Employment Resources

Account-Based Health Plans (ABHPs) have been a key part of the movement toward health care consumerism. ABHPs generally consist of a high deductible health plan coupled with some form of savings account, such as a Health Savings Account (HSA) or Health Reimbursement Account (HRA). In theory, ABHPs have the potential to lower individual and corporate health care costs by raising consumer awareness of cost — through measures such as the high upfront deductible — and by providing incentives, through the savings account accumulation, to choose the most cost-effective, quality care and forego unnecessary care.

However, not all employers that implement these plans see the expected drop in cost, nor the plan participation they envisioned. A study from Towers Perrin analyzes the factors in account-based plan strategy, design, implementation and management that characterize successful plans. High-performing programs, the study found, have the right approach to implementation, delivery and employee engagement.

One of its “most striking findings,” according to the study, is the critical role that comfort with financial risk plays in employees’ acceptance of and engagement with account-based plans. Thus, helping employees gain confidence in their ability to manage financial risk, in order to enable them to embrace the responsibilities necessary for a good account-based plan experience, is a key indicator of program success. ABHP participants who said they felt comfortable with the level of financial risk their plan exposed them to were more likely than those who were not comfortable with risk to:

• Assess their plan experience as good (88% vs. 29%)
• Say they understood how their health benefits program works (86% vs. 41%)
• Say they thought they could affect their own and their employers’ health care costs (73% vs. 50%)
• Find it appropriate that they pay a share of health care cost increases (71% vs. 40%)
• Agree that they should pay a larger share of the cost if they use more expensive health care (61% vs. 30%)

The study stresses that employers are capable of increasing employees’ comfort with risk, with benefits communications being the critical element to accomplishing this.

Another characteristic of successful programs was their ability to build a new mindset, both for employees and employers, around health and long-term commitment to the program. According to the study, both employees and their employers need to build a new mindset in order for ABHPs to reach their full potential. For example, the study found that participants in account-based plans were less satisfied than participants in traditional plans with various aspects of their health plans. However, the study states that employee dissatisfaction appeared to be based more on perception than on a realistic comparison of plan features and benefits, indicating that the account-based plan participants were thinking of their health plan in a one-year cycle — like traditional plans run — rather than in terms of the long-term benefits of an account-based plan.

According to the study, successful programs also were able to create an organizational culture in which employees trust management and believe that the company cares about employees’ well-being, and to use strategic change management initiatives, ongoing communications and visible leadership to build trust and a healthy work environment.

In sum, companies that assessed employee readiness for change, communicated honestly and consistently about the account-based plan program, and launched the program within a structured change management strategy achieved better success with their ABHPs than companies that focused on isolated plan elements or applied traditional communication techniques. Thus, companies must recognize that account-based plans are, for employees, an entirely new way to think about health care, and approach implementation strategy and communications accordingly.

Employers may amend Health Care Flexible Spending Account (FSA) plans to permit reservist employees called to active duty to request distributions from their accounts. Qualified reservist distributions (QRDs), as these disbursements of health care FSA funds are called, were created by the Heroes Earnings Assistance and Relief Act of 2008, and guidance for QRD administration can be found in Internal Revenue Service Notice 2008-82. They are an exception to the general rule that health care FSA distributions can only be made for substantiated medical expenses.

An employee who is called to active duty for a period of 180 days or more, or for an indefinite period, may request a QRD (so long as the plan provides for it, as described below). The request may be for all or a portion of the balance in the employee’s FSA. The employee must make the request no earlier than the date of the order or call to active duty and no later than the last day of the plan year (or grace period if the plan uses one) during which the order or call to duty occurred.

The Notice specifies that QRDs are optional with an employer, meaning that an employer can choose whether or not to amend its cafeteria plan to permit them. However, if QRDs are to be permitted, a plan amendment is required, and a QRD may not be made until the plan is amended. However, Notice 2008-82 does provide a transition rule for QRDs made before January 1, 2010. This rule enables plans to be amended retroactively to permit QRDs requested on or before December 31, 2009, so long as the QRD satisfies the other requirements and the retroactive amendment is made by December 31, 2009.

