Employer interference with ERISA rights and benefits. DiFederico v. Rolm Company

DiFederico v. Rolm Company, 201 F.3d 200 (3rd Cir. 2000): A former employee who contended she was terminated because her employer wanted to avoid the cost associated with long-term disability obligations had to prove that her employer had a specific intent to violate Section 510 of ERISA. Section 510 prohibits an employer from interfering with her attainment of rights or benefits associated with an employee benefit plan. Proving specific intent requires proof that the employer made a conscious decision to interfere, and when there is no direct evidence of that intent, courts apply a shifting burden analysis like the one used in employment discrimination cases. After the former employee makes an initial circumstantial showing that she was terminated for a reason that violated Section 510 and the employer articulates a legitimate reason for its action, the former employee must prove that the employer's reason was pretextual.     

An Employer Analysis of Managed Care Costs and Satisfaction: Process, Effects, and Policy

ABSTRACT: Do managed care health plans truly control costs more effectively than nonmanaged care plans? Recent evidence suggests that employees are getting used to the managed care idea and that managed care is responsible for the sharp slowdown in health-care costs. This article examines recent changes in the delivery, financing, and consumption of health care from the perspective of a large multiple-site American corporation to see whether its health-care costs are controlled and whether this control occurs at the expense of employee satisfaction. A unique aspect of this study is that managed care was implemented more slowly and in phases at one of the six sites analyzed. The results suggest the following. First, the Study Corporation's health-care costs have not significantly increased four years following the change from an indemnity to a managed care plan. The authors interpret this result to mean that managed care has controlled costs because before the change, plan costs were increasing 15 percent per year. Second, the site with the underdeveloped network did not have higher costs than the other sites based on the analysis. Third, the authors show that employee satisfaction increased after implementation of the managed care plan. Moreover, satisfaction was higher at sites with more employees, higher usage, and higher health-care costs. Last, the results suggest that plan participant satisfaction increases as the managed care network becomes more developed. Policy and benefit manager recommendations are made on the basis of these reported findings.     

COBRA notice--bankruptcy--stay. Buchanan v. Golden Casting Corporation Hourly Health Benefit Plan

In an absence of special circumstances, the automatic stay that protects an employer from suit while its bankruptcy is pending does not apply to an action brought against its employee welfare benefit plan under ERISA because the plan, not the employer, is the proper entity to sue for benefits. Similarly, the employer's automatic stay does not apply to the individual fiduciary sued for breach of fiduciary duty in administering the plan. The bankrupt employer has no property interest in either the plan assets or the assets of the individual fiduciary and, therefore, the stay does not protect them from suit.     

Die Umstellung der Anlage der Heubeck-Richttafeln von Perioden- auf Generationentafeln und ihre Wirkung auf die Kosten von Pensionszusagen

Most German employers are using mortality tables provided by Heubeck AG, a German consultancy firm, for actuarial calculations of company pension plans. Before 2005, Heubeck AG has been publishing projected future period tables rather than cohort tables. This paper analyzes the cost of using such period tables in actuarial calculations for an individual employee’s defined benefit pension plan. Our benchmark is a plan that is fairly priced by using a cohort table. We find that the employer may incur significant costs from using a period table for calculating plan benefits. As life expectancy tends to be underestimated, benefits granted will be too generous. In contrast, using period tables for determining provisions for plan liabilities in tax accounting doesn’t carry extra costs. Although yearly tax deductions differ when using period or cohort tables, tax shields are roughly the same in NPV terms. Thus, Heubeck’s switch to cohort tables means a significant improvement for benefit calculation but won’t have tax effects, on average.     

Engaging employees in health care can contain costs and improve quality

Employers need to do much more to change some of the deep-seated employee attitudes and behaviors that are driving health care costs. This article debunks common employer misconceptions about employees' attitudes and behaviors with regard to health care. It then discusses the results employers can obtain by taking specific initiatives that provide employees with the motivation and resources they need to effectively manage health risks and make informed health care decisions.     

Disability, absence and the health reform era

The total cost of employee absence for many employers is high, and the correlation between employee health and disability is clear. This article reviews several challenges employers face in managing employee health and absence in a well-integrated manner. Although such an undertaking is not easy, the additional cost national health care reform may bring makes the interrelationship between employer profitability and employee absence, health and disability more crucial than ever for employers to recognize and manage.     

The consumer-driven approach: can it pick up where managed care left off?

