IMHO: “Smoke” Signals

June 7, 2011 (PLANSPONSOR.com) - Plan sponsors spend a lot of time wondering – and worrying – about the “right” way to do things. 

They rely on the guidance of experts, the insights of publications like ours, the black – though often gray – letter of the law – and sometimes they must rely on the occasionally contradictory adjudications of the courts.   

Those contradictions have been much in evidence in the series of 401(k) revenue-sharing lawsuits, which, IMHO, continue to suffer from what seems to be a confusing “flexibility” in judicial discernment regarding the standards of fiduciary responsibility and application of ERISA’s 404(c ) safe harbors.  In fact, it is only a matter of time until some plan sponsor somewhere files an injury claim for whiplash incurred from simply trying to keep up with the direction of these decisions. 

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The most recent example was the case of Gerald George vs. Kraft Foods Global– a case the 7th U.S. Circuit Court of Appeals remanded (albeit in a split 2-1 decision) for further deliberation to a district court – that had already determined that there was no issue presented that required a formal adjudication, while granting the employer-defendant’s motion for summary judgment. 

That district court, which relied heavily on the decision of this same federal appellate court ruling in Hecker v. Deere & Coeil, reasoned that ERISA requires only that fiduciaries use a “reasoned decisionmaking process” that utilizes the appropriate methods to decide on a proper course of action in running a plan, and that in continuing to employ its current recordkeeper (Hewitt Associates) , the Kraft fiduciaries were under no obligation “to scour the market” for the cheapest fund or service provider (see Reasonable Redoubts).

However, in the recent appellate decision we find that, since hiring Hewitt in 1995, the plan’s fiduciaries had not solicited competitive bids from other recordkeepers – a finding that raised my eyebrows, as it doubtless would most retirement professionals.  Now, one should always be careful in reading judicial explanations of the facts on which they based their decisions as a complete picture, but this court said that the defendants “…emphasized that they engaged several independent consultants for advice as to the reasonableness of Hewitt’s fee and argued that in doing so they satisfied their duty to ensure that Hewitt’s fees were reasonable” – a statement that the appellate court juxtaposed against a statement that, over a 10-year period, “fees paid to Hewitt ranged between $43 and $65 per participant per year”. 

The implication seemed to be that casual conversations with “independent consultants” were no replacement for a full-blown competitive bidding process – and the fee trend, lacking context, was an eye-opener as well.  But the district court outlined a series of plan changes and negotiations over that time period that painted a very different picture – and were anything but “casual”.  True, one might well wonder why a full RFP wasn’t issued, but the district court opinion paints a picture of lots of merger-related plan changes, an active discussion, review, and comparison of fees, alongside a pattern of negotiation that both reduced fees and/or expanded services over the period in question.  In sum, the picture painted by the lower court’s opinion was the kind of thing you might expect to come from a full competitive bid without the time, pain, and yes – expense – of undertaking it.  And, yes, it was documented. 

That said, the appellate court found error in the district court’s dismissal based on a finding that the “defendants satisfied their duty of prudence by relying on the advice of their consultants”, going on to note that “although the fact that defendants engaged consultants and relied on their advice with respect to Hewitt’s fee is certainly evidence of prudence, it is not sufficient to entitle defendants to judgment as a matter of law”(1).

Ultimately, while some commentators have painted this opinion as a reversal of fortunes for employers in these cases, I am disinclined to see it that way.  Rather, to my reading you have a court that sees just enough smoke (2) to wonder if there might be a fire; a large plan that went a decade without a formal RFP (3).  Determining not that not doing so was inherently imprudent (4) – but that making that determination would require a more complete airing of the facts.

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(1) In explaining its determination, the court cited Donovan v. Cunningham, 716 F.2d 1455, 1474 (5th Cir. 1983) (stating that “[a]n independent appraisal is not a magic wand that fiduciaries may simply waive over a transaction to ensure that their responsibilities are fulfilled”);

(2) There were also issues raised about the use of two different accounting structures in two different plans for its company stock funds, and questions about how float was accounted for, in addition to questions about the use of actively managed funds.  In fact, considering the volume of the opinion dedicated to it, the company stock accounting may well have been the most compelling triable issue of fact for the appellate court.

