8-27-303 - Payment of costs Participation in plans.
8-27-303. Payment of costs Participation in plans.
(a) (1) (A) From the appropriations made each year in the general appropriations act for that purpose, the department of education is authorized to pay, on behalf of each eligible local education employee, and the employee's dependents, an amount, determined annually in the general appropriations act, on the total cost of such person's participation in the basic insurance plan. Effective July 1, 1992, each local education agency shall provide for any increased amounts needed for its eligible employees and their dependents, above the amount funded by the state for fiscal year 1991-1992, from funds appropriated for the basic education program.
(B) No state funds appropriated to fund the provisions of this part shall be distributed to any local education agency which, on April 1, 1986, was paying the total cost or a portion of the total cost of insurance for eligible employees as defined in this part, if such local education agency reduces the funding for such insurance in any fiscal year below the level of funding for such purpose in the immediately preceding fiscal year; provided, that such local education agency shall have the option to expend such funds to continue to fund such insurance, to increase the local salary supplement, to provide other employee benefits that accrue to the eligible employee and continue to be eligible to receive such state funds, or for any other improvement in the education program.
(2) If a local education agency makes medical insurance available to its eligible employees and the benefits are equal or superior to the benefits of the basic plan established pursuant to § 8-27-302(a), the local education agency shall be eligible to receive directly the payments provided for in subdivision (a)(1). Participation in an insurance trust, county-wide policy, self-insurance or similar benefit plan shall not disqualify the local education agency from these payments. The determination on the equivalency or superiority of the local benefits shall be made by an outside, independent firm or consultant. A written report shall be supplied to the local education agency in the event that local medical benefits are determined not to be equal or superior. In order to be reviewed for eligibility, a local education agency must make application to the local education insurance committee within sixty (60) days of the organization of the committee. The provisions of § 8-27-302(d) shall not be used in determining the equivalency or superiority of the local benefits. Local education agencies not making a timely application, or having medical benefits that are not equal or superior to the basic plan, shall not be eligible for direct payments.
(3) Local education agency employees, other than eligible employees within the meaning of § 8-27-302(c)(2) and subdivisions (a)(1) and (a)(2) of this section shall be allowed, along with retired teachers, to participate in the basic or supplemental plans provided for in § 8-27-302. A school board member of a local education agency may participate in the basic plan as authorized in § 8-27-302(a)(1), if the member pays the total monthly premium for the coverage the member selects. The department of education shall not assume any liability for such participation, and the total cost of such a person's participation shall be borne by the individual, unless the local education agency assumes liability for all or a portion of the cost. Nothing contained herein shall be construed to require the termination or modification of existing insurance plans covering a local education agency's retired teachers or other employees.
(b) Each person for whom payments are made under the provisions of subsection (a) shall pay the remaining portion of the total costs, but the board of the local education agency may assume all or a portion of these costs.
(c) The additional cost of optional coverage provided for by § 8-27-302(a)(2) shall be paid by the participating local education agency and its eligible participating employees.
(d) All administrative costs incurred by the state group insurance office or the insurer that are associated with the administration of the basic or supplemental plans offered herein shall be borne by the plan and included in the premium payments.
(e) (1) Payments made by the state in accordance with subsection (a) may be made by direct transfer from the state treasury to the plan, or by payroll deduction, or otherwise as the committee and the department of finance and administration deem most efficient. These payments shall not be subject to § 8-11-110.
(2) Payments due from local education agencies or participating eligible employees shall be made as directed by the committee.
(f) Any local education agency whose local insurance plan was determined to be inferior to the basic plan shall be eligible to receive directly the payments provided for in subdivision (a)(1) under the following conditions:
(1) The local education agency filed an appeal of the committee's decision regarding the status of the local insurance plan on or before December 1, 1985;
(2) The local education agency submitted the revised local insurance plan for re-evaluation by the committee within thirty (30) days of March 24, 1986;
(3) The benefits offered under the local insurance plan as originally submitted by the local education agency for evaluation by the committee were not diminished in any manner in the revised local insurance plan submitted to the committee pursuant to this subsection (f);
(4) Upon evaluation by the committee, the revised local insurance plan was determined to be equal or superior to the basic plan; and
(5) The submission, evaluation, and upgrading of the revised local insurance plan was completed no later than June 1, 1986.
If a local insurance plan was determined equal or superior to the basic plan in accordance with the provisions of this section, the local education agency was eligible to receive the direct payments provided for in subdivision (a)(1)(A) retroactive to January 1, 1986.
(g) The committee shall periodically evaluate local plans determined to be equal or superior to the basic plan to ensure that such plans maintain benefits equal or superior to the basic plan. Local education agencies shall fully cooperate with the committee in such evaluations. The committee shall issue a written report to the local education agency explaining the results of such evaluations, giving the agency an opportunity to respond to the committee's findings. If as a result of an evaluation a local plan is determined to be inferior to the basic plan, the committee shall discontinue direct payments to the affected local education agency not later than ninety (90) days after the final determination by the committee. During this period of time, the local education agency may implement improved benefits in the local plan and submit the revised local plan for evaluation. If the committee determines that the revised local plan is equal or superior to the basic plan, direct payments to the agency may continue. If benefits in the local plan are not improved or the revised local plan is determined inferior to the basic plan, the local education agency may elect to:
(1) Enroll in the basic plan pursuant to the provisions of §§ 8-27-302 and 8-27-304; or
(2) Maintain the local plan and not receive state support for such plan.
(h) Local education agencies whose local insurance plan is determined equal or superior to the basic plan shall file with the committee any changes in the benefits offered under the local plan at least thirty (30) days prior to the effective date of such changes.
(i) Any local education agency may withdraw from the basic plan authorized in § 8-27-302 following at least twenty-four (24) months of participation in that plan. The local education agency must comply with the equivalency provisions of subdivision (a)(2) and the referendum requirements contained in § 8-27-302(c) prior to withdrawal from the basic plan. Upon withdrawal, the local education agency shall be responsible for coverage for all retirees and other former employees eligible to continue healthcare coverage who were covered at the time of the termination of employment with the local education agency. The local education insurance committee may establish conditions for local education agencies which withdraw to resume coverage through the basic plan.
(j) Beginning July 1, 1998, each local education agency shall pay on behalf of each eligible employee, as defined in § 8-27-302(e)(2), participating in the health insurance coverage authorized by § 8-27-302(a) or subdivision (a)(2) as a minimum the percentage specified in the general appropriations act of the premium collected on behalf of each such employee. Distribution of a like amount to each eligible employee through a flexible spending arrangement authorized by § 125 of the Internal Revenue Code shall satisfy the requirements of this subsection (j). Such amounts shall be certified to the commissioner of education and the director of each local education agency by the local education insurance committee each fiscal year.
[Acts 1985, ch. 455, § 3; 1986, ch. 574, §§ 2, 3; 1986, ch. 674, § 1; 1992, ch. 535, § 44; 1997, ch. 513, §§ 11, 13; 1998, ch. 907, § 1; 1998, ch. 951, § 1; 1998, ch. 1109, § 2; 2001, ch. 155, § 1; 2004, ch. 586, § 1.]