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The Handbook of Employee Benefits: Health and Group Benefits 7/E

Book Description

The essential resource for designing and implementing employee benefits—bringing you up to date on critical new industry changesFor nearly three decades, HR professionals and consultants have depended on The Handbook of Employee Benefits for authoritative answers to their questions about designing and implementing competitive employee benefits packages.

Table of Contents

  1. Cover Page
  2. The Handbook of Employee Benefits: Health and Group Benefits
  3. Copyright
  4. Dedication
  5. BRIEF CONTENTS
  6. CONTENTS
  7. Preface
  8. Contributing Authors
  9. PART ONE THE ENVIRONMENT OF EMPLOYEE BENEFIT PLANS
    1. Chapter 1 The Environment of Employee Benefit Plans
      1. Employee Benefits Defined
      2. Reasons for the Growth of Employee Benefit Plans
      3. Group Technique
      4. Overall Employee Benefit Concerns
    2. Chapter 2 Functional Approach to Designing and Evaluating Employee Benefits
      1. The Functional Approach in Concept
      2. Need for the Functional Approach
      3. Consistency with an Employer’s Total Compensation Philosophy
      4. Application of the Functional Approach
    3. Chapter 3 Risk Concepts and Employee Benefit Planning
      1. Risk and Employee Benefits
      2. Insurance and Insurable Risk
      3. Summary
  10. PART TWO MEDICAL AND OTHER HEALTH BENEFITS
    1. Chapter 4 Health Plan Evolution
      1. The Early Origins of Medical Plans
      2. The Evolution of Hospital/Medical Plan Designs
      3. Managed Care Plan Designs: The Predominant Structures
      4. Variations in Plan Design
      5. Underwriting and Funding Approaches
      6. Experience Rating
      7. Provider Reimbursement Approaches
      8. Developing a Health Care Strategy
      9. Summary and Conclusions
      10. Bibliography
      11. Appendix 4.1 Health Care Cost Equation
      12. Appendix 4.2 Vision Care and Hearing Care Plans
    2. Chapter 5 Health Care Cost Containment: Demand-Side Approaches
      1. Background
      2. Wellness Programs
      3. Disease Management
      4. Value-Based Benefit Design
      5. Predictive Modeling
      6. Conclusion
    3. Chapter 6 Managing and Measuring Care Management Intervention Programs
      1. Background
      2. Types of Care Management Interventions
      3. Return on Investment in Intervention Programs
      4. Economics of Care Management
      5. Planning an Intervention Program Using the Value Chain
      6. Measuring Care Management Savings Outcomes
      7. An Actuarial Methodology for Assessing Savings
      8. Implications for the Future
      9. Appendix 6.1 Technical Aspects
    4. Chapter 7 Consumer-Driven Health Plans
      1. Why Consumer-Driven Health Care?
      2. Key Components
      3. Plan Design Basics
      4. Individually Controlled Health Accounts
      5. Other Plan Design Considerations
      6. Price and Quality Transparency
      7. Communications and Information
      8. Popularity and Growth
      9. Experience and Effectiveness
      10. Conclusion
      11. Appendix 7.1 Consumer-Driven Health Plans: Popularity and Growth
    5. Chapter 8 Understanding Behavioral Health Care Benefits
      1. Behavioral Health Care
      2. History and Industry Overview
      3. Psychotropic Medication Management
      4. Mental Health Parity
      5. The Behavioral Health Care Market Today
      6. Behavioral Health Care Benefit Plans
      7. Behavioral Health Care Benefit Plan Designs
      8. Employee Assistance Programs
      9. How Behavioral Health Benefits Work Together
      10. Behavioral Health Providers
      11. Behavioral Provider Payment Arrangements
      12. Care Management and Cost Control
      13. MBHO Accreditation
      14. Future Developments in Behavioral Health Care
      15. Conclusion
    6. Chapter 9 Health Care Quality: Are We Getting Our Money’s Worth?
      1. Is Quality of Care Important?
      2. Defining Quality
      3. Evaluating Quality
      4. Improving Quality
      5. Conclusion
    7. Chapter 10 Pharmacy Benefits
      1. Prescription Drug Plans
      2. Conclusion
      3. Appendix 10.1 Definitions
      4. Appendix 10.2 Pharmaceutical Pricing
      5. Appendix 10.3 Medication Equivalence
      6. Appendix 10.4 Specialty/Biotechnology Medications and Their Place in Prescription Drug Plans
    8. Chapter 11 Dental Plan Design
      1. Differences Between Medicine and Dentistry Drive Plan Design
      2. Providers of Dental Benefits
      3. Covered Dental Expenses
      4. Types of Plans
      5. Orthodontic Expenses
      6. Implantology and Its Services
      7. Factors Affecting the Cost of the Dental Plan
      8. Technology and Dental Plan Design
    9. Chapter 12 Long-Term Care Insurance
      1. Definition of Long-Term Care
