way it was priced and designed allowed several companies to be selected against,” Rosen said.

For example, Bethesda, Maryland-based Coventry Health Care Inc. restated its 2008 forecast twice last year because of Medicare Advantage issues, she said.

“In the first quarter of 2008, they realized their claims turnaround on the Medicare Advantage fee-for-service product was much longer than on their traditional business,” Rosen said.

As a result, “their reserving for 2007 was lower than expected.” Underreserving affected mostly plans covering large groups enrolled in employer-sponsored retiree benefits plans, she said.

Similarly, Louisville, Kentucky-based Humana Inc. “had a pricing issue with one of their Part D plans,” Rosen said. In addition to having underpriced the product, “they ended up having adverse selection” because the plan attracted more sick seniors because it was designed to protect them from exceeding their out-of-pocket maximum spending on prescription drugs.

Although they corrected the pricing for 2009, “they had to ride it out” for all of 2008, Rosen said.

As a result of its missteps and other issues, Coventry’s net income fell nearly 40 percent to $381.9 million in 2008 from $626.1 million in 2007. Humana’s profits fell 22 percent to $647.2 million in 2008 from $833.7 million in 2007.

Planned cuts in Medicare funding as Congress attempts to balance the budget likely will exacerbate insurer challenges in that business, Zaharuk said.

“Because of the deficits, the government is going to be looking for every penny,” Zaharuk said. “Quite possibly we’re seeing a repeat of what happened to Medicare before,” he added, referring to the Medicare+Choice program in the mid-1990s. After the government cut funding, insurers began withdrawing from the market.

To address expected revenue shortfalls, some analysts expect health insurers to try to raise premiums on fully insured business and administrative service fees on self-insured accounts.

“I think you’re going to see a more rational pricing environment,” said Bridget Maehr, senior financial analyst at A.M. Best.

But she doesn’t think employers will be willing to just sit back and accept price increases in the current economic environment.

The economy is likely to have a significant effect on health insurers’ group business, Zaharuk and Ellis predicted.

“In 2008, growth in the group market was flat,” Zaharuk said. “Aetna gained membership, but a lot of other companies lost membership. There’s also a loss in the market itself” as a result of layoffs and small employers dropping coverage for their employees due to the cost, he said.

Despite its enrollment gains, Aetna’s profits fell in 2008 to $1.38 billion from $1.83 billion in 2007.

“You’re seeing a lot of issues with regards to enrollment,” said Fitch Ratings’ Ellis. “Growth has shifted to state-run programs like Medicaid.”

Filed by Joanne Wojcik of Business Insurance, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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Tower Automotive, a Livonia, Michigan-based automotive supplier, mailed more than 600 notices two weeks ago to employees who have been permanently laid off since September 1 to let them know they can purchase discounted COBRA health insurance coverage through the company.

It is part of the recently approved federal stimulus bill—the American Recovery and Reinvestment Act—that offers eligible terminated employees a 65 percent discount on COBRA coverage. Enacted in 1986, COBRA allows former employees to continue their health insurance coverage for up to 18 months after they are terminated.

The catch for employers is that they must pay 65 percent of the COBRA premium and then file for reimbursement through a payroll tax credit.

Employees pay the other 35 percent.

Some companies are worried the federal requirement could cause cash flow problems because of the up-to-three-month delay for reimbursement, said Sue Mathiesen, director of research at McGraw Wentworth, a Troy, Michigan-based employee benefits and consulting company.

“The big concern right now is how many people will elect this and where the money will come from,” said Jennifer Kluge, COO of the Warren, Michigan-based Michigan Business and Professional Association. “Going through payroll taxes to get reimbursed is OK, but it is not cash to pay the premiums.”

Kluge said cash flow problems could cause some financially strapped companies to lay off more employees, freeze or cut salaries, or eliminate group health coverage, dental, life insurance, disability and other benefits.

For example, if just 25 percent of the former employees at Tower choose COBRA coverage, the company could pay up to $2 million more in extra health care claims this year because it is self-insured, said Linda Willbrandt, Tower’s senior benefits analyst. Tower employs 2,400 workers in Michigan and some 8,000 across the U.S.

“This is going to be a huge financial burden, and we aren’t sure what the actual impact will be” until former employees decide whether to take COBRA, Willbrandt said. “This is at a time that manufacturing companies are looking at every penny.”

