Bill Text: CT SB00233 | 2015 | General Assembly | Comm Sub
Bill Title: An Act Adding Volunteer Fire Departments And Volunteer Firefighters To The Partnership Plan.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2015-02-27 - Public Hearing 03/03 [SB00233 Detail]
Download: Connecticut-2015-SB00233-Comm_Sub.html
General Assembly |
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January Session, 2015 |
LCO No. 3615 | ||
*03615SB00233INS* | |||
Referred to Committee on INSURANCE AND REAL ESTATE |
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Introduced by: |
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(INS) |
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AN ACT ADDING VOLUNTEER FIRE DEPARTMENTS AND VOLUNTEER FIREFIGHTERS TO THE PARTNERSHIP PLAN.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Section 3-123aaa of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
As used in this section and sections 3-123bbb to 3-123hhh, inclusive, as amended by this act:
(1) "Health Care Cost Containment Committee" means the committee established in accordance with the ratified agreement between the state and the State Employees Bargaining Agent Coalition pursuant to subsection (f) of section 5-278.
(2) "Nonprofit employee" means any employee of a nonprofit employer.
(3) "Nonprofit employer" means (A) a nonprofit corporation, organized under 26 USC 501, as amended from time to time, that (i) has a purchase of service contract, as defined in section 4-70b, or (ii) receives fifty per cent or more of its gross annual revenue from grants or funding from the state, the federal government or a municipality or any combination thereof, or (B) an organization that is tax exempt pursuant to 26 USC 501(c)(5), as amended from time to time.
(4) "Nonstate public employee" means any employee or elected officer of a nonstate public employer.
(5) "Nonstate public employer" means a municipality or other political subdivision of the state, including a board of education, quasi-public agency or public library. A municipality and a board of education may be considered separate employers.
(6) "Partnership plan" means a health care benefit plan offered by the Comptroller to nonstate public employers, [or] nonprofit employers or volunteer fire departments under section 3-123bbb, as amended by this act.
(7) "State employee plan" means a self-insured group health care benefits plan established under subsection (m) of section 5-259.
(8) "Volunteer fire department" or "department" means a fire company or department located in this state whose membership is comprised of volunteer firefighters.
(9) "Volunteer firefighter" means an active member of a volunteer fire department who is a volunteer and performs fire duties, as set forth in section 7-314.
Sec. 2. Section 3-123bbb of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
(a) (1) Notwithstanding the provisions of title 38a, the Comptroller shall offer to nonstate public employers and nonprofit employers, and their respective retirees, if applicable, and volunteer fire departments, coverage under a partnership plan or plans. Such plan or plans may be offered on a fully-insured or risk-pooled basis at the discretion of the Comptroller. Any health insurer, health care center or other entity that contracts with the Comptroller for the purposes of this section and any fully-insured plan offered by the Comptroller under such contract shall be subject to title 38a. Eligible employers and departments shall submit an application to the Comptroller for coverage under any such plan or plans.
(2) (A) Beginning January 1, 2012, the Comptroller shall offer coverage under such plan or plans to nonstate public employers.
(B) Beginning January 1, 2013, the Comptroller shall offer coverage under such plan or plans to nonprofit employers.
(C) Beginning January 1, 2016, the Comptroller shall offer coverage under such plan or plans to the volunteer fire departments.
(b) (1) The Comptroller shall require nonstate public employers, [and] nonprofit employers and volunteer fire departments that elect to obtain coverage under a partnership plan to participate in such plan for not less than two-year intervals. An employer or department may apply for renewal prior to the expiration of each interval.
(2) The Comptroller shall develop procedures by which:
(A) Such employers and departments may apply to obtain coverage under a partnership plan, including procedures for nonstate public employers that are currently fully insured, [and] procedures for nonstate public employers that are currently self-insured and procedures for volunteer fire departments;
(B) Employers and departments receiving coverage for their employees and volunteer firefighters pursuant to a partnership plan may (i) apply for renewal, or (ii) withdraw from such coverage, including, but not limited to, the terms and conditions under which such employers and departments may withdraw prior to the expiration of the interval and the procedure by which any premium payments such employers or departments may be entitled to or premium equivalent payments made in excess of incurred claims shall be refunded to such employer or department. Any such procedures shall provide that nonstate public employees covered by collective bargaining shall withdraw from such coverage in accordance with chapters 113 and 166; and
(C) The Comptroller may collect payments and fees for unreported claims and expenses.
