Employee Benefit Plans Research Articles

BRCA1/2 germline testing among eligible persons with breast cancer in Washington state: A retrospective study using state cancer registry and claims data.

154 Background: Clinical practice guidelines have recommended germline testing certain groups of breast cancer patients (men, younger women, and triple negative) for pathogenic BRCA1/2 mutations since 1996. We linked cancer registry records with enrollment and claims records from public and commercial insurers in Washington state to assess factors associated with BRCA1/2 testing among eligible persons with breast cancer. Methods: The database consisted of Washington SEER and state cancer registry records linked with claims records from commercial insurers (Premera Blue Cross, Regence Blue Shield), Medicare, Medicaid, and the Washington State Employee Benefit Plan. Eligible patients were diagnosed with breast cancer between 2017-2019 and were age <= 50 female, any age male, or with triple negative cancer. Other inclusion criteria included first primary cancer, alive at least 3 months following diagnosis, and continuous insurance enrollment from 2 months prior to 24 months following diagnosis. We used multivariable logistic regression to examine factors associated with BRCA1/2 testing. In a secondary analysis, we examined whether receipt of testing was associated with bilateral mastectomy. Results: The study population included 1,358 women and 43 men (80.2% were non-Hispanic White, 4.1% non-Hispanic Black, 11.7% non-Hispanic Asian, and 4.9% Hispanic.) The insurance composition was as follows: 56% commercial, 15% Medicare, 19% Medicaid; 10% multiple insurers. Overall, 63% received BRCA1/2 testing. Factors that were significantly associated with testing are shown in the table. In the secondary regression model, the association between BRCA1/2 testing and bilateral mastectomy was positive (OR 1.45, 95% CI 1.07-1.98). Conclusions: Despite a trend towards more testing over time, BRCA1/2 germline testing remains underutilized among persons who are eligible for testing, with significant disparities among Medicaid and Medicare enrollees. Testing may influence management, but further study is required. Patients would benefit from more effective integration of clinical guidelines into practice.[Table: see text]

Understanding Key Drivers of Participant Cash Flows for Individually Managed Stable Value Funds

In this paper, we investigate the behavioral and statistical characteristics of cash flows for stable value funds provided by numerous U.S. employee benefit plans. We analyze participant-initiated aggregated cash flow data, representing approximately 80% of the market for large employer plans with stand-alone stable value wraps within a 401(k) offering. By leveraging this unique dataset and contextualizing the 401(k) ecosystem, we examine numerous behavioral lapse hypotheses. Our findings highlight key behavioral lapse hypotheses for modeling lapses and generating risk scenarios. We demonstrate that cash flows exhibit medium- to long-term non-monotonic trends. Factors within the plan sponsor’s ecosystem, such as employment growth, default 401(k) plan options, and the introduction of new investment options, significantly impact participant cash flow behavior indirectly. Moreover, we find that flight-to-safety behavior plays a dominant role during global market crises. Although the risk of mass lapses due to reputational issues is observed, their probability of occurrence is low. Other behavioral hypotheses discussed in the literature, such as the moneyness hypothesis, are found to be less prevalent in this context.

Rethinking the Risk of Defined Contribution Plans

In response to pension funding failures and concern that abuses in the private pension system were denying benefits to many workers, Congress passed the Employee Retirement Income Security Act of 1974 (ERISA). ERISA has several specific objectives: to ensure that workers receive pension benefits after they satisfy certain minimum requirements, to ensure that sufficient funds are set aside to pay promised pension benefits, to ensure that workers receive adequate information about their employee benefit plans, and to set higher standards of conduct for those managing employee benefits and pension funds. ERISA has been successful in accomplishing many of its goals. Today employees vest earlier, more plans are adequately funded, and plan participants are more knowledgeable about their retirement benefits. Moreover, since the passage of ERISA, increased participation and contribution rates in private pension plans have caused the average income of retired individuals to be comparable to that of the rest of the population.

Why do Malaysian Young Adults Buy Health Insurance?

