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

Name: The Handbook of Employee Benefits: Health and Group Benefits 7/E, 7th Edition
Author: Jerry Rosenbloom
ISBN: 9780071763097

by Jerry Rosenbloom

June 2011

Intermediate to advanced

1008 pages

27h 46m

English

McGraw-Hill

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Cover Page
The Handbook of Employee Benefits: Health and Group Benefits
Copyright
Dedication
BRIEF CONTENTS
CONTENTS
Preface
Contributing Authors
PART ONE THE ENVIRONMENT OF EMPLOYEE BENEFIT PLANS
Chapter 1 The Environment of Employee Benefit Plans
Employee Benefits DefinedReasons for the Growth of Employee Benefit PlansGroup TechniqueOverall Employee Benefit Concerns

Chapter 2 Functional Approach to Designing and Evaluating Employee Benefits
The Functional Approach in ConceptNeed for the Functional ApproachConsistency with an Employer’s Total Compensation PhilosophyApplication of the Functional Approach
Chapter 3 Risk Concepts and Employee Benefit Planning
Risk and Employee BenefitsInsurance and Insurable RiskSummary
PART TWO MEDICAL AND OTHER HEALTH BENEFITS
Chapter 4 Health Plan Evolution
The Early Origins of Medical PlansThe Evolution of Hospital/Medical Plan DesignsManaged Care Plan Designs: The Predominant StructuresVariations in Plan DesignUnderwriting and Funding ApproachesExperience RatingProvider Reimbursement ApproachesDeveloping a Health Care StrategySummary and ConclusionsBibliographyAppendix 4.1 Health Care Cost EquationAppendix 4.2 Vision Care and Hearing Care Plans
Chapter 5 Health Care Cost Containment: Demand-Side Approaches
BackgroundWellness ProgramsDisease ManagementValue-Based Benefit DesignPredictive ModelingConclusion
Chapter 6 Managing and Measuring Care Management Intervention Programs
BackgroundTypes of Care Management InterventionsReturn on Investment in Intervention ProgramsEconomics of Care ManagementPlanning an Intervention Program Using the Value ChainMeasuring Care Management Savings OutcomesAn Actuarial Methodology for Assessing SavingsImplications for the FutureAppendix 6.1 Technical Aspects
Chapter 7 Consumer-Driven Health Plans
Why Consumer-Driven Health Care?Key ComponentsPlan Design BasicsIndividually Controlled Health AccountsOther Plan Design ConsiderationsPrice and Quality TransparencyCommunications and InformationPopularity and GrowthExperience and EffectivenessConclusionAppendix 7.1 Consumer-Driven Health Plans: Popularity and Growth
Chapter 8 Understanding Behavioral Health Care Benefits
Behavioral Health CareHistory and Industry OverviewPsychotropic Medication ManagementMental Health ParityThe Behavioral Health Care Market TodayBehavioral Health Care Benefit PlansBehavioral Health Care Benefit Plan DesignsEmployee Assistance ProgramsHow Behavioral Health Benefits Work TogetherBehavioral Health ProvidersBehavioral Provider Payment ArrangementsCare Management and Cost ControlMBHO AccreditationFuture Developments in Behavioral Health CareConclusion
Chapter 9 Health Care Quality: Are We Getting Our Money’s Worth?
Is Quality of Care Important?Defining QualityEvaluating QualityImproving QualityConclusion
Chapter 10 Pharmacy Benefits
Prescription Drug PlansConclusionAppendix 10.1 DefinitionsAppendix 10.2 Pharmaceutical PricingAppendix 10.3 Medication EquivalenceAppendix 10.4 Specialty/Biotechnology Medications and Their Place in Prescription Drug Plans
Chapter 11 Dental Plan Design
Differences Between Medicine and Dentistry Drive Plan DesignProviders of Dental BenefitsCovered Dental ExpensesTypes of PlansOrthodontic ExpensesImplantology and Its ServicesFactors Affecting the Cost of the Dental PlanTechnology and Dental Plan Design
Chapter 12 Long-Term Care Insurance
Definition of Long-Term CareWhy LTC is an Important IssueLTC Insurance as an Employee BenefitEmployer DecisionsLTC Plan DesignLTC PricingOther LTC Contract ProvisionsLTC Insurance FinancingLTC EnrollmentLTC Upgrades and TransfersLTC Claims AdjudicationLTC RegulationConsumer Protection ProvisionsHealth Care Reform and LTC
Chapter 13 Disability Income Benefits
Disability RiskEarly HistoryThe Modern Era of Disability Income BenefitsTypes of Disability Income in the Public and Private SectorsSummary
PART THREE LIFE INSURANCE BENEFITS
Chapter 14 Group Life Insurance
Group MechanismGroup Life InsurancePermanent Forms of Group Life InsuranceGroup Paid-Up Life InsuranceLevel-Premium Group Permanent Life InsuranceRetired-Lives ReserveAccidental Death and Dismemberment InsuranceSupplemental Group Life InsuranceGroup Carve-Out PlansGroup Universal Life (GUL) Plans
Chapter 15 Business Uses of Life Insurance
Life Insurance Benefits for EmployeesLife Insurance Benefits for RetireesLife Insurance for ExecutivesInsurance for Business Continuation ArrangementsAppendix 15.1 Permanent Life Insurance Plans and FeaturesAppendix 15.2 Universal Life Insurance Programs
PART FOUR WORK/LIFE BENEFITS
Chapter 16 Time-Off Benefits and Family and Medical Leave Programs
Paid Leave TimePaid Time-Off PlansMiscellaneous Paid Leave TimeExtended Leaves of AbsencesSummaryAppendix 16.1 FLSA-Exempt and Nonexempt WorkersAppendix 16.2 Guidelines for the Term “Serious Health Condition” Under the Family and Medical Leave Act
Chapter 17 Dependent Care Programs
Employee ProblemChallenge for EmployerTypes of Employee Dependent Care BenefitsTax PolicyEmployer ObjectivesIssuesDesign of BenefitsConclusion
Chapter 18 Selected Additional Benefits: Educational Assistance Programs, Group Legal Services Plans, Qualified Transportation Fringe Benefits, and Voluntary Benefits