(3) The appellate court also took issue with the district court’s dismissal of testimony by an expert witness by the plaintiffs.  According to the appellate court, Lawrence R. Johnson reviewed the process that defendants followed when they extended Hewitt’s contract and opined that defendants acted imprudently by extending the contract without first soliciting bids from other recordkeepers.  The district court found his expertise was limited to mid-sized plans and dismissed it, while the appellate court said that “defendants have not pointed to any differences between the recordkeeping needs of mid-sized and large plans that would make experience with mid-sized plans an insufficient qualification for rendering an opinion about the recordkeeping needs of a large plan”.

(4) In a “spirited” dissent, Judge Richard D. Cudahy, who characterized the lawsuit as an “implausible class action based on nitpicking with respect to perfectly legitimate practices of the fiduciaries”, noted that “If plaintiffs can find one “expert” who will testify that the fee is too high, must there be a trial? Here, the trustees have a relationship with Hewitt going back fifteen years. They have a good sense of the dimensions of the job and Hewitt’s performance in carrying it out. Must they substitute any lower bidder that happens along?” 

Rescissions Under the PPACA

June 7, 2011 (PLANSPONSOR.com) - There have been quite a few questions on the new rescission rule under PPACA and how the rule applies in many practical situations, such as a plan terminating an individual's coverage back to the date of termination of employment (a fairly typical occurrence). 

 

Technically, this is a retroactive change, but is it a “rescission” under the new rules? 

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What is a “rescission”?

The PPACA regulations broadly define a “rescission” as a cancellation or discontinuance of coverage that has a retroactive effect.  The regulations say a cancellation is not considered a rescission if it is prospective only or is due to a failure to timely pay required premiums or contributions toward the cost of coverage.

Are there any circumstances in which rescission will be permitted?

The regulations  provide that a rescission will be permitted only if the individual has performed an act, practice or omission that constitutes fraud, or the individual has made an intentional misrepresentation of a material fact as prohibited by the terms of the plan or coverage.

Can a plan rescind coverage retroactively if there has been a mistake?

This may depend on who made the mistake and how much time has elapsed.  The regulations include an example where a plan mistakenly failed to terminate an employee who went from full-time to part-time, which normally would not have been covered under the plan.  The mistake went on for several months, with the employer continuing to deduct premiums for coverage.  The example says that the plan could not terminate coverage back to the date the employee went to part-time status because there was no evidence of fraud of intentional misrepresentation.  Later Q&A guidance explains that, in the example, the employee may have “relied” upon the coverage “for some time,” suggesting that if the mistake was caught earlier or if no premiums had been deducted, giving the employee a reason to rely on the coverage, perhaps the plan would have been able to retroactively cancel coverage.

Our plan reconciles our eligibility feed once a month and retroactively terminates coverage back to the date of an employee’s termination.  Is this a rescission?

The Q&A guidance says that, where a human resources department reconciles lists of eligible individuals via data feed once per month, and the employee has not paid premiums, this would not be considered a rescission, even if the termination is retroactive to date of termination of employment.  It is not clear whether the guidance is limited to these particular facts, or whether the Q&A also would permit a reconciliation that extends beyond a month or where an employee may have paid premiums.    

May a plan terminate coverage retroactively to the date of a participant's COBRA qualifying event?

COBRA generally says that, when someone elects COBRA, their COBRA is counted from the date of their qualifying event, meaning their active coverage ends as of that date.  However, for some events, such as divorce or death, the participant may not notify the plan of the qualifying event until well afterwards (the participant has 60 days to notify the plan and elect COBRA).  So, under COBRA, plans would terminate the individuals coverage retroactively back to the date of the qualifying event.  The Q&As clarify that the agencies do not consider this to be a rescission of coverage.

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You can find a handy list of Key Provisions of the Patient Protection and Affordable Care Act and their effective dates at http://www.groom.com/HCR-Chart.html  

Contributors:

Christy Tinnes is a Principal in the Health & Welfare Group of Groom Law Group in Washington, D.C.  She is involved in all aspects of health and welfare plans, including ERISA, HIPAA portability, HIPAA privacy, COBRA, and Medicare.  She represents employers designing health plans as well as insurers designing new products.  Most recently, she has been extensively involved in the insurance market reform and employer mandate provisions of the health-care reform legislation.

Brigen Winters is a Principal at Groom Law Group, Chartered, where he co-chairs the firm's Policy and Legislation group. He counsels plan sponsors, insurers, and other financial institutions regarding health and welfare, executive compensation, and tax-qualified arrangements, and advises clients on legislative and regulatory matters, with a particular focus on the recently enacted health-reform legislation.

PLEASE NOTE:  This feature is intended to provide general information only, does not constitute legal advice, and cannot be used or substituted for legal or tax advice.

 

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