ARTICLE
2 AS AMENDED
RELATING TO
MEDICARE EXCHANGE PROGRAM FOR MEDICARE ELIGIBLE
RETIREES
SECTION 1. Sections 36-12-1 and 36-12-4 of the General Laws
in Chapter 36-12
entitled "Insurance Benefits" are hereby amended to
read as follows:
36-12-1.
Definitions. -- The following words, as used in
sections 36-12-1 -- 36-12-14,
shall have the following meanings:
(1)
"Employer", means the state of
(2)
"Employee", means all persons who are classified employees as the term
"classified
employee" is defined under section 36-3-3, and all
persons in the unclassified and non-classified
service of the state; provided, however, that the following
shall not be included as "employees"
under sections 36-12-1 -- 36-12-14:
(i)
Part-time personnel whose work week is less than twenty (20) hours a week and
limited period and seasonal personnel;
(ii) Members of the
general assembly, its clerks, doorkeepers, and pages.
(3)
"Dependents" means an employee's spouse, domestic partner and
unmarried children
under nineteen (19) years of age. Domestic partners shall
certify by affidavit to the benefits
director of the division of personnel that the (i) partners are at least eighteen (18) years of age and
are mentally competent to contract, (ii) partners are not
married to anyone, (iii) partners are not
related by blood to a degree which would prohibit marriage in
the state of
partners reside together and have resided together for at
least one year, (v) partners are financially
interdependent as evidenced by at least two (2) of the following:
(A) domestic partnership
agreement or relationship contract; (B) joint mortgage or joint
ownership of primary residence,
(C) two (2) of: (I) joint ownership of motor vehicle;
(II) joint checking account; (III) joint credit
account; (IV) joint lease; and/or (D) the domestic partner
has been designated as a beneficiary for
the employee's will, retirement contract or life
insurance. Misrepresentation of information in the
affidavit will result in an obligation to repay the benefits
received, and a civil fine not to exceed
one thousand dollars ($1000) enforceable by the attorney
general and payable to the general fund.
The employee will notify the benefits director of the
division of personnel by completion of a
form prescribed by the benefits director when the domestic
partnership ends.
(4) "Retired
employee", means all persons retired from the active service of the state,
who, immediately prior to retirement, were employees of
the state as determined by the
retirement board under section 36-8-1, and also all retired
teachers who have elected to come
under the employees' retirement system of the state of
(5) "State
retiree", means all persons retired from the active service of the state
who,
immediately prior to retirement, were employees of the state as
determined by the retirement
board under section 36-8-1.
(6) "Teacher
retiree", means all retired teachers who have elected to come under the
employees' retirement system of the state of
(5)(7)
"Long-term health care insurance", means any insurance policy or
rider
advertised, marketed, offered, or designed to provide coverage for
not less than twelve (12)
consecutive months for each covered person on an expense
incurred, indemnity, prepaid, or other
basis for one or more necessary or medically necessary
diagnostic, preventive, therapeutic,
rehabilitative, maintenance, or personal care services, provided in
a setting other than an acute
care unit of a hospital. The term includes: group and
individual policies or riders whether issued
by insurers, fraternal benefit societies, nonprofit
health, hospital, and medical service
corporations; prepaid health plans, health maintenance
organizations; or any similar organization.
Long-term health care insurance shall not include: any
insurance policy which is offered
primarily to provide basic medicare
supplement coverage; basic hospital expense coverage; basic
medical-surgical expense coverage; hospital confinement indemnity
coverage; major medical
expense coverage; disability income protection coverage;
accident only coverage; specified
disease or specified accident coverage; or limited benefit
health coverage. This list of excluded
coverages is illustrative and is not intended to be all
inclusive.
(6)(8) "Non-Medicare-eligible
retiree "Retiree health care insurance", means the health
benefit employees who retire from active service of the state
(subsequent to July 1, 1989), who
immediately prior to retirement were employees of the state as
determined by the retirement
board pursuant to section 36-8-1, shall be entitled to
receive, until attaining Medicare eligibility.
which This health care insurance shall be equal to
semi-private hospital care, surgical/medical
care and major medical with a one hundred seventy-five
dollar ($175) calendar year deductible.