Educational Assistance Programs (Section 127 Plans)Job-Related Versus Nonjob-Related Educational AssistanceOverview and History of Educational Assistance ProgramsDefinition and Administration of an Educational Assistance ProgramSummaryGroup Legal Services PlansLegislative Basis for Group Legal Services PlansDefinition of a Group Legal Services PlanGroup Legal Services Plans as an Employee BenefitDesign, Funding, and AdministrationAdministrationSelecting an Attorney PanelSummaryQualified Transportation Fringe BenefitsCommuter Vehicle TransportationQualified ParkingThe Benefit Coordination RuleReporting and Disclosure RequirementsSummaryVoluntary BenefitsAdvantages of Voluntary BenefitsTypes of Voluntary BenefitsLegal ComplianceSummary
Chapter 19 Financial Planning as an Employee Benefit
Financial PlanningFinancial Planning as an Employee BenefitConclusion
PART FIVE SOCIAL INSURANCE PROGRAMS
Chapter 20 Social Security and Medicare: Focus on Disability, Survivorship, and Medicare Provisions
Disability BenefitsSurvivor BenefitsMedicare ProgramMedicaid
Chapter 21 Medicare Part D Prescription Drug Benefits
EnrollmentCreditable CoverageLow-Income-Subsidy BeneficiariesIncentives for Employer to ParticipateEmployer Group Waiver PlanStandard Benefit DesignTrue Out-of-Pocket CostCatastrophic CoverageLow-Income Benefit DesignMedigap InsurancePharmacy Network ContractingFormularies and Part DElectronic PrescribingMedication Therapy ManagementImpact of Skilled Nursing Facilities, Nursing Facilities, and Long-Term CareQuality MeasuresAudit IssuesCoordination-of-Benefits IssuesFWA Programs and the PERM InitiativeConclusionAppendix 21.1 Part D Cost ProjectionsAppendix 21.2 Beneficiary CommunicationsAppendix 21.3 Prescription Drug EventsAppendix 21.4 MIPPA Part D ChangesAppendix 21.5 Details of Drug Coverage in Part D FormulariesAppendix 21.6 Quality Measures In Part DAppendix 21.7 Drug Categories Covered Under Medicare Part B
Chapter 22 Workers’ Compensation
HistoryCoverage of Employees and EmployersCoverage of Injuries and DiseasesMedical Care and Rehabilitation ServicesCash BenefitsFinancing of BenefitsWorkplace Safety and HealthAdministration of Workers’ CompensationRecent Developments and Continuing ChallengesBibliographyAppendix 22.1 Calculating Insurance PremiumsBibliography
Chapter 23 Unemployment Compensation
The Basic SystemFinancing the ProgramCoverageBenefit RightsOther Benefit Programs
PART SIX EMPLOYEE BENEFIT PLAN ADMINISTRATION
Chapter 24 Strategic Benefit Plan Management
Focus of Benefits Management ActivityThe Outsourcing AlternativeSummary and ConclusionsBibliography
Chapter 25 Cafeteria Plan Design and Administration
Cafeteria Plans in GeneralAdvantages and Disadvantages of Cafeteria PlansTypes of Cafeteria PlansPlan DesignGoverning LawHistorical Evolution of Cafeteria PlansGeneral Legal RequirementsContributions and Benefit ElectionsEmployer-Provided Accident and Health PlanGroup Term Life InsuranceHealth Care Flexible Spending AccountMichelle’s LawDependent Care AssistancePaid Time Off401(k) ContributionsAdoption AssistanceHealth Savings AccountsCashPlan AdministrationERISAHIPAA CoordinationSummary Plan Description and Plan CommunicationConclusion
Chapter 26 Fiduciary Liability Issues Under ERISA
Fiduciary Duties Under the Common Law of TrustsExclusive Benefit Rule Under the Internal Revenue CodeFiduciary Standards Under ERISAWho is a Fiduciary?Liability for Fiduciary Breaches Under ERISAAllocation of Fiduciary ResponsibilitiesSummary
Chapter 27 Employee Benefits Communications
Objectives of Employee Benefits CommunicationsMandatory Disclosure RequirementsEducating EmployeesEmployer ObjectivesSummaryAppendix 27.1 Key Reporting and Disclosure Requirements of the Patient Protection and Affordable Care Act of 2010
PART SEVEN GROUP AND HEALTH BENEFIT PLAN FINANCIAL MANAGEMENT
Chapter 28 Federal Tax Law Requirements for Group Welfare Benefit Plans
General Tax Law RequirementsSection 79—Group Life InsuranceSection 105(h)—Employer Health PlansSection 125—Cafeteria PlansSection 505—Voluntary Employees’ Beneficiary AssociationsSection 4980B—COBRA Health Care Coverage ContinuationTaxation of Contributions and Benefits
Chapter 29 Funding Health Benefits: Insured Arrangements
Conventional Insurance ArrangementsAlternative Funding ArrangementsInsured Alternative Funding ArrangementsShort- and Long-Term Implications of 2010 Health Care Reform LegislationConclusion
Chapter 30 Funding Health Benefits: Self-Funded and Captive Arrangements
Noninsured (Self-Funding) ArrangementsCaptive InsuranceConclusion
PART EIGHT EMPLOYEE BENEFIT PLAN ISSUES
Chapter 31 Welfare Benefits for Retirees
Current Trends and IssuesLife InsuranceHealth Care BenefitsThe Changing Nature of the PromiseFinancingLegal Issues
Chapter 32 Employee Benefit Plans For Small Companies
Medical InsuranceDisability Income InsuranceGroup Life and AD&D InsuranceGroup Dental InsuranceCafeteria PlansCommunication of Small-Plan BenefitsConclusion
Chapter 33 Multiemployer Plans
Origins and PhilosophyGrowth and PrevalenceIndustriesRegulation and OversightEstablishing a Multiemployer PlanFundingBenefits DeterminationsAdvantages for EmployersAdvantages for WorkersThe Future of Multiemployer PlansConclusionBibliography
Chapter 34 Global Employee Benefits
Background ConsiderationsUnderstanding the Local EnvironmentGlobal Benefit Objectives and Plan DesignAdministration and Financial Management of International Benefit PlansSummary
Index
ABOUT THE EDITOR
Footnote
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Content preview from The Handbook of Employee Benefits: Health and Group Benefits 7/E, 7th Edition