By April 18, employers are required to mail out the notices to eligible employees who have been laid off since September 1.

Employers who fail to notify terminated employees are subject to fines of $110 per day per former employee. The new regulation affects most companies with 20 or more employees.

“Identifying the employees and sending out the notices takes a lot of time and paper,” Willbrandt said.

The postage for the five-page notices costs more than $1,000, she said.

On top of the 600 laid-off employees, Tower was required to mail out an additional 350 notices to workers who had been temporarily laid off but who have returned and had their benefits reinstated, she said.

The coverage is retroactive until March 1. This means employees must pay their 35 percent share on three months of COBRA premiums through May, Mathiesen said.

“The first bill will be ugly, because anybody who previously waived their COBRA right can sign up and it will be a three-month bill,” said Bill Schoof, director of employee benefits with Michigan Financial Cos. in Southfield, Michigan.

Schoof said he expects more than 50 percent of eligible employees to accept COBRA benefits. The average COBRA take-up rate is about 20 percent.

“If the average premium for an individual is $400, and employees only pay 35 percent of that, they will pay about $150 a month,” Schoof said. “This is a lower premium than they can get anywhere else for coverage.”

But even with higher health care claims expected this year for larger companies such as Tower, smaller companies in Southeast Michigan with group coverage may face even worse financial and administrative pain.

“Companies let people go because business is not that great. They might be cash poor,” Kluge said. “And now they are being asked to give the federal government interest-free loans” for up to three months.

To help companies, Kluge said the association has offered to pay the estimated $15 per notice cost charged to their members by vendors or benefit administrators to identify and send out the COBRA notices.

At SmithGroup, a Detroit-based architecture and consulting firm, COBRA notices have been mailed to about 55 laid-off or terminated employees, said Edward Dodge, the company’s vice president of human resources.

While only one has elected COBRA coverage so far, Dodge said complying with the new COBRA regulations has taken extra time and administrative expense. SmithGroup employs 800 nationally.

“What we don’t know is if we file for the tax credits on a weekly basis or a quarterly basis,” Dodge said.

Carol Rito, compliance officer with Group Associates Inc. in Bingham Farms, Michigan, said large employers can file for COBRA tax credits on a monthly or weekly basis through their payroll tax deposit filings, depending on their arrangement with the IRS.

“Smaller companies that don’t have this arrangement have to file and pay on a quarterly basis,” Rito said. “This will be a burden.”

How the new COBRA rules work:
• The federal government will provide a 65 percent subsidy for up to nine months of the COBRA premium retroactive to March 1 for certain terminated employees.

• To be entitled to the subsidy, employees must have been involuntarily terminated between September 1, 2008, and December 31, 2009, and must be eligible for COBRA.

• A special election period exists for individuals involuntarily terminated on or after last September 1 who had not elected COBRA. They will have 60 more days after receiving the notice to elect coverage, which is retroactive to March 1 if they lost their jobs before then.

• The employer pays the 65 percent on the employee’s behalf and is then reimbursed through a payroll tax credit. Large companies may be reimbursed either weekly or monthly, but smaller employers must file for the credit with their quarterly payroll taxes.

• The employee must pay 35 percent of COBRA before the employer can request reimbursement of the other 65 percent. Employers that do not charge the full COBRA premium will not be entitled to reimbursement of 65 percent of the maximum COBRA premium.

For more information:

Tool: Resources for Keeping Up With COBRA Changes

U.S. Department of Labor at www.dol.gov/ebsa/cobra.html and the IRS at www.irs.gov/pub/irs-drop/n-09-27.pdf.

Filed by Jay Greene of Crain’s Detroit Business, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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Stable-value funds have long been thought to be the safest of financial investments. But now a number of 401(k) plan sponsors are discussing whether they should communicate more with participants about how these funds operate.

In early April, The Wall Street Journal reported that Chrysler had terminated a stable-value fund offered in one of its nonqualified savings plans and that the fund paid out only 89 cents on the dollar, leaving many retirees and employees with huge losses.

As a result of that and other articles discussing the dangers of stable-value funds, consultants have received calls from employers about how to address the issue with employees.

“What happened at Chrysler was a very unique situation,” said Robert Liberto, senior vice president of Segal Advisors. “But many clients called us about it.”