Employees who retire prior to age sixty-five (65)
shall, upon the attainment of Medicare
eligibility, receive hospital care, surgical/medical services,
rights and benefits which, when taken
together with their federal Medicare program benefits (public
law 89-97), 42 U.S.C. section 1305
et seq., shall be comparable to those provided for
retirees prior to that age. The
aforementioned
program will be provided on a shared basis in accordance with
section 36-12-4.
(9)
"Medicare-eligible retiree health care insurance", means the health benefit
employees
who retire from active service of the state (subsequent
to July 1, 1989), who immediately prior to
retirement were employees of the state as determined by the
retirement board pursuant to section
36-8-1, shall have access to
when eligible for Medicare. This health care insurance shall include
plans providing hospital care, surgical/medical services,
rights and benefits which, when taken
together with their federal Medicare program benefits, 42
U.S.C. section 1305 et seq., shall be
comparable to those provided for retirees prior to the
attainment of Medicare eligibility.
(10) "Health
reimbursement arrangement", or "HRA"
means an account that:
(i)
Is paid for and funded solely by state contributions;
(ii) Reimburses a Medicare-eligible
state retiree for medical care expenses as defined in
section 213(d) of the Internal Revenue Code of 1986, as
amended, which includes
reimbursements for health care insurance premiums;
(iii) Provides
reimbursements up to a maximum dollar amount for a coverage period; and
(iv)
Provides that any unused portion of the maximum dollar amount at
the end of a
coverage period is carried forward to increase the maximum
reimbursement amount in
subsequent coverage periods.
36-12-4. Coverage
of retired employees Coverage of Non-Medicare-eligible retired
employees. -- (a)
Non-Medicare-eligible retired Retired
employees who retire retired on or before
September 30, 2008. - Any retired employee who retired
on or before September 30, 2008 shall
be entitled, until attaining Medicare eligibility,
to be covered under sections 36-12-1 -- 36-12-5
for himself and herself and, if he or she so desires, his
or her non-Medicare-eligible dependents,
upon agreeing to pay the total cost of his or her contract
at the group rate for active state
employees. Payments of any non-Medicare-eligible retired
employee for coverage shall be
deducted from his or her retirement allowance and remitted
from time to time in payment for such
contract. In addition, any retired employee who retired on or
before September 30, 2008 shall be
permitted to purchase coverage for his or her non-Medicare-eligible
dependents upon agreeing to
pay the additional cost of the contract at the group rate
for active state employees. Payment for
coverage for these dependents shall be deducted from
his or her retirement allowances and
remitted as required in payment for the contract.
(b) State state
employees retirees who retire
retired subsequent to
July 1, 1989, and on or before September 30, 2008. Non-Medicare-eligible
state State
employees who retire retired subsequent to July
1, 1989, and on or before September 30, 2008,
from active service of the state, and who were employees
of the state as determined by the
retirement board under section36-8-1, shall be entitled to
receive for himself or herself non-
Medicare-eligible a retiree health care insurance benefit as described in section36-12-1
in
accordance with the following formula:
Years of Age State's
Employee's
Service at
Retirement Share Share
10-15 60
50% 50%
16-22 60
70% 30%
23-27 60
80% 20%
28+ --
90% 10%
28+ 60
100% 0%
35+ any
100% 0%
If
the retired employee is receiving a subsidy on September 30, 2008, the state
will
continue to pay the same subsidy share until the retiree
attains age sixty-five (65).
Until December 31,
2013, when When
the state retiree reaches that age which will
qualify him or her for Medicare supplement, the
formula shall be:
Years of Service State's Contribution Employees' Share
10 – 15 50%
50%
16 – 19 70%
30%
20 – 27 90%
10%
28+ 100%
0%
(c) Non-Medicare-eligible
retired Retired employees
who retire on or after October 1,
2008. Any retired employee who retires on or after
October 1, 2008 shall be entitled, until
attaining Medicare eligibility, to be covered under sections 36-12-1 – 36-12-5 for
himself and
herself and, if he or she so desires, his or her non-Medicare-eligible
dependents, upon agreeing to
pay the total cost of the contract in the plan in which
he or she enrolls. Payments of any non-
Medicare-eligible retired employee for coverage shall be deducted from his or her
retirement
allowance and remitted from time to time in payment for such
contract. Any retired employee
who retires on or after October 1, 2008, shall be
permitted to purchase coverage for his or her
non-Medicare-eligible dependents upon agreeing to pay the additional cost
of the contract at the
group rate for the plan in which the dependent is enrolled.