The plan amendment should specify how the FSA balance of the employee requesting a QRD is determined. This could be the amount of the annual election minus disbursements to date; the amount actually contributed minus disbursements to date; or some other amount (but not to exceed the annual election minus disbursements). If the plan amendment does not specify this, the amount available for the QRD will be contributions minus disbursements. The requested distribution must be paid within a reasonable time, not to exceed 60 days after the request has been made. The QRD amount will be included in the reservist’s gross income in the year paid, and must be reported on the employee’s W-2.

The plan amendment also can specify a process for employees to request a QRD, including how many requests may be made by an employee during the same plan year and whether the employee may continue to submit FSA claims after the date the QRD is requested.

The effective date of the law creating QRDs was June 18, 2008; thus, a QRD can only be made with respect to FSA balances in effect on or after that date. Also, QRDs cannot be made from non-health FSAs, such as dependent care spending accounts.

Most of us probably associate high health care costs with older employees. Although it’s true that many health problems — especially certain chronic conditions such as hypertension, high cholesterol, and diabetes — tend to surface as an employee ages, the roots of such health issues frequently are sown at a young age. A survey from employee assistance program provider ComPsych finds that employees in their 50s and 60s had an overall healthier lifestyle than their co-workers in their 30s, indicating that wellness initiatives should in some fashion target these younger workers to help them avoid significant health problems down the road.
On several measures of healthy lifestyle, the older workers in the ComPsych study scored better than the younger workers:

• Healthy diets: 52% of workers in their 60s ate healthy diets, compared with 18% of employees in their 30s.
• Exercise: 27% of employees in their 50s exercised more than four days a week, compared with 20% of those in their 30s.
• Outlook on life: 83% of workers in their 60s reported a very positive outlook on life, compared with less than half (46%) of workers in their 30s.
• Stress: Less than a third (30%) of employees in their 60s said they had high stress levels, while almost two-thirds (65%) of those in their 30s reported high levels of stress.

Where employees are in their lives at these ages can partly explain these differences, according to ComPsych. Employees in their 30s are more likely to be in the midst of raising a family, which can add financial and time pressures that manifest themselves in more sedentary lifestyles, less healthy food choices and other negative, unhealthy behaviors. Since most people do follow the circle of life that places them squarely within such pressures during their 30s, employers should devote some attention to directing these employees to resources that can help them more effectively deal with this exciting but difficult time.

There are several ways to do this. Most companies’ health plans today include some types of wellness programs. Since younger workers are more receptive to new types of technology, make sure your wellness program communications include Web-based information, lifestyle quizzes, presentations, etc. Instead of simply communicating wellness program resources on paper, consider a CD or DVD presentation. When communicating on paper, use concise text and lots of graphics, so that materials aren’t tossed away as too time-consuming to read.

Use the same techniques for communicating the availability of the employee assistance program (EAP) and its resources. The stressors facing employees in their 30s can be abundant, with parenting young children, possibly dealing with aging parents, managing mortgage and credit card debt, etc. Stress can have a direct negative affect on one’s health. The often-overlooked EAP might be available to provide referrals for counseling for managing stress, as well as for financial issues. As with wellness programs, communicate the EAP through various media, including ways that target young, tech-savvy employees.

Your young employees might not be running up large medical bills today, but this will change as they age unless they begin to make the kinds of lifestyle decisions that bode for good health into their midlife and later years. Persuade them to tap into resources that can help them make healthy lifestyle changes sooner, rather than later. Contact us. Our specialists are eager to discuss these and other ideas for broadening the scope of your benefits offerings.

Employees’ cafeteria plan elections — whether for a flexible spending account, premium-only plan, or choice of benefits — are required to be irrevocable and generally may not be changed during the plan year. However, IRS regulations for cafeteria plans recognize that changes in an individual’s circumstances sometimes do occur, and therefore permit cafeteria plans to allow mid-year election changes based on certain changes in status.

Since the idea of making an irrevocable choice can seem daunting to employees, most employers permit election changes based on the IRS-approved changes in status. Cafeteria plan regulations require employers that permit such changes to incorporate the status change rules into their written plan document.