(c) (1) The initial open enrollment for nonstate public employers shall be for coverage beginning July 1, 2012. Thereafter, open enrollment for nonstate public employers shall be for coverage periods beginning July first.
(2) The initial open enrollment for nonprofit employers shall be for coverage beginning January 1, 2013. Thereafter, open enrollment for nonprofit employers shall be for coverage periods beginning January first and July first.
(3) The initial open enrollment for volunteer fire departments shall be for coverage beginning January 1, 2016. Thereafter, open enrollment for volunteer fire departments shall be for coverage periods beginning July first.
(d) Nothing in this section or sections 3-123ccc, as amended by this act, and 3-123ddd shall require the Comptroller to offer coverage to every employer or department seeking coverage under sections 3-123ccc, as amended by this act, and 3-123ddd from every partnership plan offered by the Comptroller.
(e) The Comptroller shall create applications for coverage for the purposes of sections 3-123ccc, as amended by this act, and 3-123ddd and for renewal of a partnership plan. Such applications shall require an employer or a department to disclose whether the employer or department will offer any other health care benefits plan to the employees or volunteer firefighters who are offered a partnership plan.
(f) (1) No employee shall be enrolled in a partnership plan if such employee is covered through such employee's employer by health insurance plans or insurance arrangements issued to or in accordance with a trust established pursuant to collective bargaining subject to the federal Labor Management Relations Act.
(2) No volunteer firefighter shall be enrolled in a partnership plan if such firefighter is covered under a group health and accident and hospital plan pursuant to section 7-464 or another health insurance plan or policy.
(g) (1) The Comptroller shall take such actions as are necessary to ensure that granting coverage to an employer or a volunteer fire department under sections 3-123ccc, as amended by this act, and 3-123ddd will not affect the status of the state employee plan as a governmental plan under the Employee Retirement Income Security Act of 1974, as amended from time to time. Such actions may include, but are not limited to, cancelling coverage, with notice, to such employer or department and discontinuing the acceptance of applications for coverage from nonprofit employers and volunteer fire departments. The Comptroller shall establish the form and time frame for the notice of cancellation to be provided to such employer or department.
(2) The Comptroller shall resume providing coverage for, or accepting applications for coverage from, nonprofit employers and volunteer fire departments if the Comptroller determines that granting coverage to such employers and departments will not affect the state employee plan's status as a governmental plan under the Employee Retirement Income Security Act of 1974, as amended from time to time.
(3) The Comptroller shall make a public announcement of the Comptroller's decision to discontinue or resume coverage or the acceptance of applications for coverage under a partnership plan or plans.
(h) The Comptroller, in consultation with the Health Care Cost Containment Committee, shall:
(1) Develop and implement patient-centered medical homes for the state employee plan and partnership plans offered under this section, in a manner that will reduce the costs of such plans; and
(2) Review claims data of the state employee plan and partnership plans offered under this section, to target high-cost health care providers and medical conditions and monitor costly trends.
Sec. 3. Section 3-123ccc of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
(a) Nonstate public employers, [and] nonprofit employers and volunteer fire departments may apply for coverage under a partnership plan in accordance with this section.
(1) Notwithstanding any provision of the general statutes, initial and continuing participation in a partnership plan by a nonstate public employer shall be a permissive subject of collective bargaining and shall be subject to binding interest arbitration only if the collective bargaining agent and the employer mutually agree to bargain over such participation.
(2) If a nonstate public employer or a nonprofit employer submits an application for coverage for all of its respective employees or a volunteer fire department submits an application for coverage for all of its volunteer firefighters, the Comptroller shall accept such application upon the terms and conditions applicable to the partnership plan, for the next open enrollment. The Comptroller shall provide written notification to such employer or department of such acceptance and the date on which such coverage shall begin, pending acceptance by such employer or department of the terms and conditions of such plan.