Liberto advises employers to be prepared to answer many questions if they send out communications regarding their stable-value funds. These funds are attractive because they offer a guarantee through an insurance wrapper. But with bond holdings dropping as a result of the markets and many insurance companies having credit issues, some are questioning the safety of these funds. The main complication of these funds is that unlike other investments, they have a market and a book value.

“Employers are dealing with a Catch-22,” said one consultant who declined to be named. “If they go and tell participants what the market-to-book ratio is, those participants might freak out and pull their money out.” If enough employees pull their money out, the plan sponsor could break its contract with the wrap provider and lose the guarantee, the consultant said.

In general, stable-value funds continue to be very safe investments, experts say. And it would make sense for employers to reassure employees about these investments, said Don Stone, president of Plan Sponsor Advisors in Chicago.

More than anything, employers just need to make sure they are keeping up with their fiduciary reviews of the stable-value funds in their plans, said Ruth Falk, a senior consultant with Watson Wyatt Worldwide.

“We are telling clients to understand who the insurance wrap providers are of their funds and if the market-to-book value drops, understand why that is happening,” she said.

—Jessica Marquez

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A diabetes disease management program conducted by the American Pharmacists Association Foundation is being made available to employers nationwide as a result of a series of successful tests.

The program, the Diabetes Ten City Challenge, has yielded substantial savings for employers even after they’ve waived co-payments for participants and paid for individual counseling. Patients also saved money and improved in several key clinical areas associated with the condition, officials said.

Results of the Diabetes Ten City Challenge, which will be published in a peer-reviewed article in the May/June issue of the Journal of the American Pharmacists Association, show average reductions in per-patient health care costs of $1,079 a year. Aggregate data for 573 participants, who were in the program an average of 14.8 months, showed they saved an average of $593 per year on their diabetes medication and supplies.

The data also identified improvements in blood glucose, cholesterol and blood pressure levels, all of which usually are elevated in diabetes patients. Moreover, the analysis found increases in usage of preventive care, such as flu vaccinations as well as eye and foot exams.

The program is based on the Asheville Project model, in which employers waive co-payments and deductibles for prescription drugs and related monitoring devices, such as glucose meters, for plan members who agree to receive periodic counseling from pharmacists. In addition, the employer pays an hourly fee to the pharmacists.

While the Asheville Project, first implemented in 1997, involved just employees and dependents of the North Carolina city and Mission Health & Hospitals, the region’s largest health care provider, the DTCC included 30 employers in 10 cities across the United States.

The same process of care used in the Asheville Project and the DTCC will be made available to employers nationwide through HealthMapRx, a Reston, Virginia-based partnership between the APhA Foundation and Mirixa Corp., said Bud Meadows, senior vice president of sales and development at Mirixa. The National Community Pharmacists Association sponsors Mirixa.

Using its technology, Mirixa will use claims data from employers’ third-party administrators or insurers to identify prospective patients and then monitor interventions provided and patients’ progress. The program also will match patients with community pharmacist coaches.

Meadows estimated the program will cost employers “only a couple of hundred dollars annually” in addition to counseling fees, which average about $400 annually per person.

But the return on investment is quick and builds over time, Meadows said.

“We’ve had some clients who have been in the program for three or four years, and we see the savings continue to improve because the patients better manage their condition and their medical expenses go down,” Meadows said.

In the first five years after implementation, for example, the city of Asheville and Mission Health saw the average cost of care for their diabetic plan members fall an average of $2,000 per patient per year, growing to nearly $3,000 per patient in the sixth year of the program.

“The second thing is … self-insured employers … are seeing reductions in their reinsurance premiums,” Meadows said.

Although the program has consistently yielded savings for employers, some health benefits experts expressed concern that economic conditions could deter some employers from adopting it.

“I do worry about the timing about getting some commitments in the current economic environment,” said Andrew Webber, president of the National Business Coalition on Health in Washington, whose members were among participants in the DTCC. “That’s what we’re hearing from our coalitions and the individual employers that we talk to.”

However, he said he hoped some employers consider adopting the program because of the short time frame in which it produced health care cost savings.

“Usually it takes longer” for a typical disease management program to produce savings, Webber said. “It’s a very good sign that this program is showing and demonstrating some gain in a short period of time.”

At least one of the DTCC participants has decided to continue the program despite its cost: Pactiv Corp., a Lake Forest, Illinois-based food and food-service packaging company.