So, under what circumstances may an employee revoke his or her cafeteria plan election and make a new one? IRS regulations provide for these change-in-status events:

• A change in legal marital status, resulting from marriage, death of a spouse, divorce, legal separation or annulment.
• A change in the number of dependents, resulting from birth, death, adoption or placement for adoption.
• A change in the employment status of the employee or of the employee’s spouse or dependent, resulting from commencing or terminating employment, being on strike or lockout, beginning or returning from an unpaid leave of absence, or changing worksites. Also, if the employee (or spouse or dependent) has a change in employment status affecting plan eligibility (such as moving from salaried to hourly when there are separate plans for each group), a mid-year election change is allowed.
• A dependent satisfying or ceasing to satisfy eligibility requirements (such as a child reaching the maximum age for dependent children under the plan).
• A change in the residence of the employee, spouse or dependent (potentially important for HMO coverage areas).

Even if an employee has had one of these change-in-status events, an election change is permitted only if it satisfies a consistency rule. This rule requires that the change be on account of and correspond with the change in status that has affected eligibility for coverage under the plan. So, for example, if the status change were the employee’s divorce, the only election change that would satisfy this consistency rule would be to cancel coverage for the ex-spouse; changes with respect to the employee or other covered dependents would not be allowed. However, if a court order required the ex-spouse to provide coverage for dependent children, a separate provision in the regulations would allow the employee to cancel dependent coverage.

In the case of an employee or other dependents newly gaining eligibility mid-year under the plan of a family member, such as if the employee marries and is eligible for coverage under the new spouse’s plan, the consistency rule would permit the employee to cancel coverage only if he or she actually became covered under the new spouse’s plan.

In addition to changing elections on account of a family status change, employees are permitted to revoke existing elections and make new ones that correspond to the employee’s special enrollment rights under HIPAA. An employee also can make an election change when the employee, or a spouse or dependent, becomes enrolled in Medicare or Medicaid.

All permitted election changes can only be made prospectively.

The election change limitations do not apply to health savings account (HSA) and 401(k) contributions. If HSA contributions are made through salary reduction under a cafeteria plan, employees may prospectively elect, revoke or change their salary reduction elections for the HSA at any time, so long as it is with respect to salary that was not currently available at the time of the election. 401(k) contributions, if part of a cafeteria plan, are subject to the 401(k) regulations, and not those for cafeteria plans.

It has been several years since the IRS finalized guidance on when employees can make mid-year changes to their cafeteria plan elections. However, these rules can sometimes be difficult to apply, given the array of circumstances that life can sometimes throw our way. The IRS guidance does include many examples on how to apply the rules. Also, cafeteria and spending account administrators, or your benefits professional, can be useful sources of information in understanding the election change rules.

We live in a culture of immediate gratification. “On-demand” cable television services, pre-prepared foods from the grocery store, fast-food carryout, and diet programs that claim you will shed pounds “without trying” all are signs that Americans have lost sight of the fact that not everything can be obtained without waiting. And when it comes to changing behaviors to eliminate unhealthy habits and adopt healthy ones — such as giving up cigarettes, losing weight, exercising more, and managing stress effectively — hard work and sustained personal effort also are required. In order to succeed, workplace wellness programs need to recognize this and include elements that engage employees over time.

Suppose you host a brown-bag lunch in your company cafeteria with a presentation on the health benefits of eating right and leading an active lifestyle. You might find that this seminar is well-attended, but observe that few employees actually seem to make the recommended changes, and that even fewer are doing so after a few months. This experience is all too common, and reflects the reality that more individuals are well-intentioned than are self-motivated. Your wellness initiatives, therefore, need to provide the motivation. Here are a few ways to do this:

• Personalize the experience by offering health risk assessments that show each employee, on an individual basis, their current health risks and the steps they should take to address them.
• Tie any offered health risk assessment incentives — such as reduced health plan premiums — not only to taking the assessment, but also to completing any recommended follow-up actions.
• Focus on helping employees want to make the sought-after lifestyle changes, because behavior change is more likely when an individual is ready to make it. This can involve offering incentives as discussed above, but also thinking of ways that would help employees see the risks of not changing (such as posting clear statistics on differences in lifespan for smokers versus non-smokers, individuals with normal blood pressure versus those with hypertension, individuals who maintain a healthy weight versus those who are overweight or obese, etc).
• Provide motivation in the form of support systems. This could involve initiatives such as Weight Watchers at Work, lunchtime walking clubs, articles in company newsletters on employee success stories, providing lists of local gyms and a small company subsidy for joining, sponsoring a “biggest loser” competition, and the like.

Most of us find any change difficult, and lifestyle changes can be daunting. Remember this facet of human nature when implementing wellness programs, and you might find employees more engaged in them, over the long run.