(3) (A) Except as specified in subparagraph (D) of this subdivision, if a nonstate public employer or a nonprofit employer submits an application for coverage for less than all of its respective employees or a volunteer fire department submits an application for coverage for less than all of its volunteer firefighters, or indicates in the application the employer or department will offer other health plans to employees or volunteer firefighters who are offered a partnership plan, the Comptroller shall forward such application to a health care actuary not later than five business days after receiving such application. Not later than sixty days after receiving such application, such actuary shall notify the Comptroller whether, as a result of the employees or volunteer firefighters included in such application or other factors, the application will shift a significant part of such employer's employees' medical risks or a significant part of such department's volunteer firefighters' medical risks to the partnership plan. Such actuary shall provide, in writing, to the Comptroller the specific reasons for such actuary's finding, including a summary of all information relied upon in making such a finding.
(B) If the Comptroller determines that, based on such finding, the application will shift a significant part of such employer's employees' medical risks or a significant part of such department's volunteer firefighters' medical risks to the partnership plan, the Comptroller shall not provide coverage to such employer or department and shall provide written notification and the specific reasons for such denial to such employer or department and the Health Care Cost Containment Committee.
(C) If the Comptroller determines that, based on such finding, the application will not shift a significant part of such employer's employees' medical risks or a significant part of such department's volunteer firefighters' medical risks to the partnership plan, the Comptroller shall accept such application for the next open enrollment. The Comptroller shall provide written notification to such employer or department of such acceptance and the date on which such coverage shall begin, pending acceptance by such employer or department of the terms and conditions of such plan.
(D) (i) If an employer included less than all of its employees in its application for coverage because of [(i)] (I) the decision by individual employees to decline coverage from their employer for themselves or their dependents, or [(ii)] (II) the employer's decision not to offer coverage to temporary, part-time or durational employees, the Comptroller shall not forward such employer's application to a health care actuary.
(ii) If a volunteer fire department included less than all of its volunteer firefighters in its application for coverage because of the decision by individual volunteer firefighters to decline coverage from the department for themselves or their dependents, the Comptroller shall not forward such department's application to a health care actuary.
(b) The Comptroller shall consult with a health care actuary who shall develop:
(1) Actuarial standards to assess the shift in medical risks of an employer's employees or a volunteer fire department's volunteer firefighters to a partnership plan. The Comptroller shall present such standards to the Health Care Cost Containment Committee for its review, evaluation and approval prior to the use of such standards; and
(2) Actuarial standards to determine the administrative fees and fluctuating reserves fees set forth in section 3-123eee, as amended by this act, and the amount of premiums or premium equivalent payments to cover anticipated claims and claim reserves. The Comptroller shall present such standards to the Health Care Cost Containment Committee for its review, evaluation and approval prior to the use of such standards.
(c) The Comptroller may adopt regulations, in accordance with chapter 54, to establish the procedures and criteria for any reviews or evaluations performed by the Health Care Cost Containment Committee pursuant to subsection (b) of this section or subsection (c) of section 3-123ddd.
Sec. 4. Section 3-123eee of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
(a) There is established an account to be known as the "partnership plan premium account", which shall be a separate, nonlapsing account within the General Fund. All premiums paid by employers and their respective employees and retirees and volunteer fire departments and their volunteer firefighters for coverage under a partnership plan pursuant to sections 3-123bbb to 3-123ddd, inclusive, as amended by this act, shall be deposited into said account. The account shall be administered by the Comptroller for payment of claims and administrative fees to entities providing coverage or services under partnership plans.
(b) The Comptroller may charge each employer and department participating in a partnership plan an administrative fee calculated on a per member per month basis, in accordance with the actuarial standards developed under subsection (b) of section 3-123ccc, as amended by this act, and subsection (c) of section 3-123ddd. In addition, the Comptroller may charge a fluctuating reserves fee the Comptroller deems necessary and in accordance with the actuarial standards developed under subsection (b) of section 3-123ccc, as amended by this act, and subsection (c) of section 3-123ddd to ensure adequate claims reserves.
(c) (1) Each employer shall pay monthly the amount determined by the Comptroller, pursuant to this section, for coverage of its employees or its employees and retirees, as appropriate, under a partnership plan. An employer may require each covered employee to contribute a portion of the cost of such employee's coverage under the plan, subject to any collective bargaining obligation applicable to such employer.
(2) Each volunteer fire department shall pay monthly the amount determined by the Comptroller, pursuant to this section, for coverage of its volunteer firefighters under a partnership plan. A department may require each covered volunteer firefighter to contribute a portion of the cost of such firefighter's coverage under the plan.
