Regulating Employee Benefits

Some people argue that there is too much government intervention, while others indicate there isn’t enough.  Given the presentation of laws in this chapter, identify an area of employee-benefits that would benefit from government regulation? Explain your answer.

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Part One: Introduction to Employee Benefits

Chapter Three: Regulating Employee Benefits

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Learning Objectives

In this chapter, you will gain an understanding of:

the need for government regulation in the employment setting.

the National Labor Relations Act of 1935.

the Internal Revenue Code.

the Fair Labor Standards Act of 1938.

the Employee Retirement Income Security Act of 1975 (ERISA) and key amendments such as the Pension Protection Act, COBRA, and HIPAA.

the Patient Protection and Affordable Care Act of 2010.

equal-opportunity employment laws.

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Overview

This chapter focuses on the regulation of employee benefits in the private sector.

The chapter introduces complex federal regulations that shape benefit practices.

A sound working knowledge is essential for effectively managing employee benefits programs.

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Exhibit 3.1

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Legal Influences on Discretionary Benefits Practices

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The Need for Government Regulation

How much can Congress or the courts

tell an employer how to run its business,

who it should hire or fire, and

how it should treat its employees?

Congress has passed employment-related laws when it believes the employee is on unequal footing with the employer.

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Labor Unions and Employee Benefits

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Workers were at a disadvantage and subject to poor pay, unsafe working condition, and virtually no job security.

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National Labor Relations Act of 1935 (NLRA)

 

 

Enacted to restore equality of bargaining power between employees and employers.

 

 

The National Labor Relations Act

Coverage.

Applies to private sector companies.

Does not apply to:

agriculture workers,

domestic service workers,

independent contractors, or

employees of federal, state, or municipal governments.

The National Labor Relations Board (NLRB) oversees enforcement.

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The National Labor Relations Act

Relevance to employee benefits.

Section 1 declares the U.S. policy to protect commerce must:

encourage collective bargaining, and

protect employees’ right to unionize.

Bargaining subjects fit one of three categories:

mandatory,

permissive, or

illegal.

 

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The National Labor Relations Act

Mandatory bargaining subjects are ones that must be negotiated if either party requests them and include:

disability pay,

health insurance,

paid time-off, and

retirement plans.

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The National Labor Relations Act

Permissive bargaining subjects are those on which neither party is obligated to bargain.

Administration of funds for benefits programs.

Retiree benefits like health insurance.

Workers’ compensation, within the scope of state workers’ compensation laws.

Illegal bargaining subjects include those that are either illegal under the NLRA or violate federal or state law.

 

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The National Labor Relations Act

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The role of labor unions goes well beyond the collective bargaining process.

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Worker Adjustment and Retraining Notification (WARN)

 

 

Failure to do so

 

 

entitles employees to pay and benefits for that period of non-notification.

 

 

requires management to give at least a 60 day notice of plant closing or mass layoffs.

 

 

The Internal Revenue Code

The Internal Revenue Code (IRC) is the set of regulations pertaining to taxation in the U.S.

e.g., sales taxes, income taxes, property taxes.

Main source of government revenue.

The Internal Revenue Service (IRS)

develops and implements the IRC, and

it levies penalties against violators.

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The Internal Revenue Code

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The IRC contains multiple regulations for benefits. For example:

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The Federal Insurance Contributions Act (FICA)

 

 

Taxes employees and employers to finance the (OASDI) program

 

 

The Federal Unemployment Tax Act (FUTA)

 

 

Provides for federal unemployment insurance benefits

 

 

The Internal Revenue Code

The IRC offers incentives for offering discretionary benefits.

Employees can deduct the cots of benefits.

Employers can also deduct the costs.

Must meet provisions of ERISA.

Must follow nondiscrimination rules prohibiting employers from giving preferential treatment to key employees and highly compensated employees.

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The Fair Labor Standards Act of 1938

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The Fair Labor Standards Act

(FLSA)

 

 

Contains provisions for minimum wage, overtime pay, and child labor

 

 

Fair Labor Standards Act (FLSA)

Coverage.

