Two recent cases (Acosta v. Macy’s, Inc. and Erwood v. Life Ins. Company of North America) serve as reminders of how easy it is for plan administrative practices to diverge from plan documents. The cases also illustrate the risks of allowing this to happen.

Healthcare services are, increasingly, being delivered in less resource-intensive settings. This “downstreaming” of care will only increase in the years to come and promises to produce lower costs, meet consumer preferences and take advantage of technological advances. However, downstreaming of care will also have significant implications for patients, payers and providers.

Employee benefit plans are a way to build “human capital” – defined as the abilities and qualities of people that make them productive. As healthcare costs absorb an increasing share of benefits funding, employers need to find new ways to help employees become secure in their ability to obtain health care, to meet other life exigencies, and to finance their needs in retirement. This blog explains the different approaches available to employers to do more with less in building employees’ human capital.

As Republican legislators continue their efforts to repeal and replace the Affordable Care Act, they keep on looking for new ways to separate portions the insurance markets into different segments. These efforts run counter to some key actuarial and insurance principles: segmenting the risk pool increases volatility and that creation of different risk pools based on health status can lead to increased premiums for many.

As more Americans work past 65, an increasing number are able to join Medicare and retain employer coverage. However, the intersection of Medicare and employer coverage has a number of traps for the unwary and some of these traps come with significant financial consequences. It is important for individuals – and employers – to understand Medicare’s complex rules and to be alert to these traps.