We live in an age of information overload. Mail piles up (both at the front door and in our e-mail inboxes) due to the volume we receive on a daily basis. Many of us quickly and automatically trash (or, if paper, recycle) everything but bills, personal or business letters, or other items that we can quickly identify as of interest or importance.

For employers, this situation adds to the challenge of communicating employee benefits matters. Employers, more than ever, are faced with developing benefits communications that employees don’t automatically zone out. Thinking about the employees in your work force and attempting to customize, or target, communications to different employee groups can help make your communications efforts more effective.

Today’s work force comprises roughly three “generations” of employees: Baby Boomers, born from 1964 and earlier; Generation X, born from 1965-1980; and Generation Y, born after 1980. Each group has different needs and focuses.

Young and in the early stages of their working careers, members of Generation Y are unlikely to be thinking about the importance of saving for retirement. They might also still have that feeling many of us have when we are very young, of infallibility and immortality, and therefore not pay attention to the health benefits their employer offers. Used to quick-changing media images, individuals in this group likely will have short attention spans, and as such could be more receptive to communications that are brief, eye-catching, and to the point, and to electronic media, such as e-mail and Internet.

Many Generation Xers are at a time in their lives when they have significant competing financial responsibilities — raising a family, acquiring a home, thinking forward to future retirement and children’s college education, and perhaps contributing toward the care of elderly parents. These employees will have been in the work force long enough to be aware of retirement plans, but might not be contributing (or not contributing enough) because of their competing financial responsibilities. Making budgeting tools a highlight of retirement plan communications could be one way to get the attention of this group. Another benefits resource likely to be useful to this group is the resource and referral services of an employee assistance program (EAP), for childcare and eldercare referrals. However, these employees might not be as aware of EAP availability as they are, say, of a retirement or health plan. Leading off communications with how the EAP can be a resource for helping to juggle multiple responsibilities can be a gateway to information on other relevant benefits.

Nearing retirement, many Baby Boomers are catching up on missed savings opportunities while preserving the value of any wealth that they have accumulated. They also might be more focused on health issues as they grapple with the effects of aging. Communications that home in on these topics are likely to generate more interest among members of this employee group.

The concept behind targeted communications is simple: We are more likely to pay attention to what interests us. Determining how to reach each group, and crafting communications accordingly, can lead to an increased ability to communicate more effectively with each group. Our benefits specialists can help. Contact us today!

Employee benefits compliance issues can challenge any size company, but can be especially troublesome in small firms that lack dedicated human resources specialists on staff who are trained and up-to-date on the deadlines and intricacies of the numerous rules and regulations that govern the field. That’s why an annual compliance review is so important. A missed filing, inadequate document or neglected rule violation, if uncovered on a Department of Labor or Internal Revenue Service audit, can result in harsh consequences for both the employee benefit plan sponsor and, possibly, employees.

The following lists some of the compliance issues that frequently plague employers, especially small businesses:

Summary plan description content and distribution. Employee benefit plans that are subject to ERISA require a summary plan description (SPD) written for and distributed to employees. The SPD describes the plan’s provisions and requirements and participants’ rights and obligations. If a plan is provided through a third party — such as a health plan through an insurance company or a 401(k) plan through a mutual fund company — that provider may supply a SPD. In many cases, a SPD may not include all the information required by ERISA or may not state information in terms that are specific enough to the particular plan or plan sponsor. Also, a busy employer might overlook that a revised SPD or a summary of material modifications must be distributed within a certain timeframe when a plan undergoes a significant change, and that a completely up-to-date SPD is required every five years. SPD distribution must be made through a method “reasonably calculated” to ensure actual receipt by participants and beneficiaries, which means more than simply making the original or revised document available to participants.

Cafeteria plan document requirements and participation restrictions. All Sec. 125 cafeteria plans require a written plan document, even simple cafeteria plans such as premium-only plans and flexible spending accounts. This requirement can be easily overlooked, especially in the case of a premium-only plan, since it is essentially a funding mechanism for the company’s health care plan. IRS regulations detail what must be included in the written plan document. A plan that does not comply with the written plan document fails to be a cafeteria plan, meaning that participants’ contributions will lose their pretax advantage. Also, cafeteria plan participants must be “employees,” a term which regulations state does not encompass self-employed individuals, including sole proprietors, partners and 2% shareholders in Subchapter S corporations. Thus, small businesses that operate in these forms must remember to restrict participation in their premium-only plan (or other type of cafeteria plan) to employees only.

