美国人力资源管理—福利管理-教学课件8.ppt

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1、8-1Chapter 8Government-Mandated Social Security and Workers Compensation Programs McGraw-Hill/IrwinCopyright 2011 The McGraw-Hill Companies,Inc.All rights reserved.8-2LEARNING OBJECTIVESBasic Social Security programs affecting employment:OASDI,Medicare,and unemployment insuranceAdministration and fu

2、nding of Social Security programsStructure of Social Security program benefitsReasoning behind workers compensation insuranceTypes of workers compensation claims8-3SOCIAL SECURITY PROGRAMSOld-Age,Survivor,and Disability Insurance(OASDI)MedicareUnemployment InsuranceSupplemental Security Income Benef

3、itsTwo federal agencies oversee Social Security programs:The Social Security Administration and the Centers for Medicare and Medicaid Services.Programs were designed to further the“common good”;ensuring progressive wages and benefits that allow employees to participate fully in a consumer-based econ

4、omy.8-4Social Security Program EligibilitySee Exhibit 8.1OASDI/Medicare Exempt from OASDI ONLY:1.Civilian employees of the federal government&railroad employees with at least 10 years of service;Exempt from Social Security contributions:1.Employees of state&local governments who are already covered

5、under other retirement plans;2.Children under 21 who work for a parent;however must participate if 18 or over and work for parents business.Interesting Facts.Social Security is the major source of income for most elderlySocial Security provides more than just“retirement”.In 2008 more than 50 million

6、 Americans received more than$53 billion in Social Security benefits.The aging workforce is placing a strain on the Social Security because there will be more retired individuals receiving benefits than employed individuals contributing to the program.In 2032,there will be just 2.1 workers per benef

7、iciary compared to 3.3 workers per beneficiary in 2007.8-5UNEMPLOYMENT INSURANCEThe current economic recession has pushed the unemployment rate at the time of this writing to almost 10%;the highest rate in 28 years.As an initial reaction,Congress passed the Emergency Unemployment Insurance Program(E

8、UC)in June 2008 to supplement unemployment benefits.Additionally,in 2009 significant temporary enhancements were made under the American Recovery and Reinvestment Act of 2009(ARRA)which provided 13 additional weeks of benefits as well as a$25 weekly increase in benefit amount.The Act is set to expir

9、e on December 31,2009;however Congress may,once again,vote for a benefit extension.8-6Unemployment Insurance AdministrationFederal LevelThe Employment and Administration in the U.S.Dept.of Labor oversees unemployment insurance programs.Both federal and state payroll taxes are collected to fund benef

10、it costs;however the federal portion is used to actually administer the benefit.State LevelThe states share of benefit costs may be used for actual employee benefits only.State employment security agencies/offices oversee the administration of the program.States also maintain records,collect taxes,p

11、rocess claims,and distribute benefits.8-7Qualifying For OASDI BenefitsThe Social Security System uses a system of credits to determine whether eligible individuals qualify for OASDI and Medicare benefits.Employees accumulate“credits”based on their payment of Social Security taxes.Employees earn one

12、social security“credit”for each$1090 of earnings,subject to a maximum of four credits per calendar year.Employees typically must have 40+credits to be eligible for retirement benefits.The number of credits required to qualify for benefits depends on a persons age and the particular Social Security b

13、enefit.8-8DETERMINING OASDI BENEFITSAverage Indexed Monthly Earnings (AIME)Sets Primary Insurance Amount(PIA)Cost of Living Adjustments(COLAs),Guards Against InflationBased on Consumer Price Index(CPI),from Department of LaborAverage Indexed Monthly Earnings(AIME)represent a persons earnings prior t

14、o age 62,disability,or death adjusted for fluctuations in income and average changes in the economy over the same period.AIME is used to ensure that participants benefits are proportionally the same.Adjustments to basic rates are made based on the Consumer Price Index which tracks the changes in the

15、 costs of goods and services in the U.S.Effective January 2009,the annual increase in Social Security benefits was 5.8 percent.8-9Old Age BenefitsEarly retirement at 62;however benefits are reduced to account for a longer benefit period.Retirement Age is gradually increasing from 65 years and will r

