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28 Cards in this Set
- Front
- Back
Benefits for retirees include:
|
Pensions
Health, Life, LTC Dental, Vision, Hearing spousal / dependents’ benefits |
|
TYPES OF COORDINATION OF AN EMPLOYER PLAN WITH MEDICARE
|
Medicare is primary, Er plan is secondary
M = final Medicare coverage (after ded/coinsurance) C = Er plan coverage (in the absence of Medicare) C * % = Er plan coverage after ded / coinsurance are applied P = Cost of Er plan benefits Standard COB P = the lesser of C * % or C – M (usually C - M) Exclusion method P = (C – M) * % independent of timing of bills Carveout method P = (C * %) – M P depends on timing of bills Supplement method Er plan pays a portion of the amount that Medicare plan does not pay. Combinations |
|
Relative Costs of the Benefits to the ER
|
Standard COB (P highest)
Exclusion (P middle) Carveout (P lowest) Supplement method varies. Mnemonic: “Co-excavates” Co ex cavat s COB carveout supp exclusion |
|
YESTERDAY’S RETIREMENT PLANS
|
Continuations of active-life plans
Retirees paid same premiums as actives Standard COB Easy eligibility for retirement benefits (55 + 5yos) |
|
TOMORROW’S RETIREMENT PLANS
Ways for Employers to Control Retirement Plan Costs |
increase retirees’ contributions
Fixed Er contribution (a.o.t. % of costs) stricter COB eliminate benefits that Medicare covers stricter eligibility reqs make benefits service-related use cost-controls: CM, DM, UM, QM enroll retirees in an HMO: premiums lower HMO’s have built-in CM, DM, UM, QM use spousal initiatives surcharge make spouse use his/her own plan compensate for deductible leveraging Manage prescription drugs (Not as important now, since Medicare will soon cover them) Negotate pharmacy discounts and manufacturer rebates Drug utilization review Formularies mail-order pharmacies (cheaper) Improve administration. |
|
The Effect of the Medicare Modernization Act on Employer Retirement Plan Design
|
If the employer’s drug plan is actuarially equivalent to Medicare’s:
The government will reimburse 28% of drug charges between $250 and $5000 This subsidy is tax-free to the employer. |
|
An employer’s options, given the new Medicare Drug Plan, are:
|
For employers whose current plans are richer than Medicare’s New Plan:
Continue the same coordination method. Issues: Drug prices will vary depending on which competing private plan retirees sign up with under Medicare. Drug expenses are small; COB is inefficient to compute Use a PBM to simplify the coordination. Er pays the PBM to provide supplemental coverage over Medicare. For employers whose current plans are weaker than Medicare’s New Plan: Improve the plan to equal Medicare’s, in order to get the 28% subsidy. |
|
Difficulties in enforcing a retirement plan
|
grandfathered ee’s
hard to communicate with retireess hard to get them to change physicians deductible leveraging plan cost trend exceeds underlying trend |
|
FUNDING OF RETIREMENT PLANS
(Prefunding vs. Pay-as-you-go) Advantages of Prefunding (funding) |
tax advantages
allocates costs between generations of ph’s interest earned FAS 106 costs lower makes plan attractive (competitive) assets sheltered from corporate raiders cashflows more stable |
|
Disadvantages of Prefunding
|
cash not available for other uses (acquisitions)
Er must borrow cash (cost of capital) less choice of investments lose flexibility to change plan design regulations |
|
ACTUARIAL ASSUMPTIONS: HOW THEY DIFFER BETWEEN HEALTH PLAN VALUATIONS and PENSION PLAN VALUATIONS
Health assumptions that are also Pension Plan assumptions |
Inflation
discount rate, long-term ror on assets salary increases Medicare increases Decrements (and why they are more important for Health than for Pension) (q) post-retirement death rate Health includes COLA (w) pre-retirement termination rate terminators don’t get health benefits (r) retirement rate Health has no early-retirement reductions (d) disability rate Medicare covers some disabilities affects employer plan cost |
|
Health assumptions specific to Health plans (Why Health Valuation is harder than Pension Valuation)
|
Retiree plan costs
Difficulties in setting cost assumptions: actives / retiree costs differ costs vary by age composite / tiered premiums missing claims data grandfathering estimating admin expenses Split the cost valuation into classes of retirees: Retirees over 65 have lowest plan cost Retirees under 65 have highest cost. Retirees who are disabled vary Use incurred claims as a cost measure. Current retiree contributions expected increase per year variations by class (<65, >65, Disabled) Total health care cost trend inflation, utilzation, technology, plan benefit changes, demographic changes. hospital vs. drugs vs. physician cost trends trend should begin at current level, then grade down Leveraging Medicare Assumptions Part A & Part B premium increases, deductible increases, benefit increases Gross vs. Net plan cost trend (i.e. with vs. without leveraging) ee participation % spouses’ plan continuation rate dependents’ plan termination rates |
|
General Considerations in choosing Assumptions
|
Assumptions must be consistent
Health assumptions should match pension plan assumptions. |
|
ACTUARIAL FUNDING METHODS FOR HEALTH PLANS
|
PUC, Entry Age Normal, etc.