The spread of the COVID-19 pandemic has amplified the importance of health insurance. Although most of the companies in Malaysia usually provide employee benefit plans such as medical coverage to their employees, the COVID-19 pandemic that severely impacted the economy and employment has also abruptly exposed the unemployed and retrenched workers to the risk of high medical costs. Thus, this study aims to identify the factors that affect the purchase intention of health insurance among Malaysian young adults in the transitional period of life and could be vulnerable to potentially catastrophic expenses in severe injury or illness. Using a convenience sampling method, a set of self-administered questionnaires was distributed to 200 young adults in Malaysia who are aged between 18 to 25 years old. The results show that attitude, perceived behavioural control, and perceived financial benefits significantly influence health insurance's purchase intention. This study offers an insight into the rationale of buying health insurance among Malaysian young adults, mainly from the behavioural perspective. The finding also suggests important managerial implications to the associated parties, particularly in reinforcing a positive attitude towards health insurance's purchase intention among Malaysian young adults.

ERISA Confronts ESG

Environmental, Social and Governmental issues, (“ESG”), has been paired with “Human Capital” issues in a sweeping movement that has progressed from university theories to the board rooms of some of the world’s biggest corporations over the last decade. There has also been a rapid growth of investments funds that advertise consideration of ESG and related issues. A practical question is whether employee benefit plans that are subject to strict regulations under the federal law known as ERISA can incorporate ESG considerations in selecting investments for these plans. At present, there is a distinct split of authority due to conflicting rules by the US Department of Labor. This paper will explore some of the key issues regarding ERISA and ESG.

North Dakota, which once lost its fight to regulate PBM practices, gets a rematch

North Dakota, which once lost its fight to regulate PBM practices, gets a rematch

An Agency Costs Theory of Employee Benefits Plan Law

This Article breaks new ground by using agency costs analysis to conceptualize the relationship between benefit plan sponsors and plan participants. The analysis provides normative insights on how governance mechanisms may mitigate agency costs. It also illuminates how those normative insights can be used to improve positive law. Courts, scholars, and policymakers have long tried to force employee benefit plan relationships into the pigeonholes used in donative trust law, and often bemoaned the results. Changing trends in benefit plan typology and importance have increased the disconnect between the relationships that exist in donative trusts and those in benefit plans. This Article argues that it is time to bring a new lens, agency costs analysis, to bear on the challenges in building governance mechanisms that enable American workers to accumulate the financial resources they need for a secure retirement and decrease the social safety net costs of supporting superannuated individuals.

Unbelievable: ERISA's Broken Promise [ver. 4.0; August 2021

A central but generally neglected objective of federal regulation of pension and welfare benefit plans was to improve overall economic efficiency by providing workers with accessible and reliable information on which to base their career and financial planning. Simple dissemination of plan terms and financial data (full disclosure) cannot achieve that objective because few workers are equipped with the skills needed to evaluate the costs and benefits of complex retirement saving or health care programs. For that reason ERISA, the Employee Retirement Income Security Act of 1974, requires curated disclosure of plan-related information: it must be presented a format that is both understandable to the average plan participant and sufficiently complete to empower workers to make best use of the program. The length and complexity of most employee benefit plans creates tension between understandability and completeness, calling for tradeoffs to achieve optimal disclosure. As implemented ERISA’s understandability standard has been jettisoned by plan sponsors seeking protection from liability for failing to tell workers enough. Required plan summaries became unreadable, but plan sponsors could get away with that, both because there was no administrative or judicial enforcement of the understandability standard, and because they could tout the advantages of their benefit plans to workers by means of unregulated informal communications. The demise of understandability is only half the story. Federal courts also degraded the reliability of mandatory disclosures by finding that the obligation to provide reasonably accurate and complete information is enforceable only in a suit for appropriate equitable relief. In consequence, disclosure defects are often presented as estoppel claims, which triggers search for individual detrimental reliance, and translates into widespread under-enforcement of the reliability standard. This article explores the policy dimension of ERISA disclosure law and chronicles the decay of the equilibrium Congress envisioned. From the perspective of workers it is a saga of disappointment, disillusionment, and defeat. The new balance serves the interests of federal courts (reduced caseload) and some employers (increased flexibility), but likely contributes to the increasing standardization of employee benefit plans, decreasing their utility as instruments of workforce management. Far worse, it abandons ERISA’s goal of improved economic performance through better-informed career and financial planning. Yet those costs are not immutable: employers’ liability exposure could be recalibrated by regulation to revive understandability and approach optimal disclosure.

