8-27-207 - Health insurance plan for employees of local governments and quasi-governmental organizations Local government insurance committee. [Amended effective January 1, 2010. See the Compiler's
8-27-207. Health insurance plan for employees of local governments and quasi-governmental organizations Local government insurance committee. [Amended effective January 1, 2010. See the Compiler's Notes.]
(a) There is hereby created a local government insurance committee, to be composed of the commissioner of finance and administration, the comptroller of the treasury, the state treasurer, a member to be appointed by the Tennessee Municipal League and a member to be appointed by the Tennessee County Services Association. The commissioner, the comptroller of the treasury and the state treasurer are authorized to designate an alternate representative to attend, participate and vote at meetings of the committee when that respective member is unable to attend. Such designation must be made in writing to the chair of the committee.
(b) The local government insurance committee has the authority, either independently or with the assistance of the state insurance committee and/or the local education insurance committee, to establish a health insurance plan for employees of local governments and quasi-governmental organizations established for the primary purpose of providing services for or on behalf of state and local governments.
(c) Such plan is authorized to be established, contingent upon sufficient participation on the part of eligible organizations to make the plan economically feasible.
(d) The local government insurance committee has the authority to enter into contracts with insurance companies, claims administrators and other organizations for some or all of the insurance benefits or services, including actuarial and consulting advice, necessary to administer the plans authorized in this section. The procurement of such contracts shall be governed by the provisions of § 12-4-109, and the rules promulgated thereunder.
(e) Participation by local governments and eligible quasi-governmental organizations shall be voluntary.
(f) The costs of the plan, including plan administration, shall be fully borne by participating local governments and eligible quasi-governmental organizations. The staff for the state group insurance program shall act as staff for the local government insurance plan. [Amended effective January 1, 2010. See the Compiler's Notes.]
(g) The local government insurance committee shall have the authority to promulgate rules and regulations for the purpose of administering the group insurance plan for employees of local governments and quasi-governmental organizations and the authority to delegate to a subcommittee or to staff the ability to handle and resolve disputes, including appeals, regarding benefits and the application of medical necessity guidelines of the insurance plan.
(h) At the discretion of the local government insurance committee, a dental insurance plan may be offered as part of the basic plan or as an optional plan.
(i) County officials shall be allowed to participate in any plan established by the local government insurance committee even if the county does not participate. The cost of such participation shall be determined by the committee and the official may be required to bear the full cost of such participation.
(j) Notwithstanding the provisions of title 56 to the contrary, the local government insurance committee is authorized to enter into self-insured contracts with health maintenance organizations established pursuant to title 56, chapter 32. The committee shall permit participation in such health maintenance organizations only in those locations for which the organization has been issued a certificate of authority by the department of commerce and insurance.
(k) For purposes of this section and determining eligibility to participate within a health insurance plan established pursuant to this section, the term employees of local governments and quasi-governmental organizations established for the primary purpose of providing services for or on behalf of state and local governments shall include, but is not limited to, utility district commissioners appointed or elected pursuant to § 7-82-307. Nothing contained within the provisions of this subsection (k) shall be construed to diminish, in any way, the provisions and requirements set forth within subsections (c), (e) and (f).
(l) (1) The surviving spouse and eligible dependent children of a participant in the health plan authorized in subsection (b), who maintains family coverage, who is a member of the Tennessee army national guard or the Tennessee air national guard, who has been activated for federal duty or who has been called up on state active duty, and who is subsequently killed in the performance of that duty, may participate in the group health insurance plan authorized in this section.
(2) The surviving spouse's cost and dependent children's cost of the coverage provided in this section shall be equal to twenty percent (20%) of the monthly premium paid by employees for the same coverage. The military department shall pay the balance of the monthly premium.
(3) The criteria for determination of eligibility of dependent children shall be the same as those established by the local government insurance committee for participating employees and their families.
(4) In the event that the surviving spouse becomes eligible for insurance coverage through a subsequent marriage, the extension of coverage authorized in this subsection (l ) shall be terminated on the first day of the following month. The local government insurance committee may establish specific conditions for extensions in instances where preexisting conditions may apply during such transfer of coverage.
(5) In the event that insurance coverage under the local government plan is terminated for the surviving spouse pursuant to subdivision (l )(4), but the surviving spouse is unable to secure, through the new coverage, insurance coverage for the eligible dependent children, such children may continue coverage under the provisions of this section; provided, that they continue to meet all dependent eligibility requirements.
(6) The provisions of this subsection (l ) shall be retroactive to September 11, 2001. As individuals who are qualified for such extension are identified, elect coverage and pay the appropriate contribution, the coverage shall be provided on a prospective basis.
[Acts 1989, ch. 544, § 1; 1991, ch. 128, § 3; 1992, ch. 904, § 1; 1996, ch. 936, § 7; 1997, ch. 513, §§ 3, 10; 1998, ch. 905, § 2; 1999, ch. 116, § 2; 2004, ch. 629, § 1; 2005, ch. 376, § 3; 2009, ch. 502, § 2.]