The minimum wage provision applies to private sector and government agencies.

Does not cover all employees.

The overtime pay provision applies to nonexempt employees, excluding exempt jobs.

Generally, executives and other professionals.

Determining exempt or nonexempt became more complex with passage of the FairPay Rules.

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Fair Labor Standards Act (FLSA)

Relevance to employee benefits practices.

Nonexempt employees receive overtime pay of one and one-half their normal hourly pay.

Employee benefits linked to pay increase also.

An employee making $14.42 an hour works 300 hours of overtime.

Their additional contribution to a retirement plan equals $108.15.

($7.21 X 300 X 5 percent)

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Employee Retirement Income Security Act of 1974

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The Employee Retirement Income Security Act of 1974 (ERISA)

 

 

Regulates the establishment and implementation of several employee benefits practices

 

 

Including medical care, life and disability insurance programs, and retirement programs

 

 

Employee Retirement Income Security Act of 1974

Deficiencies in the private sector pension system prompted the law’s passage.

Prior to ERISA, employers could arbitrarily determine benefit parameters.

ERISA preempts most state laws, is detailed and complex.

Amended several times.

COBRA , the Pension Protection Act, and others.

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ERISA

Coverage.

Generally covers the private sector.

Does not cover:

government plans,

church plans,

workers’ compensation plans,

plans maintained outside the U.S.,

top hat plans, and

plans covering partners or sole proprietors.

Enforced by the U.S. Department of Labor.

 

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ERISA

Relevance to benefits practices.

Until ERISA, there were only limited restrictions on retirement plans.

ERISA has several major objectives.

To ensure adequate information on plans.

To set standards of conduct for those managing plans.

To determine adequate funding is set aside for plans.

To ensure qualified workers receive benefits.

To safeguard benefits when plans are terminated.

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Exhibit 3.2

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Summary of ERISA Titles

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ERISA

Relevance to benefits practices.

ERISA has four broad titles.

Title I specifies a variety of protections.

Title II includes the IRC provisions.

Title III address ERISA enforcement.

Title IV establishes the Pension Benefit Guarantee Corporation (PBGC).

Titles I and II set minimum standards to “qualify.”

Qualified plans and nonqualified plans.

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ERISA – Defining Pension Plans and Welfare Plans

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ERISA applies to pension plans and welfare plans.

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Pension plans

 

 

Provide retirement income, or

 

 

Result in a deferral of income

 

 

Welfare plans

 

 

Provide benefits when someone is unable to work, or

 

 

Any benefit in section 302(c) of the Labor Management Relations Act, 1947

 

 

ERISA – Defining Pension Plans and Welfare Plans

The two most common pension plans.

A defined benefit plan guarantees retirement benefits.

Expressed as a monthly or annual sum equal to a percentage of pay X number of years employed.

In a defined contribution plan, both parties make annual contributions to an employee’s account.

Amount received depends on investment performance.

Employees contribute a percentage of annual pay and employers invest these funds in a number of ways.

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ERISA – Defining Pension Plans and Welfare Plans

Another important term is multiemployer plans, aka Taft-Hartley plans.

May include pension or welfare benefits.

For workers who move from employer to employer when work is available.

Characteristics include:

A limited set of benefits.

Contributions must be held in trust and audited.

Both parties have equal representation.

A separate fund must be used for pensions.

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Exhibit 3.3

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Permissible Benefits in Taft-Hartley Plans

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ERISA – Scope of Coverage

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Scope of Coverage

 

 

ERISA covers pension plans and welfare plans but most provisions pertain to pension plans.

 

 

The protection of employee rights (Title I) addresses seven issues, two of which apply to welfare plans and two address group health plans.

 

 

Title I: Protecting Employee Rights

Title I contains provisions on:

Reporting and disclosure,

Minimum standards for participation and vesting,

Funding,

Fiduciary responsibilities,

Administration and enforcement,

Continuation coverage and standards for group health plans, and

Group health plan portability, access, and renewability requirements.

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Exhibit 3.2

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Summary of ERISA Titles

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Title I: Protecting Employee Rights

Congress saw the need for Title I due to:

Many companies terminated pension plans after employees completed several years of service.