16、each 67 years in 2022.The retirement program includes incentives for individuals to delay their retirement until reaching full retirement age.Individuals may receive retirement credits until age 70 subject to a maximum percentage increase.8-10OASDI BENEFITS FOR FAMILY MEMBERSWife or husband age 62 a

17、nd olderWife or husband under 62,if she or he is taking care of children under 16 or is disabledFormer husband or wife age 62 and olderChildren up to age 18,ages 18-19 if full time students through 12th grade or disabled children of any ageThe OASDI program includes an offset program to reduce the d

18、ollar amount for a dual income family so that the working spouse does not receive two Social Security retirement payments.8-11DISABILITY BENEFITS ELIGIBILITYMental or Physical Impairment Lasting 12 MonthsMust Have 40 Credits,20 Credits in Last 40 Quarters6 Month Waiting PeriodBlinded Workers Need on

19、ly 40 CreditsWorkers Age 23,6 Credits in 3 YearsWorkers 24-31,Work Half of Period8-12MEDICAREPart A-Hospitalization InsurancePart B-Supplemental Health Insurance Medigap-Supplements Parts A&BMedicare Advantage:Part CMedicare Prescription Drug Benefit:Part D8-13MEDICARE PART A COVERAGEInpatient hospi

20、tal care in a semiprivate room,meals,general nursing,and other hospital supplies and services Home health services Hospice care Skilled nursing facility care 8-14MEDICARE PART B COVERAGEVoluntary Medical Insurance80%of Services&Supplies,$100 DeductibleDiagnosis,Therapy,&SurgeryConsultationMedical Se

21、rvices&SuppliesMedication,not Self-AdministeredOutpatient Hospital ServicesStructureVoluntary supplemental insurance is structured similarly to indemnity medical insurance.After the deductible is met,expenses are paid at 80%.8-15MEDIGAP COVERAGESupplements Parts A&BOffered by Private Insurers10 Choi

22、ces in Level of ProtectionMedicare Select Offers Protection with Lower Premiums,Less ChoiceAvailable in 47 States8-16MEDICARE ADVANTAGE:PART CEstablished in 1997 Protection from Private PlansFee-for-ServicesManaged CareMedical Savings AccountsNovember Enrollment PeriodExtended Benefits in 20068-17ME

23、DICARE PRESCRIPTION DRUG BENEFIT Covers 75%of prescription drug costs after a calendar year deductible of$295 up to$2700.After that,expenditures up to$4350 are not covered by Medicare.This is called the“donut hole”.Medicare covers 95%of prescriptions for each dollar spent in excess of$4350 spent dur

24、ing the calendar year.8-18MEDICARE AS PRIMARY PAYERIndividual with Medicare coverage may also have another individual or employer-sponsored health insurance plan.Medicare is the primary if the secondary is:a retiree health insurance program;an employer-sponsored health insurance plan with less than

25、20 employees;or COBRA.Other more specific rules apply to employer or union-based health insurance benefits.No-fault insurance,liability insurance,and black lung benefits are always primary.8-19FINANCING OASDI&MEDICARE PROGRAMSFICA Requires Equal Employer&Employee ContributionsAt 7.65%for both partie

26、s beginning in 199015.3%for self-employedOASDI ProgramsSECA Requires Self-Employed to Pay 15.3%in 200715.3%for OASDI2.90%for MedicareThe Medicare tax supports Medicare Part A.Employers and employee contribute 1.45%while the self-employed contribute 2.9%.Social Security benefits are adequately funded

27、 through 2019;without changes in the tax structure the fund would be depleted in 2040.8-20UNEMPLOYMENT DISQUALIFYING EVENTSRefusal of Suitable WorkMisconductParticipation in a Labor DisputeRegular Breaks During SchoolDeliberate Misrepresentation to Receive Benefits8-21Unemployment InsuranceEligibili

28、ty CriteriaMust be involuntary separationMinimum wage earnings metA waiting period in most statesA capacity to workWorker is actively seeking workUnemployment Insurance provides a weekly benefit to those who are unemployed through no fault of their own.8-22UNEMPLOYMENT BENEFIT AMOUNTSVaries by State