LifePlanning: A Better Retirement Planning Option for Our Times

Ten thousand turn 65 daily. Majority look forward to retiring in the beginning and then become afraid of outcomes they often hear about- dealing with institutional care, becoming a burden, or running out of money. This is not because retirees do not plan, but despite of having planned their entire life for retirement. Many employers provide financial retirement planning such as a 401K plan. Individuals have relied on employee benefit plans to ready themselves, yet few are “very confident” about it. Two-thirds of retirees say their most recent employers did “nothing” to help them transition into retirement; 16% are “not sure” what their employers did. Many may be overlooking important factors in their strategies. Among retirees who currently have a retirement strategy, 85% have factored Social Security and Medicare benefits into their strategy. Most have included on-going living expenses (79%), total savings and income needs (57%) into their plan. Fewer than half have considered other critical factors (e.g., investment returns, ongoing healthcare costs, inflation, long-term care needs, tax planning, etc.). Only 9% have contingency plans for retiring sooner than expected and/or savings shortfalls. The truth is that education offered by employers tends to be traditional planning advice, which may not be enough to address the concerns retirees will have in retirement. To this, we introduce a multi-disciplinary LifePlanning Framework which takes a wholistic, integrated approach in addressing the many complex issues of retirement found in health, housing, finance, legal, and family. Our results may impact future practice, research, and policy.

Employee Benefits Disclosure: Recent Evidence from Bangladesh

This study explores the extent of employee benefits disclosure and short-term and long-term employee benefits plans maintained by the Bangladeshi companies. An employee benefits disclosure index and a form for collecting data about long-term and short-term employee benefit plans maintained by the companies are created and descriptive statistical analysis is applied to the collected data. The extent of employee benefits disclosure in Bangladesh is low. However, disclosure practice is not consistent across all the categories. Disclosure is very poor under IAS 19 Employee Benefits and companies do not provides any disclosure under IAS 26 Accounting and Reporting by Retirement Benefit Plans. Compliance and disclosure under local regulations in Bangladesh are very good. Recognized provident fund and gratuity fund are the two most common long-term employee benefits provided by the companies and they are sharing profits with their employees. But companies don’t provide any detailed disclosure regarding other short-term employee benefits and defined benefit plans. The disclosure pattern of foreign companies is far better than that of domestic companies. Relevant authorities should take the necessary step to ensure full compliance with disclosure provisions of IAS 19 as well as IAS 26 and encourage them to provide detailed disclosure regarding short-term employee benefits.

Unbelievable: ERISA’s Broken Promise

A central but generally neglected objective of federal regulation of pension and welfare benefit plans was to improve overall economic efficiency by providing workers with accessible and reliable information on which to base their career and financial planning. Simple dissemination of plan terms and financial data (full disclosure) cannot achieve that objective because few workers are equipped with the skills needed to evaluate the costs and benefits of complex retirement saving or health care programs. For that reason ERISA, the Employee Retirement Income Security Act of 1974, requires curated disclosure of plan-related information: it must be presented a format that is both understandable to the average plan participant and sufficiently complete to empower workers to make best use of the program. The length and complexity of most employee benefit plans creates tension between understandability and completeness, calling for tradeoffs to achieve optimal disclosure. As implemented ERISA’s understandability standard has been jettisoned by plan sponsors seeking protection from liability for failing to tell workers enough. Required plan summaries became unreadable, but plan sponsors could get away with that, both because there was no administrative or judicial enforcement of the understandability standard, and because they could tout the advantages of their benefit plans to workers by means of unregulated informal communications. The demise of understandability is only half the story. The federal courts have also degraded the reliability of mandatory disclosures by finding that the obligation to provide reasonably accurate and complete information is enforceable only in a suit for appropriate equitable relief. In consequence, disclosure defects are often presented as estoppel claims, and the necessary showing of individual detrimental reliance translates into widespread under-enforcement of the reliability standard. This article explores the policy dimension of ERISA disclosure law and chronicles the decay of the equilibrium Congress envisioned. From the perspective of workers it is a saga of disappointment, disillusionment, and defeat. The new balance may serve the interests of federal courts (reduced caseload) and some employers (increased flexibility), but it also likely contributes to the increasing standardization of employee benefit plans, decreasing their utility as instruments of workforce management. Far worse, it abandons ERISA’s goal of improved economic performance through better-informed career and financial planning.