Many companies were forced to terminate plans due to insufficient funding.

Many companies did not provide employees information about their pension plans.

The absence of federal regulations led to financial failure of many pension plans.

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Title I: Protecting Employee Rights

Part 1: Reporting and Disclosure.

Employers must provide employees with understandable, comprehensive information.

And advance notification of plan termination.

Employees are entitled to receive reports on their status in the plan.

Employers are required to report detailed data about the plans to the U.S. Treasury Department.

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Title I: Protecting Employee Rights

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Strict participation requirements apply to pension plans.

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Employees must be allowed to participate after age 21, and

 

 

Have completed one year of service (based on 1,000 work hours)

 

 

Companies may not exclude employees due to advanced age

 

 

Vesting refers to an employee’s non-forfeitable rights to pension benefits

 

 

Title I: Protecting Employee Rights

Part 3: Funding.

Employers must contribute sufficient funding.

If underfunded, companies must notify participants.

Failure to comply leads to monetary penalties.

If underfunded, employers must make necessary adjustments or risk the federal government placing liens on the employer’s assets.

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Title I: Protecting Employee Rights

Part 4: Fiduciary Responsibilities.

Fiduciaries are those who manage benefits plans.

Commonly employers, insurance companies, attorneys, corporate directors, officers, or principal stockholders.

Fiduciary responsibilities include:

Use the care, skill, and diligence of a prudent person.

Diversify investments, minimizing large losses.

Act according to the plan document,

as long as it is consistent with ERISA.

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Title I: Protecting Employee Rights

Part 5: Administration and Enforcement.

Three federal agencies share responsibility:

The U.S. Department of Labor,

The Internal Revenue Service (IRS), and

The Pension Benefit Guarantee Corporation (PBGC).

Part 6: Continuation Coverage.

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) provides employees to elect continuation coverage if lost.

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Title I: Protecting Employee Rights

Part 7: Group Health Plan Portability, Access, and Renewability Requirements.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

is another amendment imposing requirements on group health plans and their issuers relating to:

portability,

increased access by limiting preexisting conditions,

renewability, and

health care privacy.

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Title II: Amendments to the IRC

Some mirror Title I

Participation.

Vesting.

And minimum funding standards.

Others pertain to

Nondiscrimination of coverage requirements.

Contribution and benefits limits to plans, and

IRAs and Keogh Plans for self-employed.

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Title III: Jurisdiction

Grants power to the U.S. Department of Labor for administering and enforcing Title I.

Employee Benefits Security Administration possesses responsibility for enforcing Title I.

The Pension and Welfare Benefits Administration enforces ERISA by:

conducting investigations, and

evaluating compliance.

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Title IV: Plan Termination Insurance

Established the Pension Benefit Guarantee Corporation (PBGC).

The PBGC pays monthly retirement benefits.

Since 1974, the PBGC has provided payments to about 1.5 million workers in 4,800 failed plans.

In 2015 alone, they paid $5.7 billion.

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The Consolidated Omnibus Reconciliation Act of 1985

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COBRA is a substantial amendment to ERISA, Title I

COBRA is a substantial amendment to ERISA, Title I.

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Under COBRA

 

 

Companies must permit qualified beneficiaries to elect continuation coverage under group health plans if they would lose coverage due to a qualifying event.

 

 

COBRA applies to all private sector employers with 20 or more employees.

 

 

COBRA

Relevance to group health plans.

A qualified beneficiary is an individual covered by a group health plan.

A qualifying event are certain events that would cause an individual to lose health coverage.

Death of the covered employee,

Termination or reduction in hours of employment,

Divorce or legal separation,

A dependent child becoming independent,

Covered employee becomes eligible for Medicare.

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COBRA

Relevance to group health plans.

The election period refers to the period that begins with the qualifying event and extends 60 days.

Beneficiaries are responsible for paying the premiums during continuation coverage.

Companies can charge up to 102% of the cost of premiums.

The extra 2% is to cover administration costs.