“Pactiv results from 2007-08 in the Diabetes Ten City Challenge have been positive,” a company spokeswoman said. “Pactiv participants are still engaged in this program and, as a group, are achieving the clinical outcomes as recommended by the American Diabetes Association. In addition, preliminary data analysis of the group shows a reduction in the overall health care costs for the group.”

Filed by Joanne Wojcik of Business Insurance, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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Chicago law firm Schiff Hardin said it would cut costs with an early retirement program and other moves, including canceling the company picnic and holiday parties.

The actions are designed to avoid the kind of mass layoffs rippling through the legal industry, said managing partner Ronald Safer.

“We’re not going to do that,” he promised. But in a memo to colleagues, he noted: “As always, we will critically assess the performances of everyone at the firm—partners, associates and staff—as part of our commitment to professional excellence.”

And Schiff will adopt a cost-cutting measure gaining momentum at law firms hit by the recession: It plans to delay until January 1 the start date for this year’s entering crop of law school graduates.

Safer wouldn’t quantify the overall amount of projected savings.

The 375-lawyer firm, whose revenue fell slightly last year, will require all attorneys to bear the full cost of health and disability insurance coverage—part of an effort to spread the pain that at other firms is focused on junior attorneys losing their jobs, Safer said.

“It may sound trite, but we have a consensus. … It’s the [equity partners] who are going to take responsibility for it,” he said. In his memo, Safer said retirement incentives would be offered to non-attorney staff members who turn 60 before July 1.

The firm also will cancel its “attorney dinner dance” this year and replace the equity partners’ retreat with a business meeting in Chicago. Summer associates, or interns, also will feel the pain. Schiff said this year’s program would be shortened to eight from 12 weeks and be more “content focused.”

Filed by Steven R. Strahler of Crain’s Chicago Business, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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California Gov. Arnold Schwarzenegger said it is “absolutely right” for the California Workers’ Compensation Appeals Board to reconsider two controversial case decisions.

The board made an unusual announcement, saying Monday, April 6, that it would reconsider en banc decisions it made earlier this year in Wanda Ogilvie v. City and County of San Francisco and in the consolidated case of Mario Almaraz v. Environmental Recovery Services and Joyce Guzman v. Malpitas Unified School District.

The board in both cases ruled that a schedule adopted in 2005 for rating permanent disabilities can be rebutted with certain evidence.

But those decisions quickly came under fire from payers and the governor for putting upward pressure on workers’ comp rates.

“It’s absolutely right for the Workers’ Compensation Appeals Board to reconsider its earlier decision, and its decision to do so shows that board members recognize the importance of this issue,” the governor said in a statement Tuesday, April 7. “It is important that we assist California workers injured on the job, and it is also important that we protect businesses to be sure they can weather the current economy and create jobs.”

The board said it will reconsider its prior decisions so that interested parties can provide it further briefing and amicus briefs.

Filed by Roberto Ceniceros of Business Insurance, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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Employees view receiving mobile devices, such as BlackBerrys, from their companies as a benefit, but at a large price, according to a recent survey of 627 employees commissioned by WorldatWork.

One-third of employees surveyed said that they view receiving wireless devices from their companies as part of their total rewards package. Half of employees surveyed said they felt that these devices signify their status or importance at the company.

But at the same time, 42 percent of employees said they believe that by getting the devices, they are expected to always be available. Three out of four respondents said they never turn their devices off. Most employees surveyed said they use their wireless devices between one and five hours per day during what they consider nonwork time.

“Basically employees view this as a double-edged sword,” said Kathie Lingle, director of the Scottsdale, Arizona-based Alliance for Work-Life Progress, a division of WorldatWork.

On one hand, employees seem to value receiving the devices from their companies, she says. On the other hand, the devices make them feel “like they have a noose tied around their necks,” Lingle said.

To address this, companies need to put policies in place, she said. For example, accounting firm Ernst & Young has a policy that says employees are not expected to look at their e-mail on weekends.

“They are very concerned about overwork and making sure that employees know that there are some boundaries,” Lingle said.

However, such corporate policies are pretty rare, she noted.

“I suspect that it’s more common for companies to hand out these devices than to create policies around their usage,” Lingle said.

And given the current economic climate, Lingle doubts that employees are going to approach their HR managers anytime soon about creating such a policy.

“Employees are worried about losing their jobs, so they aren’t about to bring this up,” she said.

—Jessica Marquez

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