From Schism to Prism: Equitable Relief in Employee Benefit Plans

Denials of relief for even clear violations of statutory protections have left some injured benefit plan participants and beneficiaries without compensation and failed to provide appropriate incentives for compliance. Many of the remedial failures can be traced to a 1993 U.S. Supreme Court case, which narrowly construed the relevant statute's provision for appropriate equitable relief. I argue that since 2002, the Supreme Court slowly and subtly has been shifting its approach to equitable relief in benefits cases. Because the Court's development of the remedial jurisprudence has been subtle and incremental, neither lower courts nor scholars have fully recognized the shift. I rely on theoretical approaches to equity, scholarly commentary across fields of law, and the Supreme Court's jurisprudence to consider the definition of appropriate equitable relief. I then articulate a detailed analysis for use in determining when appropriate equable relief should be available in benefits cases. Applying the analysis to three important categories of benefits cases shows that, properly interpreted, the Employee Retirement Income Act's provision for appropriate equitable relief is neither so unconstrained as to threaten the viability of benefit plans nor so pinched as to deny remedies for rights granted by the statute.

Employee Benefit Plan Audits: The Current State and Future Direction

SUMMARYEmployee benefit plans represent vital components of our economic system and are a critical employment and retirement consideration for many individuals and the organizations that employ them. Surprisingly, the extant academic research and official authoritative standards on audits of employee benefit plans are sparse. This paper describes the current state of employee benefit plan audit quality, focusing on a recent report from the Department of Labor. Next, a proposed statement on auditing standards specific to employee benefit plans is described and summarized. Concluding, I provide insights on potential future directions for this industry of audits.

Health Education Careers in a Post-Health Reform Era.

Since enactment of the Patient Protection and Affordable Care Act in 2010, health education specialists (HES) have made important contributions in implementing the law's provisions at the individual, family, and population levels. Using their health education competencies and subcompetencies, HES are improving public understanding of health insurance literacy and enrollment options, conducting community health needs assessments required of nonprofit hospitals, modifying policies or systems to improve access to health screenings and preventive health services, strengthening clinical and community linkages, and working with employee benefit plans. In addition to educating stakeholders about their complementary training and roles with respect to clinical providers, HES must keep abreast of rapid changes catalyzed by the Affordable Care Act in terms of health standards, payment models, government regulations, statistics, and business practices. For continued career growth, HES must continually acquire new knowledge and skills, access and analyze data, and develop interprofessional partnerships that meet the evolving needs of employers as the nation pursues health for all.

Supreme Court Accepts Religious Hospitals' View of Concept of Church Plan

The US Supreme Court, on June 5, unanimously held (8–0) that an employee benefit plan maintained by a church‐affiliated entity, dubbed by the Court a principal‐purpose organization (defined below), qualifies as a church plan, irrespective of whether it was established by a church (Advocate Health Care Network v. Stapleton).

Refining Mandatory Disclosure: Statement Presented to the ERISA Advisory Council, June 6, 2017

Design recommendations for improving the effectiveness of ERISA-mandated disclosures reporting the contents and operation of employee benefit plans.

Marketing non-US private equity funds in the United States: a roadmap through the various regulations and tax implications

PurposeTo discuss general legal considerations for non-US private equity sponsors who seek to market their funds to US institutional investors.Design/methodology/approachExplains relevant aspects of US securities laws, commodity exchange laws, pension and employee benefit plan laws, federal income tax laws, and the Foreign Account Tax Compliance Act (FATCA).FindingsThe evolving US regulatory regime necessitates careful planning and thorough knowledge of relevant laws and regulations to effect a successful US marketing effort.Originality/valuePractical guidance from experienced investment funds and tax lawyers.

Allowing States to Help Workers Save for Retirement Department of Laborrs Proposed Rulemaking That Provides a Safe Harbor for State Savings Programs under ERISA

There is a “retirement crisis” in America. Even though some would view this as hyperbole, the empirical evidence reflects that “[t]he average working household has virtually no retirement savings” and that the “collective retirement savings gap among working households age 25-64 ranges from $6.8 to $14 trillion.” Contributing to this crisis is that fact that almost 70 million Americans do not have access to a retirement savings plan through their employers. This problem is more prevalent in the small business community; more than half of small business employers do not offer a retirement plan to their employees. Research reflects that an important predictor for retirement readiness is participation in an employee benefit plan – employees save more in a workplace plan than they would on their own. For example, even though there are a number of non-employer based retirement savings options, such as IRAs, few workers utilize them. States, concerned with the economic stability of their citizens, have created laws that require private sector employers to implement in their workplaces state-administered payroll deduction savings programs. Even though many states are currently debating whether to adopt the programs, this Article will focus on California, Illinois and Oregon, who have enacted laws creating payroll deduction savings programs. One obstruction to wider adoption of such measures at the state level has been uncertainty about the effect of the Employee Retirement Income Security Act’s (ERISA) broad preemption of state laws that “relate to” private sector employee benefit plans and ERISA’s prohibition on requiring employers to offer employee benefit plans. To remedy this problem, the Department of Labor (DOL) has published a Notice of Proposed Rulemaking (NPRM) that would make clear “that state payroll deduction savings programs with automatic enrollment that conform to the safe harbor in [the] proposal do not establish ERISA plans.” This Article begins by discussing the current law concerning ERISA's preemption of state laws that “relate to” private sector employee benefit plans and provides a discussion of DOL’s proposed rulemaking that provides a safe harbor for state payroll deduction savings programs. The Article then transitions into an examination of the current state-based initiatives, analyzes specific state legislative proposals under the requirements of the proposed rulemaking and proposes what, if any, changes need to be made to the state payroll deduction savings programs to ensure that the programs will not run afoul of ERISA. The Article concludes by analyzing policy concerns regarding state payroll deduction savings programs, provides comment on the DOL proposed rulemaking and provides additional elements of a model state payroll deduction savings program.