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The Health Insurance Portability and Accountability Act of 1996

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HIPAA contains three main provisions.

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Employees must have access to a new employer’s health plan

 

 

Limits preexisting conditions

 

 

Protects the transfer, disclosure, and use of health information

 

 

Exhibit 3.4

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Prohibited Reasons for Limiting Participation in Group Health Plans under HIPAA

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The Pension Protection Act of 2006

The PPA strengthens employee rights.

An amendment to ERISA.

Focuses on employee rights in two ways.

For defined benefits plans, employers who under-fund their program pay much higher premiums.

For defined contribution plans, the law makes it easier to employees to participate.

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The Patient Protection and Affordable Care Act of 2010

The PPACA, or ACA mandates health care coverage and sets minimum plan standards.

The goal is to reduce the number of uninsured.

Congress estimates the costs to reach $971 billion through 2019.

Individuals must be covered by employer or independently. (Individual mandate)

Companies with 50 or more employees must offer health care plans. (Employer mandate)

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Equal-Employment Opportunity Laws

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Several federal laws, overseen by the EEOC

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The Equal Pay Act of 1963

 

 

Title VII of the Civil Rights Act of 1964

 

 

The Age Discrimination in Employment Act of 1967

 

 

The Pregnancy Discrimination Act of 1978

 

 

The Americans with Disabilities Act of 1990

 

 

The Civil Rights Act of 1991

 

 

The Genetic Information Nondiscrimination Act of 2008

 

 

The Equal Pay Act of 1963

Congress enacted the Equal Pay Act of 1963 to remedy unequal women’s pay.

Exceptions are when pay is based on seniority, merit, quantity or quality of production, or a differential based on something other than gender.

Wages are income and benefits.

Pertains explicitly to jobs of equal worth.

Compensable factors include skill, effort, responsibility, and working condition.

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Title VII of the Civil Rights Act of 1964

Coverage.

Private sector and government employees.

Relevance to employee benefits.

It is unlawful for employers to:

refuse to hire, or otherwise discriminate with respect to compensation, including employee benefits.

limit or deprive employment opportunities or adversely affect status due to race, color, religion, sex, or national origin.

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The Age Discrimination in Employment Act of 1967

The ADEA prohibits discrimination in employment based on age.

Specifies employee benefits and sets limits on early retirement practices.

The Older Workers Benefit Protection Act places more restrictions on benefits practices.

An older employee may not be required to pay more for a benefit as a condition of employment.

The equal benefit or equal cost principle allows employers to charge the older employee more for benefits whose cost varies with age of person covered.

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The Pregnancy Discrimination Act of 1978 (PDA)

The PDA prohibits discrimination against pregnant women in all employment practices.

Applies to the same organizations as Title VII of the Civil Rights Act.

Employers must not treat pregnancy less favorable than other conditions.

Protects employee rights such as credit for previous service, accrued retirement benefits, and accumulated seniority.

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The Americans with Disabilities Act of 1990 (ADA)

Under the ADA, employers:

must provide the same health care coverage regardless of disability status.

may not discriminate due to coverage costs.

cannot impose different requirements for retirement plans due to disabilities.

The Americans with Disabilities Act Amendments Act of 2008 (ADAAA) redefined the term disability.

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The Civil Rights Act of 1991

Requires a company must prove a challenged employment practice is a business necessity.

The suspect practice prevented irreparable financial damage to the company.

Applies to the same groups as the Civil Rights Act of 1964.

Extends coverage to Senate employees and political appointees of the executive branch.

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The Genetic Information Nondiscrimination Act of 2008

GINA protects against discrimination through unlawful misuse of genetic information.

Contains two titles.

Title I applies to employer-sponsored health plans.

Prohibits use of genetic information to discriminate, determine eligibility or set premiums.

Title II applies to the employment setting.

Restricts collection of genetic information and disclosure of that information.

Covers private sector and government.

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Summary

Chapter three focused on the regulation of employee benefits in the private sector.

The chapter introduced complex federal regulations that shape benefit practices.

A sound working knowledge is essential for effectively managing employee benefits programs.

 

Copyright © 2018 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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