Supreme Court Ruling Did Not Resolve Church Plan Challenges

The next stage will be to determine if the hospital boards or plan committees fit within the principal-purpose definition and whether the hospitals are affiliated with a religious organization, says Tess Gee, with Miller & Chevalier.

Following oral arguments in March in three cases challenging health care organizations’ church plan status, the U.S. Supreme Court found plans maintained by principal-purpose organizations qualify as “church plans.”

However, it did not rule that the hospitals in these cases were principal-purpose organizations. Congress amended the church plan definition, adding the provision that: “A plan established and maintained for its employees … by a church … includes a plan maintained by an organization … the principal purpose … of which is the administration or funding of [such] plan … for the employees of a church …, if such organization is controlled by or associated with a church.”

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Tess Gee, member in the ERISA & Employee Benefits Litigation practice at Miller & Chevalier in Washington, D.C., tells PLANSPONSOR, “These cases are not over at all for these hospitals.”

She says the next stage will be to determine if the hospital boards or plan committees fit within that principal-purpose definition. The plaintiffs will also have to show they are affiliated with a religious organization.

While these determinations are legal, in part, they are very much fact-based and will have to be litigated on a case-by-case basis, Gee adds. “[Justice Elena] Kagan noted twice in separate footnotes that these were issues expressly not being addressed by the court. They were assuming committees for these three plans were principal-purpose organizations, but the issue will still have to be decided before a lower court,” she points out.

In a statement by Karen Ferguson, director of the Pension Rights Center, she says, “The court merely ruled that a religiously-affiliated entity can establish a ‘church plan’ that is exempt from federal pension law. However, the Court noted that its ruling did not address a second requirement of the law, that an exempt church plan be maintained by an ‘organization’ that has administration of the plan as its principal purpose.” She notes that the hospitals in the cases heard by the court take the position that a pension plan’s internal retirement committee is the “organization” contemplated by federal pension law.

Gee says an additional takeaway is if a sponsor of a plan thinks it falls within the church plan definition, and has gotten a determination letter from Internal Revenue Service (IRS), it doesn’t really count for much. “The Supreme Court made it clear it was not giving deference to government analyses of decisions,” she points out. “The IRS letters do say committees are principal-purpose organizations, but this isn’t expected to be given much weight in lower courts; the courts will look beyond what has been decided in the past.”

Plan sponsors that believe their plan is exempt but have no IRS letter are no worse off, because the issues will be reviewed de novo,’ Gee adds. “Plan sponsors should review the entity that is maintaining the plan and go through what the church plan exemption requires with respect to the principal-purpose organization definition to see if it satisfies the definition.”

Reducing Health Care Costs Through Behavioral Modification

Minimal behavior change can significantly reduce the costs of health care in retirement and potentially allow employees to save more towards retirement, a study finds.

Rising health care costs are projected to be the most burdensome expenses in retirement, but minimal behavioral change can significantly lower the price tag. These conclusions are from HealthView Services’ 2017 Retirement Health Care Costs Data Report, which draws from 70 million health care cases as well as actuarial, government and economic data.

According to a HealthView case study cited in the report, a 50-year-old with Type II diabetes who follows doctor’s orders can potentially add eight additional years to life expectancy and save an average of $5,000 annually in out-of-pocket costs before retirement. The firm notes that if the same individual invests that sum into a fund that earns a 6% return, that person would have more than $120,000 by age 65 or an extra $14,000 per year (assuming the person lives to the actuarial projected age of 80). With another $2,750 per year in health care savings in retirement, this individual would have generated almost $17,000 more in annual retirement income.

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These findings emphasize the importance of communicating effective benefits packages in order for employees to make the most out of the offerings most beneficial to them. Adding a health component to financial wellness programs or adopting programs that incentivize healthy behavior may help as well.

But participants who don’t address their health issues through behavior modification could be looking at a very expensive retirement, as could employers enduring higher health care costs.

According to HealthView, retirement health care cost inflation is expected to increase at an annual rate of 5.47% for the next decade. This translates to triple the rate of inflation between 2012 and 2016, and more than double the projected Social Security cost-of-living-adjustments (COLAs).

The study indicates that a healthy 65-year old couple retiring today is expected to need $321,994 to cover total health care costs in retirement, when factoring in projected expenses for Medicare Part B and D premiums, as well as supplemental and dental insurance. When accounting for deductibles, copays, hearing, vision, and cost sharing, that number jumps to $404,253 in today’s dollars or $607,662 in future dollars.

Medicare Part B premiums alone jumped by 16% in 2016. So far in 2017, they have increased by 10% despite a 24% decrease predicted by the Medicare Board of Trustees.

HealthView Services reports that the main driver behind these rising expenses is the increase in retirement health care inflation.

The report notes that “Through a short-term lens, the average 65-year-old couple that retires in 2017 will pay $11,369 in their first year for health care—$670 more than the same couple retiring in 2016. By age 85, those 2017 retirees will spend $39,208 (or $1,915 more for the same coverage than last year’s retirees).”

Women in particular may face a larger burden due to increased life expectancy. HealthView finds that women live on average two years longer than men. The firm projects that expected health care costs for a healthy 63-year-old woman retiring this year (living to age 89) would need $362,607 in future dollars or 29.9% more than a 65-year-old male.

But regardless of age or gender, the firm finds that minimal behavioral change can reduce health care expenses and boost savings as well as longevity.

“Although these numbers may seem out of reach, the savings required to cover health care when meeting retirement savings goals are often more modest than might be expected,” says HealthView President and CEO Ron Mastrogiovanni. “A 55-year-old can increase 401(k) contributions by as little as $17 per paycheck to address their retirement health care premiums, assuming a company match of 50% and they are meeting an 85% incomer replacement ratio savings goal.”

The full 2017 Retirement Health Care Costs Data Report can be found at HVSFinancial.com

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