Barriers to Enrollment in a Pharmacist-Led Fitness, Nutrition, and Weight Management Coaching Program

Objectives: To investigate barriers to utilization of a pharmacist-led fitness, nutrition, and weight management coaching program, as well as describe patient reported expectations and explore the patient characteristics potentially associated with a higher willingness to participate in the future. Design: Cross-sectional, descriptive study using an anonymous, electronic survey. Setting: A large, national, grocery store chain. Participants: Employee benefit plan members, eligible for a pharmacist-led fitness, nutrition, and weight management (FNWM) coaching program, who were not currently or previously enrolled in the program, and met coaching program qualifications. Intervention: Peer-reviewed, electronic survey administered and collected using an Internet survey analysis software. Main Outcome Measures: Barriers to enrollment in the pharmacist-led fitness, nutrition, and weight management coaching program. Results: Of 1,130 emailed employees, 352 responded and 133 met study inclusion criteria and completed the whole survey. Of those who fit inclusion criteria, the majority (53.4%) of the respondents were aware of the coaching program (75.2%) and expressed interest in future participation (53.4%). “I am already taking steps to improve my health” and “I do not have time to participate in the program” were the highest rated barriers for both those interested and not interested in participating in the coaching program. The majority of participants believed pharmacists were qualified to provide the coaching service (78.2%) and preferred one-on-one coaching with the pharmacist (67.7%). Key topics respondents wanted the pharmacist to cover included general diet and nutrition, weight management strategies, and vitamins and supplements. Conclusion: The two major barriers reported in the study were lack of time and the use of other health improvement methods; however, a large number of respondents indicated future interest in participating. Future programs may be able to increase utilization by focusing on programming that is more accommodating to participants’ schedules and integrating along with other weight loss programs. This study also provides some support regarding patient acceptance of pharmacists in innovative roles, such as fitness, nutrition, weight management coaching. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties Type: Original Research

Untrustworthy: ERISA's Eroded Fiduciary Law

The trust law analogy has come to dominate judicial thinking about employee benefit plans. Yet despite its rise to rhetorical prominence, ERISA fiduciary law has been dramatically transformed by a series of uncoordinated low-visibility judicial decisions on multiple fronts. These apparently unconnected case law developments reveal a startling pattern of mutually reinforcing restrictions on ERISA’s protection of pension and welfare benefits. This study makes the case that both the scope and the intensity of fiduciary oversight have been radically pruned back in the courts. Notwithstanding the congressional declaration that attempts to relax workers’ federal fiduciary protections “shall be void as against public policy”, the U.S. Supreme Court has shown the way to curtail fiduciary obligations. That de facto or implicit exculpation, combined with unilateral employer control over both plan terms and plan interpretation, indicate that the federal courts have defanged — or deranged — ERISA’s fiduciary regime. In the course of chronicling ERISA’s trust law turn and exposing how untrustworthy workers’ fiduciary defenses have become, the article explains, contrasts, extends, and ultimately reconciles the two premier scholarly analyses of ERISA’s fiduciary regime: Daniel Fischel & John H. Langbein, ERISA’s Fundamental Contradiction: The Exclusive Benefit Rule, 55 U. Chi. L. Rev. 1105 (1988); and Dana Muir & Norman Stein, Two Hats, One Head, No Heart: The Anatomy of the ERISA Settlor/Fiduciary Distinction, 93 N.C. L. Rev. 459 (2015).