Managed care has failed and health care costs are once again out of control. Given the current political, social and economic environment, there are now two options: a single-payer health care system, or an aggressive and global employer health benefits redesign that strongly encourages consumer-driven behavior. This article discusses the failure of managed care and ways that employers can promote consumer-driven behavior now using available tools and plan provisions.     

Access to services: what are the real needs?

Adequate accessibility to managed care services is typically a key determining factor when an employer decides to implement a managed care plan. And although it can be difficult for an employer to determine what constitutes adequate accessibility, it is necessary in order for managed care utilization and associated cost savings to be maximized.     

Health risk management: well-being for the employee and the bottom line

For most employers, a small percent of the employee/participant population accounts for a large percent of health care costs. However, the population of this high-cost group changes from year to year. The fundamental problem is keeping employees out of the high-risk/high-cost segment, something plan design changes cannot address but that integrated health risk management (IHRM) can help achieve. This article explains how employers can implement an IHRM program to significantly lower health care costs to a degree unattainable through traditional cost-control strategies, while simultaneously raising workers' productivity and well-being.     

The consumer-driven approach: defining and measuring success

Employers' reluctance to implement consumer-driven health plans (CDHPs) is at least in part due to their not understanding how to define and measure the success of CDHPs. To assist employers, the authors define potential points of success for CDHPs in the areas of consumer engagement, consumer financial considerations and employee health and productivity. They then offer ways of measuring success in those areas, as well as in the area of employer cost control. By taking a carefully considered approach to the decision of whether to offer a CDHP, employers can grasp potential opportunities to control health care costs.     

The Effects of Consumer-Directed Health Plans on Health Care Spending

We use unique data from an insurer that exclusively offers high-deductible, "consumer-directed" health plans to identify the effect of plan features, notably employer contributions to the spending account, on health care spending. Our results show that the marginal dollar contributed by the employer to the spending account is entirely spent on outpatient and pharmacy services. In contrast, out-of-pocket spending was not responsive to the amount the employer contributes to the spending account. Our results represent the first plausibly causal estimates of the components of consumer-driven health plans on health spending. The magnitudes of the effects suggest important health care spending consequences to higher employer contributions to spending accounts. Our findings are most directly relevant to health reimbursement arrangement plan designs, though our results are still of value to health savings account plan designs.     

Exploring the Optimal Design of an Employer-Sponsored Sickness-Disability Compensation Insurance Plan When Sickness Presenteeism Is Penalized

We explore the impact of presenteeism, absenteeism, and shirking on the optimal design of an employer-sponsored sickness-disability compensation insurance plan when the employer penalizes sickness presenteeism. We assume an employee's health follows a simple multistate model with a “severely ill” sickness state. To combat absenteeism, the employer randomly verifies an employee's claim of sickness. However, to combat presenteeism, we also introduce the new concept of a presenteeism penalty whereby employees who are found to be at work in the “severely ill” sickness state are sent home and receive a penalized sick pay that is lower than the normal sick pay. Thus sick employees must decide whether to stay at home and receive a sick pay or go to work sick and run the risk of being sent home and penalized. We further assume (1) employees are risk-averse utility maximizers, (2) each employee has a strategy for staying home or working while sick that maximizes his or her lifetime expected discounted utility, and (3) an employee's strategy is unknown to the employer. The primary plan design factors that affect an employee's lifetime expected discounted utility and the employer's discounted expected accounting profits over an employee's working lifetime are the sick pay, the presenteeism penalty, and two health check probabilities. Volterra integral equations are used to derive expressions for an employee's lifetime expected discounted utility and the employer's expected discounted accounting profits over an employee's lifetime under various employee strategies. Laplace transforms are used to derive asymptotic expressions for the solutions to these integral equations. These asymptotic solutions are used to explore the impact of these factors on the optimal sickness compensation insurance plan design.     

Integrating benefits decision making

Integrated employee benefit decision making helps employees use their benefits more wisely and identify opportunities to balance their immediate benefits needs (such as health care) and future benefits needs (such as retirement). This article discusses how employers can overcome employees' behavioral barriers to making integrated employee benefit decisions by changing the ways benefits are communicated and employees are presented with action decisions. Undertaking these steps allows employers to not only improve their employees' overall financial perspectives, but also furthers plan sponsors' goals of actively promoting personal responsibility with respect to retirement funding and changing employee behavior with respect to controlling health care costs.     

