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Retiree Medical Benefits and ERISA Guidelines

What is Meant by “Retiree Medical” Benefits?

Also known as “post-retirement health insurance,” these benefits are typically employer-sponsored benefit plans for retired workers 55 and older.

In an earlier article titled “Other Post Employment Benefits (OPEB),” this author discussed the fact that certain specified non-pension benefits are offered after the employee retires or leaves a company in exchange for their current service. Retiree medical benefits represent the vast majority of these OPEB obligations.

How Does ERISA Apply to Retiree Medical Benefits?

If a plan is sponsored by an employer or union (other than a government employer or public employee union, or non-profit employer), it is governed by ERISA.

ERISA governed benefits plans typically contain a “reservation of rights” provision in both the Summary Plan Description (“SPD”) and the more technical official plan document, which allows the plan sponsor to change or terminate all or parts of the plan. Plan changes must be implemented and communicated in accordance with ERISA guidelines.

Where Can a Beneficiary Learn More about their Retiree Medical Benefits?

Every beneficiary of an ERISA-sponsored benefits plan should have a current copy of their Summary Plan Description, which outlines the benefits offered by the plan.

A plan sponsor is required to provide this SPD when a new plan takes effect; when an employee becomes eligible to participate in a plan; or upon written request of a plan participant or beneficiary. There are also updating requirements if significant plan changes are made. If a beneficiary has lost a copy of their plan, they can contact the plan sponsor for a replacement copy.

The customer service department of the plan sponsor, or its third party administrator, should also be able to help a beneficiary understand the benefits to which they are entitled under a plan.

What is the Risk Associated with Retiree Medical Benefits?

Retiree medical benefits represent an unfunded financial liability that must be reflected on the sponsor’s financial statements. Given the economic pressures facing corporations today, many employers are taking steps to reduce or eliminate this costly obligation.

When retiree medical plans are terminated, the beneficiaries who are not yet Medicare eligible must find individual coverage in the private health insurance market. As the cost of healthcare accelerates, these benefits become increasingly expensive to replace.

What Should a Plan Participant Do?

If a beneficiary discovers that their plan includes a “reservation of rights” provision, there is very little action that can be taken. Many plan participants do not read or fully understand their plan documentation, and learn of their exposure only after a benefit is withdrawn.
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