Annual report filing. Except for fully insured welfare plans with fewer than 100 participants, a Form 5500 must be filed for employee benefit plans subject to ERISA for IRS and DOL reporting. Many employers are tuned into this requirement for their qualified retirement plans, but are unaware that it applies to welfare plans — health plans, for example — as well, unless the plan meets the exception noted. Fortunately, if filings have been missed in the past, a plan sponsor can file them late under the Delinquent Filer Voluntary Compliance Program and received reduced penalties. Unfortunately, if the missed filings are uncovered on an agency audit, that program is not available.

Employee benefit plans are a critical element of most companies’ overall compensation programs, and are key in attracting and retaining the best employees. They also provide tax advantages for participating employees and the organizations sponsoring the plans. Compliance with applicable rules and regulations is essential to avoiding adverse consequences and getting the most from your company’s investment in your employee benefits programs. Contact one of our benefits specialists today.

Although hordes of consumers use the Internet as a tool for seeking out medical information, new studies show that only a scarce few are using physician ratings sites to choose their doctor. More than 80% of California based adults say they use the Internet for health-related information, such as medical symptoms and diagnoses, according to a Harris Interactive poll commissioned by the California HealthCare Foundation. However, only a handful of adults are visiting and using the information from physician ratings sites. As a matter of fact, less than 25% of those surveyed say they have visited physician ratings sites, and only 2% of those actually made a physician change based on the information they found. Even fewer, less than 1%, say they made a hospital or health plan switch based on online ratings.

Will ratings sites ever take off?

Some experts say these statistics prove it will be a long while before physician ratings sites grow in popularity — and that they may never catch on at all. However, other industry professionals believe that few patients visit these sites because the market is still in its infancy. They believe that as the ratings information becomes more in-depth, more consumers will flock to the sites. Additionally, some insurers are encouraging members to use their own ratings sites. In these types of networks, members pay less out of pocket if they visit a physician that meets the insurer’s “quality criteria.” However, many doctors claim this system is flawed.

Physicians should still watch their online reps

Although physician ratings sites aren’t skyrocketing in popularity as of yet, industry experts say that physicians should still be concerned about their online reputation. For many decades, word-of-mouth has been deemed the most influential advertisement for any business. Therefore, continuous negative word-of-mouth could lead to a medical professional’s downfall. Patients are already sharing information online about medical conditions and other health issues, and this communication can spread like wildfire. Some experts predict the details about specific physicians, especially those who are either exceptionally great or really terrible, will soon follow suit in the online world.

Small, but growing

Although few patients are actually using the information gleaned from physician ratings sites, these sites have seen an uptick in visitors over the past few years. According to a Harris Interactive survey of 1,007 Californians, the number of people who say they have visited one of these sites has grown from just 14% in 2004 to 22% in 2007. Some medical industry experts believe the only reason more patients aren’t taking action based on the information they find is because the sites often don’t include details specific to their needs. Additionally, most patients are not willing to switch physicians if they are happy with their current provider. However, they may be more likely to take online advice if they are unhappy with their doctor, have been diagnosed with a medical condition or if they have recently moved.

Keeping a close eye on ratings sites

Although these sites have yet to take off, the American Medical Association and other organized medicine groups are keeping watch over the market. In some cases, the AMA has opposed ratings sites. As a matter of fact, the association joined forces with other medical groups in Missouri to push back UnitedHealth Group’s plan to use claims data to rank physicians.

Additionally, some states are regulating physician ranking and ratings networks. For example, some states require health plans to use quality measures for rankings instead of price. Plus, some rules allow physicians to see the basis for their ratings and have an opportunity to appeal.

The use of health and wellness programs continues to grow, with more than three-quarters of the employers in a recent survey offering them, and more than half of those without programs planning to implement one. Increasingly, these employers are encouraging employee participation in wellness initiatives by offering incentives for participation, with more than seven in 10 employers doing so in 2008. Why? Employers are becoming more successful in measuring these programs� return on investment, and finding that they are more than breaking even.

The survey is the second annual from Health2 Resources, and respondents were employers that are members of the National Association of Manufacturers and the ERISA Industry Committee.

