PA 15-93—sSB 913

Labor and Public Employees Committee

Planning and Development Committee

Insurance and Real Estate Committee

AN ACT CONCERNING THE ENROLLMENT OF NONSTATE PUBLIC EMPLOYEES IN THE STATE EMPLOYEE HEALTH PLAN

SUMMARY: This act requires the comptroller to offer nonstate public employers coverage under the state employee health insurance plan for their employees and retirees. It defines “nonstate public employer” as a municipality or other state political subdivision, including a board of education, quasi-public agency, or public library. A municipality and a board of education may be considered separate employers.

The act requires nonstate employees and retirees to be pooled with the state employee plan as long as their employer's application is approved under the act's requirements. Prior law allowed the comptroller to provide insurance to these same people and employers under another state health care plan, known as the partnership plan, but it did not pool them with state employees.

Beginning October 1, 2015, the act closes the partnership plan to new enrollment by nonstate public employers. It does not require any nonstate public employer enrolled in the partnership plan to enroll in the state plan.

If an employer seeks to cover fewer than all of its employees under the state plan, the comptroller must forward the application to the Health Care Cost Containment Committee (HCCCC) to review it for a potential disproportionate shift of an employer's medical risks. If the committee finds a disproportionate shift, then the comptroller must deny the application. The act outlines the application process and other details related to joining the state plan.

Under the act, premium payments for coverage must be set at the same rate as those for the state employee plan. The act permits the comptroller to charge an administrative fee.

The act requires a nonstate public employer to pay monthly premiums in an amount determined by the comptroller for providing coverage for the group's employees and retirees. It permits an employer to require a covered employee or retiree to pay part of the coverage cost, subject to any applicable collective bargaining agreement.

Lastly, the act prohibits the comptroller from offering nonstate employees coverage under the state plan until the State Employees' Bargaining Agent Coalition (SEBAC) consents to incorporate the act's terms into its collective bargaining agreement and submits this consent to both chambers of the General Assembly.

EFFECTIVE DATE: October 1, 2015, except for the sections providing definitions and requiring SEBAC consent, which are effective upon passage.

POOLING NONSTATE PUBLIC EMPLOYEES IN THE STATE EMPLOYEE HEALTH PLAN

The act requires the comptroller to offer to any nonstate public employer coverage under the state employee health insurance plan for its nonstate public employees and retirees. Under the act, nonstate public employees include employees and elected officials.

The act requires that such nonstate participants be pooled with the state employee plan as long as the employer application is approved under the act's requirements. Prior law allowed the comptroller to provide insurance to these same employees and employers under another state plan, known as the partnership plan, but it did not pool them with state employees. The act closes the partnership plan to any new nonstate public employees beginning October 1, 2015. It also specifies that nothing in the act requires any nonstate public employer enrolled in the partnership plan to enroll in the state plan.

Premium payments under the act must be at the same rate as those for the state plan, including state employee contributions, and the employer must make payments to the comptroller. It permits the comptroller to charge a monthly, per-member administrative fee. A nonstate public employer may require each nonstate public employee to contribute a portion of the cost of his or her coverage under the plan, subject to any collective bargaining obligation applicable to such nonstate public employer.

The act specifies that it does not (1) require the comptroller to offer coverage to every nonstate public employer seeking coverage under the state employee plan and (2) prohibit the comptroller from procuring coverage for nonstate public employees from other vendors who are not providing state employee coverage.

Application Process

The act requires the comptroller to create applications for coverage under, and renewal of, the state employee plan. The applications must require a nonstate public employer to disclose whether it will offer any other health care benefits plan to employees offered the state employee plan. Under the act, employees covered by a nonstate public employer with a health plan or insurance arrangement operated through a trust established according to collective bargaining under the federal Labor Management Relations Act cannot enroll in the state plan.

The act allows a nonstate public employer to submit an application for coverage under the state employee plan to the comptroller. If an employer applies for coverage of all of its nonstate public employees, the comptroller must provide coverage by the first day of the third calendar month following such application.

