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IBM Employee Issues ERISA Applies To The IBM HRA


 

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I am not a legal professional and things seem to still be evolving on the IBM HRA, but here is my interpretation of ERISA as it applies to the IBM HRA and ExtendHealth. This was my response to a question I received earlier on ibmretireeissues.

Can you net this out?

My interpretations of the highlighted portions of the ERISA summary posted on the DOL website as I posted on these list-serves are:

  1. ERISA applies to the IBM HRA.
  2. IBM established and controls the HRA and as such has a fiduciary responsibility to the beneficiaries.
  3. ExtendHealth as the organization responsible for administration of the HRA also has a fiduciary responsibility to the beneficiaries.
  4. IBM/EH must provide a SPD to the beneficiaries but have not [yet].

?

My concerns/suspicions/opinions based on my personal observations/experiences are:

  1. IBM has exceeded its authority and created a possible conflict of interest by requiring that individual health insurance be purchased through, Extend Health, a private health exchange and the organization responsible for administration of the IBM HRA, in order to receive the benefits of the IBM HRA.
  2. Extend Health is engaging in a conflict of interest violation of ERISA through the deceptive practices of limiting the health insurance choices of the IBM HRA beneficiaries and by “pushing” those individual health plans that maximize commissions for Extend Health.
  3. IBM has a fiduciary responsibility to ensure that Extend Health, as the administrator of the IBM HRA, does not engage in practices that violate requirements of ERISA.
  4. If IBM is, or should be, aware of Extend Health violations of ERISA and does not take corrective action, then IBM is also in violation of ERISA.
  5. In light of the above, it is also possible, but can not be known without access to the detailed IBM HRA Plan documents and the contract between IBM and Extend Health, that Extend Health may be incentivised to limit claims to the IBM HRA so as to maximize the funds to be returned to IBM at the end of the calendar year, which would also be a violation of ERISA.


From: skip.mcgaughey@...
To: IBM_RETIREE@...
Date: Thu, 10 Oct 2013 11:16:18 -0700
Subject: IBM Employee Issues RE: ERISA Applies To The IBM HRA

?

Thanks for the information and post.
Do you or anyone know any IBM knowledgeable legal people or retired federal regulators who can help us with understanding the legal and regulatory issues associated with ERISA.
Thanks.....
Skip.McGaughey@... ?


---In ibm_retiree@..., wrote:

The IBM Health Reimbursement Arrangement (HRA) is an employee [retiree] welfare benefit plan [health plan] and, as such, the Employee Retirement Income Security Act – ERISA applies.

Below are applicable sections of ERISA, from the DOL website, with highlights added.

Employee Retirement Income Security Act — ERISA

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.
ERISA requires plans to provide participants with including important information about plan features and funding; provides for those who manage and control plan assets; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and gives participants the right to sue for benefits and breaches of fiduciary duty.
There have been a number of amendments to ERISA, expanding the protections available to health benefit plan participants and beneficiaries. One important amendment, the , provides some workers and their families with the right to continue their health coverage for a limited time after certain events, such as the loss of a job. Another amendment to ERISA is the which provides important new protections for working Americans and their families who have preexisting medical conditions or might otherwise suffer discrimination in health coverage based on factors that relate to an individual's health. Other important amendments include the Newborns' and Mothers' Health Protection Act, the Mental Health Parity Act, and the Women's Health and Cancer Rights Act.
In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or plans which are maintained solely to comply with applicable workers compensation, unemployment, or disability laws. ERISA also does not cover plans maintained outside the United States primarily for the benefit of nonresident aliens or unfunded excess benefit plans.
?

Plan Information

The Employee Retirement Income Security Act (ERISA) requires plan administrators — the people who run plans — to give plan participants in writing the most important facts they need to know about their retirement and health benefit plans including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others are available upon request, free-of-charge or for copying fees. The request should be made in writing.
One of the most important documents participants are entitled to receive automatically when becoming a participant of an ERISA-covered retirement or health benefit plan or a beneficiary receiving benefits under such a plan, is a summary of the plan, called the summary plan description or SPD. The plan administrator is legally obligated to provide to participants, free of charge, the SPD. The summary plan description is an important document that tells participants what the plan provides and how it operates. It provides information on when an employee can begin to participate in the plan, how service and benefits are calculated, when benefits becomes vested, when and in what form benefits are paid, and how to file a claim for benefits. If a plan is changed, participants must be informed, either through a revised summary plan description, or in a separate document, called a summary of material modifications, which also must be given to participants free of charge.
In addition to the summary plan description, the plan administrator must automatically give participants each year a copy of the plan's summary annual report. This is a summary of the annual financial report that most plans must file with the Department of Labor. These reports are filed on government forms called the Form 5500. The summary annual report is available at no cost. To learn more about the plan assets, participants may ask the plan administrator for a copy of the annual report in its entirety.
If participants are unable to get the summary plan description, the summary annual report or the annual report from the plan administrator, they may be able to obtain a copy by writing to the U.S. Department of Labor, EBSA, Public Disclosure Room, Room N-1513, 200 Constitution Avenue, N.W., Washington, D.C. 20210, for a nominal copying charge. Participants should provide their name, address and phone number to enable EBSA to contact them to follow up on the request.