      2. Why LTC is an Important Issue
      3. LTC Insurance as an Employee Benefit
      4. Employer Decisions
      5. LTC Plan Design
      6. LTC Pricing
      7. Other LTC Contract Provisions
      8. LTC Insurance Financing
      9. LTC Enrollment
      10. LTC Upgrades and Transfers
      11. LTC Claims Adjudication
      12. LTC Regulation
      13. Consumer Protection Provisions
      14. Health Care Reform and LTC
    10. Chapter 13 Disability Income Benefits
      1. Disability Risk
      2. Early History
      3. The Modern Era of Disability Income Benefits
      4. Types of Disability Income in the Public and Private Sectors
      5. Summary
  11. PART THREE LIFE INSURANCE BENEFITS
    1. Chapter 14 Group Life Insurance
      1. Group Mechanism
      2. Group Life Insurance
      3. Permanent Forms of Group Life Insurance
      4. Group Paid-Up Life Insurance
      5. Level-Premium Group Permanent Life Insurance
      6. Retired-Lives Reserve
      7. Accidental Death and Dismemberment Insurance
      8. Supplemental Group Life Insurance
      9. Group Carve-Out Plans
      10. Group Universal Life (GUL) Plans
    2. Chapter 15 Business Uses of Life Insurance
      1. Life Insurance Benefits for Employees
      2. Life Insurance Benefits for Retirees
      3. Life Insurance for Executives
      4. Insurance for Business Continuation Arrangements
      5. Appendix 15.1 Permanent Life Insurance Plans and Features
      6. Appendix 15.2 Universal Life Insurance Programs
  12. PART FOUR WORK/LIFE BENEFITS
    1. Chapter 16 Time-Off Benefits and Family and Medical Leave Programs
      1. Paid Leave Time
      2. Paid Time-Off Plans
      3. Miscellaneous Paid Leave Time
      4. Extended Leaves of Absences
      5. Summary
      6. Appendix 16.1 FLSA-Exempt and Nonexempt Workers
      7. Appendix 16.2 Guidelines for the Term “Serious Health Condition” Under the Family and Medical Leave Act
    2. Chapter 17 Dependent Care Programs
      1. Employee Problem
      2. Challenge for Employer
      3. Types of Employee Dependent Care Benefits
      4. Tax Policy
      5. Employer Objectives
      6. Issues
      7. Design of Benefits
      8. Conclusion
    3. Chapter 18 Selected Additional Benefits: Educational Assistance Programs, Group Legal Services Plans, Qualified Transportation Fringe Benefits, and Voluntary Benefits
      1. Educational Assistance Programs (Section 127 Plans)
      2. Job-Related Versus Nonjob-Related Educational Assistance
      3. Overview and History of Educational Assistance Programs
      4. Definition and Administration of an Educational Assistance Program
      5. Summary
      6. Group Legal Services Plans
      7. Legislative Basis for Group Legal Services Plans
      8. Definition of a Group Legal Services Plan
      9. Group Legal Services Plans as an Employee Benefit
      10. Design, Funding, and Administration
      11. Administration
      12. Selecting an Attorney Panel
      13. Summary
      14. Qualified Transportation Fringe Benefits
      15. Commuter Vehicle Transportation
      16. Qualified Parking
      17. The Benefit Coordination Rule
      18. Reporting and Disclosure Requirements
      19. Summary
      20. Voluntary Benefits
      21. Advantages of Voluntary Benefits
      22. Types of Voluntary Benefits
      23. Legal Compliance
      24. Summary
    4. Chapter 19 Financial Planning as an Employee Benefit
      1. Financial Planning
      2. Financial Planning as an Employee Benefit
      3. Conclusion
  13. PART FIVE SOCIAL INSURANCE PROGRAMS
    1. Chapter 20 Social Security and Medicare: Focus on Disability, Survivorship, and Medicare Provisions
      1. Disability Benefits
      2. Survivor Benefits
      3. Medicare Program
      4. Medicaid
    2. Chapter 21 Medicare Part D Prescription Drug Benefits
      1. Enrollment
      2. Creditable Coverage
      3. Low-Income-Subsidy Beneficiaries
      4. Incentives for Employer to Participate
      5. Employer Group Waiver Plan
      6. Standard Benefit Design
      7. True Out-of-Pocket Cost
      8. Catastrophic Coverage
      9. Low-Income Benefit Design
      10. Medigap Insurance
      11. Pharmacy Network Contracting
      12. Formularies and Part D
      13. Electronic Prescribing
      14. Medication Therapy Management
      15. Impact of Skilled Nursing Facilities, Nursing Facilities, and Long-Term Care
      16. Quality Measures
      17. Audit Issues
      18. Coordination-of-Benefits Issues
      19. FWA Programs and the PERM Initiative
      20. Conclusion
      21. Appendix 21.1 Part D Cost Projections
      22. Appendix 21.2 Beneficiary Communications
      23. Appendix 21.3 Prescription Drug Events
      24. Appendix 21.4 MIPPA Part D Changes
      25. Appendix 21.5 Details of Drug Coverage in Part D Formularies