(d) If any payment due by an employer or a department under this section is not submitted to the Comptroller by the tenth day after the date such payment is due, interest to be paid by such employer or department shall be added, retroactive to the date such payment was due, at the prevailing rate of interest as determined by the Comptroller.
(1) The Comptroller may terminate participation in the partnership plan by a nonprofit employer on the basis of nonpayment of premium or premium equivalent, provided at least ten days' advance notice is given to such employer, which may continue the coverage and avoid the effect of the termination by remitting payment in full at any time prior to the effective date of termination.
(2) (A) If a nonstate public employer fails to make premium payments or premium equivalent payments as required by this section, the Comptroller may direct the State Treasurer, or any other officer of the state who is the custodian of any moneys made available by grant, allocation or appropriation payable to such nonstate public employer, to withhold the payment of such moneys until the amount of the premium or premium equivalent or interest due has been paid to the Comptroller, or until the State Treasurer or such custodial officer determines that arrangements have been made, to the satisfaction of the State Treasurer, for the payment of such premium or premium equivalent and interest. Such moneys shall not be withheld if such withholding will adversely affect the receipt of any federal grant or aid in connection with such moneys.
(B) If no grant, allocation or appropriation is payable to such nonstate public employer or is not withheld, pursuant to subparagraph (A) of this subdivision, the Comptroller may terminate participation in a partnership plan by a nonstate public employer on the basis of nonpayment of premium or premium equivalent, provided at least ten days' advance notice is given to such employer, which may continue the coverage and avoid the effect of the termination by remitting payment in full at any time prior to the effective date of termination.
(3) The Comptroller may terminate participation in the partnership plan by a volunteer fire department on the basis of nonpayment of premium or premium equivalent, provided at least ten days' advance notice is given to such department, which may continue the coverage and avoid the effect of the termination by remitting payment in full at any time prior to the effective date of termination.
[(3)] (4) The Comptroller may request the Attorney General to bring an action in the superior court for the judicial district of Hartford to recover any premium or premium equivalent, interest costs, paid claim expenses or equitable relief from a terminated employer or department.
Sec. 5. Section 3-123fff of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
(a) There is established a Nonstate Public Health Care Advisory Committee. The committee shall make advisory recommendations to the Health Care Cost Containment Committee concerning health care coverage for nonstate public employees. The advisory committee shall consist of nonstate public employers and employees participating in a partnership plan and shall include the following members appointed by the Comptroller: (1) Three municipal employer representatives, one of whom represents towns with populations of one hundred thousand or more, one of whom represents towns with populations of at least twenty thousand but under one hundred thousand, and one of whom represents towns with populations under twenty thousand; (2) three municipal employee representatives, one of whom represents employees in towns with populations of one hundred thousand or more, one of whom represents employees in towns with populations of at least twenty thousand but under one hundred thousand, and one of whom represents employees in towns with populations under twenty thousand; (3) three board of education employers, one of whom represents towns with populations of one hundred thousand or more, one of whom represents towns with populations of at least twenty thousand but under one hundred thousand, and one of whom represents towns with populations under twenty thousand; and (4) three board of education employee representatives, one of whom represents towns with populations of one hundred thousand or more, one of whom represents towns with populations of at least twenty thousand but under one hundred thousand, and one of whom represents towns with populations under twenty thousand.
(b) There is established a Nonprofit and Volunteer Fire Department Health Care Advisory Committee. The committee shall make advisory recommendations to the Health Care Cost Containment Committee concerning health care coverage for nonprofit employees and volunteer firefighters. The advisory committee shall consist of nonprofit employers and their respective employees and volunteer fire departments and their respective volunteer firefighters participating in a partnership plan and shall include the following members appointed by the Comptroller: (1) Three nonprofit employer representatives; [and] (2) three nonprofit employee representatives; (3) three volunteer fire department representatives; and (4) three volunteer firefighter representatives.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
January 1, 2016 |
3-123aaa |
Sec. 2 |
January 1, 2016 |
3-123bbb |
Sec. 3 |
January 1, 2016 |
3-123ccc |
Sec. 4 |
January 1, 2016 |
3-123eee |
Sec. 5 |
January 1, 2016 |
3-123fff |
Statement of Purpose:
To allow volunteer fire departments to apply to the partnership plan for health coverage for their volunteer firefighters.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]