Changing employee values: deepening discontent?

This article presents a synthesis of data on employee attitudes gathered over the last 25 years. Most of the findings confirm the hypothesis that employees are discontented and expect more from their jobs now than they have in the past. While managerial satisfaction has remained relatively constant, the work satisfaction among hourly and clerical employees has sharply decreased. The authors attribute dissatisfaction to changes in the expectations and values of employees and warn that the deterioration of work attitudes may result in increased operating costs due to poor quality work, reduced output, absenteeism, etc. Instituting an employer attitude survey is suggested as a means of improving communication between management and employees and increasing job satisfaction.     

Hospital use behaviors and associated costs in a health insurance organization, Japan

Physicians are known to play an important role in the rise of health care costs. But patients--the other side of the chain of health care systems--have been given little attention. The present study utilized the outpatient claims (in the belief that the outpatient hospital visits are mainly decided by the patients) from a health insurance organization in Japan (the Fukuoka Prefecture public service mutual aid association for government employees who serve in small cities, towns, and villages) to analyze the employee behaviors in the use of hospital care and the costs associated with these behaviors. Number of diseases diagnosed for an employee, number of claims an employee submitted for one disease, number of hospitals an employee visited, number of claims an employee had from one hospital, and the total number of claims an employee submitted were used to describe the hospital use behaviors. Results showed that some employees exhibited unusual behaviors, characterized by having an extremely large number of diseases diagnosed, visiting a large number of different hospitals, having a large number of claims, etc. Higher medical expenditures were associated with such behaviors. The findings of this study suggest that the patients' role in the rise of health care costs cannot be ignored, and cost-containment strategies targeting modification of patient behaviors in the use of hospital care may prove to be very useful.     

Employee contributions: a primer on their use, historical trends and overall fit within benefits strategy

This article focuses on the use of employee contributions as a strategic tool within employee health plans. While most employers require some form of employee contributions for health care, there is no clear "one-size-fits-all" solution. A myriad of strategies are in place, some active and some passive. This article reviews both common and emerging strategies and how they differ based on industry, employer size and region; discusses how employee contribution strategy fits within overall benefits strategy; and provides a strategic framework for approaching employee contributions in the future.     

A framework for redesigning or fine-tuning your benefit package--results from a national survey of stressful life events

The results of a national survey of stressful life events are introduced as a useful framework for redesigning or fine-tuning corporate benefit packages to better meet employee needs, as well as to attract and retain top talent. Among the specific recommendations are (a) expanded bereavement leave, (b) hospice services, (c) employee assistance program access, (d) child care/elder care and (e) group legal services. Offering benefits that enable individuals to cope more effectively with major life event stressors is viewed as a powerful way of strengthening the psychological contract between employee and employer.     

Global added value of flexible benefits

Flexible benefits, or "flex," is a strategic human resources solution that can give companies a truly competitive edge in winning the global war for talent and containing costs. Several companies in Asia plan to implement flex in the next few years, and a number of emerging best practices in flexible benefits design are being developed. This article discusses the many advantages of flex, flex best practices emerging across Asia, and important considerations for employers when designing flexible benefits. Finally, the author shows how one global company in Singapore found flex to be an effective differentiator for attracting and retaining talent as well as helping manage employee health care costs.     

Compliance Costs for Employers: UK PAYE and National Insurance, 1995–96

This paper, based upon research financed by the Inland Revenue and the Contributions Agency of the DSS, presents calculations of the compliance costs for employers of PAYE and National Insurance in 1995–96. Total costs are estimated to have been of the order of £1.3 billion. The costs are very unequally spread across employers, whether measured per employee or per pound of tax raised. They are particularly high for small new employers. For the largest employers, these costs may be offset by the cash-flow benefits of acting as tax collectors. The composition of labour and other costs is calculated and estimates are made of compliance costs under various payroll ‘technologies’. The main determinants of compliance costs, for an employer, are analysed using weighted least-squares regression analysis. Finally, some policy implications are considered.     

The price of fear: Estimating the financial cost of bullying and harassment to the NHS in England

Using a spectrum of measures, this paper estimates some of the financial costs of bullying and harassment to the NHS in England. By means of specific impacts resulting from bullying and harassment to staff health, sickness absence costs to the employer, employee turnover, diminished productivity, sickness presenteeism, compensation, litigation and industrial relations costs, we conservatively estimate bullying and harassment to cost the taxpayer £2.281 billion per annum.