      26. Appendix 21.6 Quality Measures In Part D
      27. Appendix 21.7 Drug Categories Covered Under Medicare Part B
    3. Chapter 22 Workers’ Compensation
      1. History
      2. Coverage of Employees and Employers
      3. Coverage of Injuries and Diseases
      4. Medical Care and Rehabilitation Services
      5. Cash Benefits
      6. Financing of Benefits
      7. Workplace Safety and Health
      8. Administration of Workers’ Compensation
      9. Recent Developments and Continuing Challenges
      10. Bibliography
      11. Appendix 22.1 Calculating Insurance Premiums
      12. Bibliography
    4. Chapter 23 Unemployment Compensation
      1. The Basic System
      2. Financing the Program
      3. Coverage
      4. Benefit Rights
      5. Other Benefit Programs
  14. PART SIX EMPLOYEE BENEFIT PLAN ADMINISTRATION
    1. Chapter 24 Strategic Benefit Plan Management
      1. Focus of Benefits Management Activity
      2. The Outsourcing Alternative
      3. Summary and Conclusions
      4. Bibliography
    2. Chapter 25 Cafeteria Plan Design and Administration
      1. Cafeteria Plans in General
      2. Advantages and Disadvantages of Cafeteria Plans
      3. Types of Cafeteria Plans
      4. Plan Design
      5. Governing Law
      6. Historical Evolution of Cafeteria Plans
      7. General Legal Requirements
      8. Contributions and Benefit Elections
      9. Employer-Provided Accident and Health Plan
      10. Group Term Life Insurance
      11. Health Care Flexible Spending Account
      12. Michelle’s Law
      13. Dependent Care Assistance
      14. Paid Time Off
      15. 401(k) Contributions
      16. Adoption Assistance
      17. Health Savings Accounts
      18. Cash
      19. Plan Administration
      20. ERISA
      21. HIPAA Coordination
      22. Summary Plan Description and Plan Communication
      23. Conclusion
    3. Chapter 26 Fiduciary Liability Issues Under ERISA
      1. Fiduciary Duties Under the Common Law of Trusts
      2. Exclusive Benefit Rule Under the Internal Revenue Code
      3. Fiduciary Standards Under ERISA
      4. Who is a Fiduciary?
      5. Liability for Fiduciary Breaches Under ERISA
      6. Allocation of Fiduciary Responsibilities
      7. Summary
    4. Chapter 27 Employee Benefits Communications
      1. Objectives of Employee Benefits Communications
      2. Mandatory Disclosure Requirements
      3. Educating Employees
      4. Employer Objectives
      5. Summary
      6. Appendix 27.1 Key Reporting and Disclosure Requirements of the Patient Protection and Affordable Care Act of 2010
  15. PART SEVEN GROUP AND HEALTH BENEFIT PLAN FINANCIAL MANAGEMENT
    1. Chapter 28 Federal Tax Law Requirements for Group Welfare Benefit Plans
      1. General Tax Law Requirements
      2. Section 79—Group Life Insurance
      3. Section 105(h)—Employer Health Plans
      4. Section 125—Cafeteria Plans
      5. Section 505—Voluntary Employees’ Beneficiary Associations
      6. Section 4980B—COBRA Health Care Coverage Continuation
      7. Taxation of Contributions and Benefits
    2. Chapter 29 Funding Health Benefits: Insured Arrangements
      1. Conventional Insurance Arrangements
      2. Alternative Funding Arrangements
      3. Insured Alternative Funding Arrangements
      4. Short- and Long-Term Implications of 2010 Health Care Reform Legislation
      5. Conclusion
    3. Chapter 30 Funding Health Benefits: Self-Funded and Captive Arrangements
      1. Noninsured (Self-Funding) Arrangements
      2. Captive Insurance
      3. Conclusion
  16. PART EIGHT EMPLOYEE BENEFIT PLAN ISSUES
    1. Chapter 31 Welfare Benefits for Retirees
      1. Current Trends and Issues
      2. Life Insurance
      3. Health Care Benefits
      4. The Changing Nature of the Promise
      5. Financing
      6. Legal Issues
    2. Chapter 32 Employee Benefit Plans For Small Companies
      1. Medical Insurance
      2. Disability Income Insurance
      3. Group Life and AD&D Insurance
      4. Group Dental Insurance
      5. Cafeteria Plans
      6. Communication of Small-Plan Benefits
      7. Conclusion
    3. Chapter 33 Multiemployer Plans
      1. Origins and Philosophy
      2. Growth and Prevalence
      3. Industries
      4. Regulation and Oversight
      5. Establishing a Multiemployer Plan
      6. Funding
      7. Benefits Determinations
      8. Advantages for Employers
      9. Advantages for Workers
      10. The Future of Multiemployer Plans
      11. Conclusion
      12. Bibliography
    4. Chapter 34 Global Employee Benefits
      1. Background Considerations
      2. Understanding the Local Environment
      3. Global Benefit Objectives and Plan Design
      4. Administration and Financial Management of International Benefit Plans
      5. Summary
  17. Index
  18. ABOUT THE EDITOR
  19. Footnote
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