general function of a benefits manager in the area of benefits plan design (4)
- understand organization’s underlying compensation and benefits program and philosophy
- understand specific objectives that the benefits plan is intended to address.
- must also examine the plan(s) from tax and marketplace perspectives
- should be aware of possible longer term impacts to the organization
services provided by the employee benefit plan administrator in benefits plan delivery
- (a) New employee benefits orientation
- (b) Policy clarification on eligibility, coverage and applicability of plan provisions
- (c) Dealing with exceptional circumstances and unusual cases
- (d) Collection and processing of enrollment data, claims information and requests for plan distributions either via the Internet or through submission of paper forms
- (e) Benefits counseling and response to employee inquiries for active employees, terminating and retiring employees, and employees with disabilities or on some form of leave.
As part of the benefits management function, there are continuous human resource questions and issues that must be resolved. These include (4)
- denial of claims
- confusion over waiting periods
service areas covered by a managed care network
coverages under a health plan.
Three major acts that affect disclosure and other requirements are the
- Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
- the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Patient Protection and Affordable Care Act of 2010 (PPACA).
- ____ has principal jurisdiction over the reporting and disclosure requirements of Title I of ERISA
- _____ and the _____ have regulatory and interpretive responsibility for legislation related to employee benefit plans.
- The Department of Labor (DOL)
- Internal Revenue Service (IRS) & Department of Health and Human Services (DHHS)
If a change is made to the plan that affects information contained in the SPD, a _______ must be provided within 210 days after the close of the plan year in which a modification was adopted
summary of material modifications (SMM)
ERISA requires plan sponsors to provide all plan participants and beneficiaries a ______ which describes in “understandable terms” the participants’ and beneficiaries’ rights as well as the benefits and responsibilities under the plan.
summary plan description (SPD)
In addition to the statement of ERISA rights, SPD, SMM, SAR and notification of benefit determination, plan participants also must receive:
- (a) For group health plans: Women’s Health and Cancer Rights Act notices and medical child support order notices.
- (b) For pension plans, among the key items are:
- COBRA notices
- HIPAA notices
- wellness program disclosure
periodic pension benefit statements
statement of accrued and nonforfeitable benefits
domestic relations order (DRO) and qualified domestic relations order (QDRO) notices
qualified default investment alternative notices.
In ______, the DOL issued final regulations on the use of electronic communication (and recordkeeping) technologies by employee pension and welfare benefit plans.
The final regulations specify that electronic media can be used if the following conditions are met (5):
- (a) ensure that the system for furnishing documents results in actual receipt by participants (read receipt, etc)
- (b) The plan administrator must protect the confidentiality of personal information relating to an individual’s account and benefits.
- (c) Electronically delivered documents must be prepared and furnished in a manner consistent with requirements applicable to the disclosure.
- (d) The plan administrator must notify each participant of the disclosure documents and the significance of the documents.
- (e) The plan administrator must notify participants of their right to request and review, free of charge, a paper copy of each such document, if the document is required by ERISA.
An SPD must contain information on (6):
- (a) Plan administration
- (b) Plan eligibility requirements
- (c) Summary of benefits, rights and obligations
- (d) The Pension Benefit Guaranty Corporation (PBGC) for pension plans
- (e) Claims and appeals processes
- (f) ERISA rights
a universal repository of information on census, demographic characteristics, eligibility and other plan information for multiple benefit plans within an organization. It eliminates information “silos” where information is housed in one location and is inaccessible to decision makers because of organizational, database, or benefit plan boundaries.
common relational database
Applications of common relational databases and their applicability to the work of a benefits administrator
- Executive information systems (EIS)
- Imaging and optical storage
- Access to information over the Internet
- Client-server technology
- Employee self-service
are powerful end-user tools that provide management information, such as risk exposures, utilization patterns and factors driving benefit plan costs. Using a PC, a benefits manager can immediately access summaries and analyses and present in graphical display information that he or she routinely needs to understand and to manage the firm’s benefit plans.
Executive information systems (EIS)
allows customer-driven updating of personal data, benefits modeling, retirement planning and the like, eliminating the need for telephone calls or personal visits to the administrator’s office. Ideally, applications are delivered directly to each employee’s desktop or personal technology devices.
The two social network templates that a company intranet may use for benefits communications are:
Various approaches can be used to make benefit plan comparison more relevant, and some experts have identified comparative methodologies including the following:
- (1) Comparison of benefits payable to employees under different circumstances
- (2) Comparison of actual costs to the employer for different benefit plans
- (3) Measurement of plans on a basis that uses uniform actuarial methods and assumptions and focuses on the relative value of the benefits provided
- (4) Comparison of benefit plan features to isolate specific plan provisions that may be appealing to certain employee groups and offer a competitive advantage.
What responsibilities/activities are benefits managers called on to perform when organizations undergo structural changes?