29、-No Federal Rules Maximum of 26 Weeks(13 week extension may be granted)Due to recent economic recession,21 additional weeks may be added to the permanent programFunded by FUTA tax;currently employers pay 6.2%of first$7,000 earned by each employee(the minimum taxable wage set by FUTA).However states

30、have established their own taxable wage base that ranges from$7,000 to$35,700.An employers actual tax burden varies according to their experience rating.8-23WORKERS COMPENSATION OBJECTIVESTo provide sure,prompt,and reasonable income and medical benefits to work-accident victims,or income benefits to

31、 their dependents,regardless of fault.To provide a single remedy and reduce court delays,costs,and workloads arising out of personal injury litigation.To relieve public and private charities of financial drains.To eliminate payment of fees to lawyers and witnesses as well as time-consuming trials an

32、d appeals.To encourage maximum employer interest in safety and rehabilitation through appropriate experience-rating mechanisms.To promote frank study of causes of accidents(rather than concealment of fault),reducing preventable accidents and human suffering 8-24There is a Difference!Workers compensa

33、tion differs from Social Security disability insurance and Medicare.It pays for medical care for work-related injuries beginning the date/time of incident.It pays temporary disability benefits and may pay permanent partial or permanent total disability payments.It may pay for rehabilitation and trai

34、ning.Social Security pays disability benefits but only when the disability precludes work.It may also pay for rehabilitation.Social Security also pays survivor benefits and typically begins 5 months from date of incident.8-25WORKERS COMPENSATION COSTSIn December 2008,employers generally paid$0.46 pe

35、r civilian employee for each hour worked to provide workers compensation protectionThe hourly amount was substantially higher for workers in goods-producing industries at$0.84,and substantially lower for employees in service-providing industries at$0.36Although these amounts represent no more than 3

36、 percent of the total compensation costs(that is,the total cost of wages,salary,and all employer-sponsored benefits),the annual costs for employees in goods-producing industries is quite highThere is wide variation in the cost of workers compensation from state to state8-26Claims,Benefits,and Income

37、Claims1.Injury at work2.Occupational disease3.Death claimBenefit1.Unlimited 2.Medical care3.Disability income4.Death benefit5.Rehabilitation servicesTypes of Disabilities&IncomeTemporary total disabilitiesTemporary partial disabilitiesPermanent disabilitiesPermanent partial disabilities-scheduled in

38、juries-nonscheduled injuriesStates determine benefit amounts/duration based upon either the impairment or wage-loss approach.8-27TortsDual Capacity is a legal doctrine that applies to the relationship between the employer and the employee.An employers action does not protect it from common law activ

39、ity generated by the employee.Employers have four typical responses to employee tortes:1.Pre-existing condition2.Employee negligence3.Employee conduct4.Safety violations by the employeeAn Employers Intentional ActsMost courts hold intentional acts to harm employees as the necessary basis for employe

40、e-initiated tortes.An employee may initiate one of two types of lawsuits:deliberate and knowing tortes or violations of an affirmative duty.Employees in most states also have the right to litigate based upon employer retaliation for either filing a claim or pursuing their rights under workers comp.8

41、-28Financing&Tax Obligations for Workers CompWorkers comp laws specify the permissible methods of funding.Employers general ascribe to workers compensation insurance through private carriers or in some instances through state funds.A third option is self-insurance which requires bonding and self-adm

42、inistration of the plan.Taxes are paid on benefits only when:The employee returns to work for light duty.When they offset Social Security,Old Age,Survivor,or OASDI benefits.When benefit does not directly result from work related injury.8-29Its a relationshipWorkers compensation laws may modify some

43、of the provisions under FMLA and COBRA.FMLA guarantees leave and the right for the employee to return to their job or a substantially similar position.Employees may continue their health insurance during and after a qualifying event.This chapter identifies and explains government-mandated social security and workers compensation programs.It also identifies and clarifies the relationship(s)between the various government-sponsored or regulated benefits.