Fiduciary Responsibilities

The protects your plan's assets by requiring that those persons or entities who exercise discretionary control or authority over plan management or plan assets, have discretionary authority or responsibility for the administration of a plan, or provide investment advice to a plan for compensation or have any authority or responsibility to do so are subject to fiduciary responsibilities. Plan fiduciaries include, for example, plan trustees, plan administrators, and members of a plan's investment committee.
The primary responsibility of fiduciaries is to run the plan solely in the interest of participants and beneficiaries and for the exclusive purpose of providing benefits and paying plan expenses. Fiduciaries must act prudently and must diversify the plan's investments in order to minimize the risk of large losses. In addition, they must follow the terms of plan documents to the extent that the plan terms are consistent with ERISA. They also must avoid conflicts of interest. In other words, they may not engage in transactions on behalf of the plan that benefit parties related to the plan, such as other fiduciaries, services providers, or the plan sponsor.
Fiduciaries who do not follow these principles of conduct may be personally liable to restore any losses to the plan, or to restore any profits made through improper use of plan assets. Courts may take whatever action is appropriate against fiduciaries who breach their duties under ERISA including their removal.


 

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You make some very good points on IBM possibly being in violation of ERISA, due to the fact that our retirement plans had to be approved by the IRS in conjunction of ERISA law.? There is another side issue with IBM pushing us into this Extend Health Medicare Exchange.? My wife and I have been with Kaiser for 11 years now and Kaiser was not as part of the original plans being offered by Extend Health, who we were told was our only choice for a medical plan.? Then a couple of weeks later, all of us who were currently with Kaiser, got a letter from IBM, saying that not only could me remain with them if we choose to do so, we were also told that an HRA would be set up for us.? This was good news to me, since there are no doctors locally who will take a new Medicare patient.

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Now let me get to my main point.? Two of my retired IBM friends here in Salem, Oregon have been with Aetna for some time and want to stay with them.? But the only available Medigap plan on Extend Health's list are Humana, Blue Cross and AARP/United Healthcare.? Both of these individuals have had bad experiences with all three of these companies and don't want to go with them.? What it looks like to me, is that by IBM making an exception and letting those of us with Kaiser stay with them and setting up an HRA for us, they have created a precedent for others to stay with the company they have been with and also have an HRA.? Now any of us are free to get our healthcare from any company that we want.? But IBM is telling us that if we don't go with Extend Health and now are able to remain with Kaiser, they won't set up an HRA for us.? This smells to high heaven and looks like grounds for a class action lawsuit.

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Like other poster said, I am not a legal professional either, but it sure doesn't sound right.

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LRG ??

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From: ibmpensionissues@... [mailto:ibmpensionissues@...] On Behalf Of retired_engineer@...
Sent: Saturday, October 12, 2013 10:52 AM
To: ibm_retiree
Cc: ibmretiree; ibmpension; ibmpensionissues
Subject: [ibmpensionissues] RE: IBM Employee Issues RE: ERISA Applies To The IBM HRA

?

?


I am not a legal professional and things seem to still be evolving on the IBM HRA, but here is my interpretation of ERISA as it applies to the IBM HRA and ExtendHealth. This was my response to a question I received earlier on ibmretireeissues.

Can you net this out?

My interpretations of the highlighted portions of the ERISA summary posted on the DOL website as I posted on these list-serves are:

  1. ERISA applies to the IBM HRA.
  2. IBM established and controls the HRA and as such has a fiduciary responsibility to the beneficiaries.
  3. ExtendHealth as the organization responsible for administration of the HRA also has a fiduciary responsibility to the beneficiaries.
  4. IBM/EH must provide a SPD to the beneficiaries but have not [yet].

?

My concerns/suspicions/opinions based on my personal observations/experiences are:

  1. IBM has exceeded its authority and created a possible conflict of interest by requiring that individual health insurance be purchased through, Extend Health, a private health exchange and the organization responsible for administration of the IBM HRA, in order to receive the benefits of the IBM HRA.
  2. Extend Health is engaging in a conflict of interest violation of ERISA through the deceptive practices of limiting the health insurance choices of the IBM HRA beneficiaries and by “pushing” those individual health plans that maximize commissions for Extend Health.
  3. IBM has a fiduciary responsibility to ensure that Extend Health, as the administrator of the IBM HRA, does not engage in practices that violate requirements of ERISA.
  4. If IBM is, or should be, aware of Extend Health violations of ERISA and does not take corrective action, then IBM is also in violation of ERISA.
  5. In light of the above, it is also possible, but can not be known without access to the detailed IBM HRA Plan documents and the contract between IBM and Extend Health, that Extend Health may be incentivised to limit claims to the IBM HRA so as to maximize the funds to be returned to IBM at the end of the calendar year, which would also be a violation of ERISA.