Payment for coverage for these
dependents shall be deducted from the retired employee's
retirement allowances and remitted as
required in payment for the contract. The Director of
Administration shall develop and present to
the chairpersons of the House Finance Committee and the
Senate Finance Committee by May 23,
2008 a retiree health plan option or options to be
offered to retirees eligible for state-sponsored
medical coverage who are under age sixty-five (65) or are not
eligible for Medicare. This plan
will have a reduced benefit level and will have an
actuarially based premium cost not greater than
the premium cost of the plan offered to the active state
employee population. This new plan
option will be available to employees retiring after
September 30, 2008, and their non-Medicare-
eligible dependents.
(d) State state
employees retirees who retire on or
after October 1,
2008. Employees Non-Medicare-eligible state
retirees who retire on or after October 1, 2008
from active service of the state, and who were employees
of the state as determined by the
retirement board under section 36-8-1, and who have a minimum of
twenty (20) years of service,
and who are a minimum of fifty-nine (59) years of age,
shall be entitled to receive for himself or
herself a non-Medicare-eligible retiree health care
insurance benefit as described in section 36-
12-1. The State state
will subsidize 80% of the cost of the health insurance plan for individual
coverage in which the retired state employee retiree
is enrolled in. Payments of any retired
employee for coverage shall be deducted from his or her
retirement allowance and remitted from
time to time in payment for such contract.
(e) Medicare-eligible
state retirees who retire on or after October 1, 2008. Until
December 31, 2013, the state shall subsidize eighty
percent (80%) of the cost of the Medicare-
eligible health insurance plan for individual coverage in
which the state retiree is enrolled,
provided the employee retired on or after October 1, 2008; has
a minimum of twenty (20) years of
service; and is a minimum of fifty-nine (59) years of age.
Payments for coverage shall be
deducted from his or her retirement allowance and remitted
from time to time in payment for such
health insurance plan.
(e)(f)
Retired employees, including retired teachers, who are non-Medicare-eligible
and
who reach the age of sixty-five (65) shall be allowed to
continue to purchase group health care
insurance benefits in the same manner as those provided to
retired employees who have not
reached the age of sixty-five (65).
SECTION 2. Chapter 36-12 of the General Laws entitled
"Insurance Benefits" is hereby
amended by adding thereto the following section:
36-12-4.1. Coverage
of Medicare-eligible retired employees. -- (a) The
director of the
department of administration shall ensure retired employees
access to Medicare-eligible retiree
health care insurance. Under this program, the state will
establish a health reimbursement account
(HRA) funded by state contributions for each
Medicare-eligible state retiree who elects to receive
health care insurance through the state-sponsored program.
(b) The funds
contained in the HRA may be utilized for any eligible medical care
expenses as defined in section 213(d) of the Internal Revenue
Code of 1986, as amended, which
includes reimbursements for health care insurance premiums.
(c) The director of
the department of administration shall procure services to maximize
consumer choice and options with respect to the individual
policies available to Medicare-eligible
retirees.
(d) The maximum state
contribution to each Medicare-eligible state retiree's HRA
account will be equal to the lowest-cost Medicare
supplemental plan that is filed with the Office
of the Health Insurance Commissioner of
sponsored program, and that meets the provisions of the
Medicare-eligible retiree health care
insurance benefit defined in section 36-12-1(9). The maximum
state contribution will vary by age
as specified by the rates set forth in the Medicare
supplemental plan filing.
(e) For
Medicare-eligible state retirees who retired before September 30, 2008,
effective
January 1, 2014, the state of
a monthly basis. The amount of such credit shall be
calculated based on the retiree's years of
service, as a percentage of the maximum state contribution
set forth in (d) above, and in
accordance with the following formula:
Years of Service State's
Contribution Employees
Share
10 – 15 50%
50%
16 – 19 70%
30%
20 – 27 90%
10%
28+ 100%
0%
(f) For
Medicare-eligible state retirees who retire on or after October 1, 2008,
effective
January 1, 2014, the state of
account equal to 80% of the maximum state contribution set
forth in (d) above, provided the
retiree has a minimum of twenty (20) years of service and is
at least fifty-nine (59) years of age.
(g) Medicare-eligible
teacher retirees may purchase the individual policies available to
Medicare-eligible state retirees
under the state-sponsored program.
SECTION 3. This article shall take effect as of July 1,
2013.