According to the survey, in 2008, 77% of the employers offered health and wellness programs � a 5% increase over 2007 � and 48% offered disease management programs. Among the health and wellness programs:

Between 2007 and 2008 the survey reported a �substantial shift� in the types of incentives employees could earn for taking part in health and wellness programs. The use of gift cards � now the most prevalent incentive � increased from 17% to 28%, while offering a premium reduction declined from 41% to 26%. In 2008, employers used these incentives:

The value of incentives ranged between $100 and $300 per person per year, with the average incentive value being just under $200.

The most common behaviors rewarded with an incentive were participation in the health and wellness initiative (48% of employers provided the incentive for this), completing a program (38%), and signing up for or enrolling in a program (25%). The survey notes that these behaviors are easy to track, and they �steer clear of regulatory caps on monetary incentives� that the Health Insurance Portability and Accountability Act (HIPAA) place on programs tied to a health-related standard. That said, some employers did require the employee to achieve an outcome or goal before awarding the incentive (16% for achieving this during the program, 12% for achieving it after the program, and 6% for maintaining it after the program).

Most employers implementing health and wellness programs still do not measure return on investment (ROI), with only 36% of respondents saying they had attempted to do this in 2008 and 26% saying they had done so successfully. Among those who were able to measure ROI, 83% estimated an ROI greater than break-even in 2008, up from 66% in 2007.

The complete survey results are available through the ERISA Industry Committee�s web site, www.eric.org.

Despite their proven reliability in safely reducing health care costs, many consumers continue to have doubts about the use of generic drugs. Communications programs that increase employees’ knowledge about generics and their comfort level in speaking with prescribers about generic medications can help to overcome these doubts, increase use of generics in a health plan and, ultimately, result in substantial cost savings.

Data on consumers’ limited knowledge of generic drugs comes from a survey from Prescription Solutions, a UnitedHealth Group company. Among the surveyed adults, 31% did not know or did not believe that generics have the same active ingredients and same effectiveness as brand-name drugs. Furthermore, two-thirds did not understand the actual cost difference between generic drugs and brand-name drugs. On average, a brand-name drug costs 50%-70% more than its generic counterpart. A separate analysis from the Food and Drug Administration (FDA) indicates that drug costs per day can fall by 14% to 16% if an individual uses generics instead of brand-name drugs, depending on the individual’s medical needs. Individuals who can fully satisfy their medical needs with generic drugs can see as much as a 52% reduction in their daily medication costs, according to the FDA analysis.

Consumers’ reluctance to try generics is especially surprising, given that a majority of the Prescription Solutions survey respondents: 71%-remain concerned about prescription drug costs, and 27% have either delayed filling, not filled, or not taken a prescription as prescribed in an effort to save money.

The survey also found that doctors and pharmacists are the key influencers in encouraging the use of generics. Of those surveyed who take generic drugs on a weekly basis, 64% said their doctor recommended the generic and 43% said a pharmacist recommended the generic. Of those surveyed who do not take generic drugs on a weekly basis, 58% said they would if a pharmacist brought a generic to their attention as a less expensive yet identical substitute, and 52% said they would do this if their doctor made the recommendation.

As noted at the beginning of this article, communications programs that increase employees’ knowledge about generics and their comfort level in speaking with prescribers about generic medications can address misconceptions and concerns about generic drug use. A study published in the March 2009 issue of the journal Medical Care found that generic drug use was most closely associated with communications with providers about generics, and with an individuals’ comfort level with generic substitution, leading to the conclusion that educational campaigns that focus on these two areas might be most effective in influencing generic drug use.

To increase individuals’ comfort level with generic substitution, an educational campaign should stress the key facts about generics:

• Although generics might differ in appearance from their brand-name counterparts, they have the same active ingredients and adhere to the same FDA standards.
• Generic medications cost less, not because they are of a lesser quality, but because the manufacturer of the generic has no research and development costs to recover, and also spends no money on promoting the product to physicians and consumers.
• Plan design, too, can encourage generic use. Plan designs that require a higher member copayment for a brand-name drug than for the generic substitute can lead to higher generic use, as can completely waiving the copayment for generics (or for certain classes of generics). Generic use also can be increased through mail-order programs.

Overcoming ignorance or unawareness of the true nature of generics can reap savings for an employer, making the money spent on communications and education a worthwhile investment.