If a nonstate public employer applies for coverage for less than all of its nonstate public employees, or indicates that it will offer other health plans to the employees who are offered the state health plan, the comptroller must forward the application to HCCCC for review within five business days after receiving it. This requirement does not apply if the employer is not covering all employees because (1) some employees have declined coverage on their own or (2) the employer chose not to cover temporary, part-time, or durational employees.

Disproportionate Medical Risks

The act requires HCCCC to examine the applications it receives to determine if the application will shift a significantly disproportionate part of a nonstate public employer's medical risks to the state employee plan. It must make this determination within 30 days after receiving the application.

If HCCCC certifies to the comptroller that the application will shift a significantly disproportionate part of an employer's medical risks to the state employee plan, the comptroller cannot provide that employer coverage. If HCCCC does not certify a disproportionate shift, the comptroller must provide coverage by the first day of the third calendar month following the deadline for receiving the certification.

Collective Bargaining and Other Provisions

The act requires a nonstate public employer's initial and continuing participation in the state employee plan to be a mandatory subject of collective bargaining and subject to binding interest arbitration according to the same procedures and standards that apply to other mandatory subjects of bargaining under the state employee, municipal employee, or teacher bargaining laws.

The act specifies that the state plan is not (1) an unauthorized insurer or (2) a multiple employer welfare arrangement. Any licensed insurer in this state may conduct business with the state employee plan.

Retirees

The act allows any nonstate public employer eligible to enroll its employees in the state employee plan under the act to also apply for coverage of its retirees. Premiums charged for retiree coverage must be the same as the state's premiums, including any premiums paid by retired state employees. The act otherwise provides the same application process for retirees as for employees, including: (1) prohibiting approval of applications that HCCCC determines will shift a significantly disproportionate part of retiree medical risks to the state plan and (2) the timeframes for an application's approval or rejection.

Plan Renewal and Withdrawal

The act requires the comptroller to offer coverage in the plan for periods of at least three years.

He must also develop procedures for nonstate public employers already in the plan to (1) apply for renewal or (2) withdraw from such coverage. A nonstate public employer may apply for renewal before each interval's expiration.

The procedures must at least address:

1. the terms and conditions allowing a nonstate public employer to withdraw before the expiration date of the current coverage,

2. refunds to employers for premium payments or premium equivalent payments made in excess of incurred claims, and

3. the process of any unionized employees withdrawing from the plan in accordance with relevant state collective bargaining laws.

Monthly Premiums

The act requires a nonstate public employer to pay monthly premiums in an amount determined by the comptroller for providing coverage for the group's employees and retirees. Late payments are subject to interest at the prevailing rate, as determined by the comptroller. The act permits an employer to require a covered employee or retiree to pay part of the coverage cost, subject to any applicable collective bargaining agreement.

If an employer fails to make premium payments, the act authorizes the comptroller to direct the state treasurer, or any state officer who holds state money (i. e. , grants, allocations, or appropriations) owed the employer, to withhold payment. The money must be withheld until the (1) employer pays the comptroller the past due premiums plus interest or (2) treasurer or state officer determines that arrangements satisfactory to the treasurer have been made for paying the premiums and interest.

The act prohibits the treasurer or state officer from withholding state money from the group if doing so impedes receipt of any federal grant or aid.

State Employee Plan Premium Account

The act establishes a separate, nonlapsing state employee plan premium account in the General Fund. The comptroller must (1) deposit the premiums collected from nonstate public employers, employees, and retirees into this account and (2) administer the account, with the advice of HCCCC, to pay claims and administrative fees to entities providing coverage or services under the plan.

BACKGROUND

Related Act

PA 15-5, June Special Session, 416 and 417, permits the UConn Board of Trustees to provide health care coverage for UConn graduate assistants and fellows through the partnership plan.

OLR Tracking: JLK: ND: MS: bs