BRIEF CONTENTS

Preface

Contributing Authors

PART ONETHE ENVIRONMENT OF EMPLOYEE BENEFIT PLANS

1 The Environment of Employee Benefit PlansJerry S. Rosenbloom

2 Functional Approach to Designing and Evaluating Employee BenefitsG. Victor Hallman III

3 Risk Concepts and Employee Benefit PlanningGary K. Stone

PART TWOMEDICAL AND OTHER HEALTH BENEFITS

4 Health Plan EvolutionDennis F. Mahoney

5 Health Care Cost Containment: Demand-Side ApproachesDavid Harvey

6 Managing and Measuring Care Management Intervention ProgramsIan Duncan

7 Consumer-Driven Health PlansDiane S. Luedtke

8 Understanding Behavioral Health Care BenefitsEdward Jones, Ann McClanathan, Dagmar King and Diane S. Luedtke

9 Health Care Quality: Are We Getting Our Money’s Worth?William ...

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Employee Benefits Design and Planning: A Guide to Understanding Accounting, Finance, and Tax Implications

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

by Jerry Rosenbloom

BRIEF CONTENTS

Become an O’Reilly member and get unlimited access to this title plus top books and audiobooks from O’Reilly and nearly 200 top publishers, thousands of courses curated by job role, 150+ live events each month,
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