Benefits = f(YOS, salary, plan costs, plan cost trend) Divide valuation into <65, >65, Disabled …and into Indemnity vs. HMO Assume each ee retires at date of first eligibility. Could ignore young ee’s (delayed funding eligibility) Done. |
|
Benefits for retirees include:
|
Pensions
Health, Life, LTC Dental, Vision, Hearing spousal / dependents’ benefits |
|
TYPES OF COORDINATION OF AN EMPLOYER PLAN WITH MEDICARE
|
Medicare is primary, Er plan is secondary
M = final Medicare coverage (after ded/coinsurance) C = Er plan coverage (in the absence of Medicare) C * % = Er plan coverage after ded / coinsurance are applied P = Cost of Er plan benefits Standard COB P = the lesser of C * % or C – M (usually C - M) Exclusion method P = (C – M) * % independent of timing of bills Carveout method P = (C * %) – M P depends on timing of bills Supplement method Er plan pays a portion of the amount that Medicare plan does not pay. Combinations |
|
Relative Costs of the Benefits to the ER
|
Standard COB (P highest)
Exclusion (P middle) Carveout (P lowest) Supplement method varies. Mnemonic: “Co-excavates” Co ex cavat s COB carveout supp exclusion |
|
YESTERDAY’S RETIREMENT PLANS
|
Continuations of active-life plans
Retirees paid same premiums as actives Standard COB Easy eligibility for retirement benefits (55 + 5yos) |
|
TOMORROW’S RETIREMENT PLANS
Ways for Employers to Control Retirement Plan Costs |
increase retirees’ contributions
Fixed Er contribution (a.o.t. % of costs) stricter COB eliminate benefits that Medicare covers stricter eligibility reqs make benefits service-related use cost-controls: CM, DM, UM, QM enroll retirees in an HMO: premiums lower HMO’s have built-in CM, DM, UM, QM use spousal initiatives surcharge make spouse use his/her own plan compensate for deductible leveraging Manage prescription drugs (Not as important now, since Medicare will soon cover them) Negotate pharmacy discounts and manufacturer rebates Drug utilization review Formularies mail-order pharmacies (cheaper) Improve administration. |
|
The Effect of the Medicare Modernization Act on Employer Retirement Plan Design
|
If the employer’s drug plan is actuarially equivalent to Medicare’s:
The government will reimburse 28% of drug charges between $250 and $5000 This subsidy is tax-free to the employer. |
|
An employer’s options, given the new Medicare Drug Plan, are:
|
For employers whose current plans are richer than Medicare’s New Plan:
Continue the same coordination method. Issues: Drug prices will vary depending on which competing private plan retirees sign up with under Medicare. Drug expenses are small; COB is inefficient to compute Use a PBM to simplify the coordination. Er pays the PBM to provide supplemental coverage over Medicare. For employers whose current plans are weaker than Medicare’s New Plan: Improve the plan to equal Medicare’s, in order to get the 28% subsidy. |
|
Difficulties in enforcing a retirement plan
|
grandfathered ee’s
hard to communicate with retireess hard to get them to change physicians deductible leveraging plan cost trend exceeds underlying trend |
|
FUNDING OF RETIREMENT PLANS
(Prefunding vs. Pay-as-you-go) Advantages of Prefunding (funding) |
tax advantages
allocates costs between generations of ph’s interest earned FAS 106 costs lower makes plan attractive (competitive) assets sheltered from corporate raiders cashflows more stable |
|
Disadvantages of Prefunding
|
cash not available for other uses (acquisitions)
Er must borrow cash (cost of capital) less choice of investments lose flexibility to change plan design regulations |
|
ACTUARIAL ASSUMPTIONS: HOW THEY DIFFER BETWEEN HEALTH PLAN VALUATIONS and PENSION PLAN VALUATIONS
Health assumptions that are also Pension Plan assumptions |
Inflation
discount rate, long-term ror on assets salary increases Medicare increases Decrements (and why they are more important for Health than for Pension) (q) post-retirement death rate Health includes COLA (w) pre-retirement termination rate terminators don’t get health benefits (r) retirement rate Health has no early-retirement reductions (d) disability rate Medicare covers some disabilities affects employer plan cost |
|
Health assumptions specific to Health plans (Why Health Valuation is harder than Pension Valuation)
|
Retiree plan costs
Difficulties in setting cost assumptions: actives / retiree costs differ costs vary by age composite / tiered premiums missing claims data grandfathering estimating admin expenses Split the cost valuation into classes of retirees: Retirees over 65 have lowest plan cost Retirees under 65 have highest cost. Retirees who are disabled vary Use incurred claims as a cost measure. Current retiree contributions expected increase per year variations by class (<65, >65, Disabled) Total health care cost trend inflation, utilzation, technology, plan benefit changes, demographic changes. hospital vs. drugs vs. physician cost trends trend should begin at current level, then grade down Leveraging Medicare Assumptions Part A & Part B premium increases, deductible increases, benefit increases Gross vs. Net plan cost trend (i.e. with vs. without leveraging) ee participation % spouses’ plan continuation rate dependents’ plan termination rates |
|
General Considerations in choosing Assumptions
|
Assumptions must be consistent
Health assumptions should match pension plan assumptions. |
|
ACTUARIAL FUNDING METHODS FOR HEALTH PLANS
|
PUC, Entry Age Normal, etc.
Benefits = f(YOS, salary, plan costs, plan cost trend) Divide valuation into <65, >65, Disabled …and into Indemnity vs. HMO Assume each ee retires at date of first eligibility. Could ignore young ee’s (delayed funding eligibility) Done. |