?


From: skip.mcgaughey@...
To: IBM_RETIREE@...
Date: Thu, 10 Oct 2013 11:16:18 -0700
Subject: IBM Employee Issues RE: ERISA Applies To The IBM HRA

?


Thanks for the information and post.
Do you or anyone know any IBM knowledgeable legal people or retired federal regulators who can help us with understanding the legal and regulatory issues associated with ERISA.
Thanks.....
Skip.McGaughey@... ?



---In ibm_retiree@..., <retired_engineer@...> wrote:

The IBM Health Reimbursement Arrangement (HRA) is an employee [retiree] welfare benefit plan [health plan] and, as such, the Employee Retirement Income Security Act – ERISA applies.

Below are applicable sections of ERISA, from the DOL website, with highlights added.

Employee Retirement Income Security Act — ERISA

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.
ERISA requires plans to provide participants with including important information about plan features and funding; provides for those who manage and control plan assets; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and gives participants the right to sue for benefits and breaches of fiduciary duty.
There have been a number of amendments to ERISA, expanding the protections available to health benefit plan participants and beneficiaries. One important amendment, the , provides some workers and their families with the right to continue their health coverage for a limited time after certain events, such as the loss of a job. Another amendment to ERISA is the which provides important new protections for working Americans and their families who have preexisting medical conditions or might otherwise suffer discrimination in health coverage based on factors that relate to an individual's health. Other important amendments include the Newborns' and Mothers' Health Protection Act, the Mental Health Parity Act, and the Women's Health and Cancer Rights Act.
In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or plans which are maintained solely to comply with applicable workers compensation, unemployment, or disability laws. ERISA also does not cover plans maintained outside the United States primarily for the benefit of nonresident aliens or unfunded excess benefit plans.
?

Plan Information

The Employee Retirement Income Security Act (ERISA) requires plan administrators — the people who run plans — to give plan participants in writing the most important facts they need to know about their retirement and health benefit plans including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others are available upon request, free-of-charge or for copying fees. The request should be made in writing.
One of the most important documents participants are entitled to receive automatically when becoming a participant of an ERISA-covered retirement or health benefit plan or a beneficiary receiving benefits under such a plan, is a summary of the plan, called the summary plan description or SPD. The plan administrator is legally obligated to provide to participants, free of charge, the SPD. The summary plan description is an important document that tells participants what the plan provides and how it operates. It provides information on when an employee can begin to participate in the plan, how service and benefits are calculated, when benefits becomes vested, when and in what form benefits are paid, and how to file a claim for benefits. If a plan is changed, participants must be informed, either through a revised summary plan description, or in a separate document, called a summary of material modifications, which also must be given to participants free of charge.
In addition to the summary plan description, the plan administrator must automatically give participants each year a copy of the plan's summary annual report. This is a summary of the annual financial report that most plans must file with the Department of Labor. These reports are filed on government forms called the Form 5500. The summary annual report is available at no cost. To learn more about the plan assets, participants may ask the plan administrator for a copy of the annual report in its entirety.
If participants are unable to get the summary plan description, the summary annual report or the annual report from the plan administrator, they may be able to obtain a copy by writing to the U.S. Department of Labor, EBSA, Public Disclosure Room, Room N-1513, 200 Constitution Avenue, N.W., Washington, D.C. 20210, for a nominal copying charge. Participants should provide their name, address and phone number to enable EBSA to contact them to follow up on the request.

Fiduciary Responsibilities

The protects your plan's assets by requiring that those persons or entities who exercise discretionary control or authority over plan management or plan assets, have discretionary authority or responsibility for the administration of a plan, or provide investment advice to a plan for compensation or have any authority or responsibility to do so are subject to fiduciary responsibilities. Plan fiduciaries include, for example, plan trustees, plan administrators, and members of a plan's investment committee.
The primary responsibility of fiduciaries is to run the plan solely in the interest of participants and beneficiaries and for the exclusive purpose of providing benefits and paying plan expenses. Fiduciaries must act prudently and must diversify the plan's investments in order to minimize the risk of large losses. In addition, they must follow the terms of plan documents to the extent that the plan terms are consistent with ERISA. They also must avoid conflicts of interest. In other words, they may not engage in transactions on behalf of the plan that benefit parties related to the plan, such as other fiduciaries, services providers, or the plan sponsor.
Fiduciaries who do not follow these principles of conduct may be personally liable to restore any losses to the plan, or to restore any profits made through improper use of plan assets. Courts may take whatever action is appropriate against fiduciaries who breach their duties under ERISA including their removal.

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