MISSISSIPPI LEGISLATURE
1998 Regular Session
To: Insurance; Appropriations
By: Representative Reynolds
House Bill 1071
AN ACT TO CREATE THE PUBLIC EMPLOYEES LIFE AND HEALTH INSURANCE PLAN; TO AMEND SECTION 25-15-3, MISSISSIPPI CODE OF 1972, TO INCLUDE IN THE PLAN THOSE EMPLOYEES OF POLITICAL SUBDIVISIONS AND INSTRUMENTALITIES OF THE STATE, INCLUDING PUBLIC SCHOOL DISTRICTS AND COMMUNITY/JUNIOR COLLEGE DISTRICTS, WHO ARE MEMBERS OF THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM AND OTHER RETIREMENT SYSTEMS ADMINISTERED BY THE BOARD OF TRUSTEES OF THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM; TO AMEND SECTION 25-15-5, MISSISSIPPI CODE OF 1972, TO REQUIRE EACH STATE AGENCY AND EACH POLITICAL SUBDIVISION AND INSTRUMENTALITY OF THE STATE THAT PARTICIPATES IN THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM OR ANY OTHER RETIREMENT SYSTEM ADMINISTERED BY THE BOARD OF TRUSTEES OF THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM TO BE A PARTICIPANT IN THE PLAN; TO AMEND SECTION 25-15-7, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE PROVISIONS OF THIS ACT; TO AMEND SECTION 25-15-13, MISSISSIPPI CODE OF 1972, TO PROVIDE WHEN EMPLOYEES OF POLITICAL SUBDIVISIONS AND INSTRUMENTALITIES OF THE STATE ARE ELIGIBLE TO PARTICIPATE IN THE PLAN; TO PROVIDE THAT PARTICIPANTS IN THE PUBLIC SCHOOL EMPLOYEES HEALTH INSURANCE PLAN SHALL BECOME PARTICIPANTS IN THE PUBLIC EMPLOYEES LIFE AND HEALTH INSURANCE PLAN; TO ALLOW RETIRED EMPLOYEES TO PARTICIPATE IN THE PLAN BY CONTINUING TO PARTICIPATE IN THE PLAN OR SIGNING UP INITIALLY WITHIN 90 DAYS AFTER RETIREMENT; TO PROVIDE THAT RETIRED EMPLOYEES' SPOUSES AND DEPENDENT CHILDREN MAY PARTICIPATE IN THE PLAN DURING SUCH TIME AS THE RETIRED EMPLOYEE PARTICIPATES IN THE PLAN; TO ALLOW SURVIVING SPOUSES AND DEPENDENT CHILDREN OF DECEASED ACTIVE OR RETIRED EMPLOYEES TO PARTICIPATE IN THE PLAN BY CONTINUING TO PARTICIPATE IN THE PLAN OR SIGNING UP INITIALLY WITHIN 90 DAYS AFTER THE EMPLOYEE'S DEATH; TO PROVIDE FOR OPEN ENROLLMENT PERIODS DURING WHICH ACTIVE EMPLOYEES, RETIRED EMPLOYEES, SPOUSES, SURVIVING SPOUSES AND DEPENDENT CHILDREN WHO ARE NOT PARTICIPANTS IN THE PLAN MAY ELECT TO PARTICIPATE IN THE PLAN; TO AMEND SECTION 25-15-14, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT CERTAIN EMPLOYEES WHO TERMINATE THEIR EMPLOYMENT BEFORE BEING ENTITLED TO RECEIVE A RETIREMENT ALLOWANCE SHALL BE ELIGIBLE TO PARTICIPATE IN THE PLAN IN THE SAME MANNER AS FOR RETIRED EMPLOYEES; TO AMEND SECTION 25-15-15, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT THE STATE SHALL PAY THE FULL COST OF HEALTH INSURANCE FOR FULL-TIME EMPLOYEES OF PUBLIC SCHOOL DISTRICTS AND SCHOOL BUS DRIVERS EMPLOYED BY SCHOOL DISTRICTS AND FOR FULL-TIME EMPLOYEES OF PUBLIC COMMUNITY/JUNIOR COLLEGE DISTRICTS AND LIBRARY STAFF MEMBERS OF PUBLIC LIBRARIES; TO PROVIDE THAT THE COST OF INSURANCE AND DEPENDENT COVERAGE FOR EMPLOYEES OF POLITICAL SUBDIVISIONS AND INSTRUMENTALITIES OF THE STATE SHALL BE THE SAME COST AS THAT FOR STATE EMPLOYEES; TO PROVIDE THAT THE COST OF INSURANCE FOR EMPLOYEES OF POLITICAL SUBDIVISIONS AND INSTRUMENTALITIES OF THE STATE MAY BE PAID IN WHOLE OR IN PART BY THE EMPLOYER, AND ANY PART OF THE COST NOT PAID BY THE EMPLOYER SHALL BE PAID BY THE EMPLOYEE; TO PROVIDE THAT THE COST OF INSURANCE FOR RETIRED EMPLOYEES, SPOUSES, SURVIVING SPOUSES AND DEPENDENT CHILDREN WHO ARE UNDER AGE 65 SHALL BE THE SAME COST AS THAT FOR ACTIVE EMPLOYEES; TO AUTHORIZE THE BOARD TO AUTHORIZE THE THIRD-PARTY ADMINISTRATOR OF THE SELF-INSURED PROGRAM TO COLLECT PREMIUMS AND CHARGE LATE PAYMENT CHARGES; TO AUTHORIZE THE BOARD TO ALLOW OR REQUIRE ENTITIES PARTICIPATING IN THE PLAN TO PAY PREMIUMS AND OTHER CHARGES BY ELECTRONIC FUNDS TRANSFER; TO PROVIDE THAT THE BOARD SHALL INVEST ALL FUNDS IN THE PUBLIC EMPLOYEES INSURANCE ACCOUNT IN THE SAME MANNER AS FUNDS ARE INVESTED BY THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM; TO AMEND SECTION 25-15-23, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT NO POLITICAL SUBDIVISION OR INSTRUMENTALITY OF THE STATE THAT PARTICIPATES IN THE PLAN SHALL BE AUTHORIZED TO WITHDRAW FROM THE PLAN; TO AMEND SECTION 25-15-101, MISSISSIPPI CODE OF 1972, TO DELETE THE REQUIREMENT THAT SCHOOL DISTRICTS PROVIDE POLICIES OF GROUP INSURANCE FOR CERTIFICATED PERSONNEL; TO PROVIDE THAT THE GROUP INSURANCE COVERAGE AUTHORIZED FOR EMPLOYEES OF CERTAIN POLITICAL SUBDIVISIONS SHALL NOT BE AUTHORIZED FOR THOSE EMPLOYEES WHO ARE COVERED BY THE PLAN; TO AMEND SECTIONS 27-104-31 AND 37-19-34, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE PROVISIONS OF THIS ACT; TO AMEND SECTION 41-95-7, MISSISSIPPI CODE OF 1972, TO DELETE FROM THE HEALTH CARE PURCHASING POOL THAT IS TO BE ESTABLISHED BY THE MISSISSIPPI HEALTH FINANCE AUTHORITY BOARD STATE EMPLOYEES, SCHOOL DISTRICT AND COMMUNITY/JUNIOR COLLEGE DISTRICT EMPLOYEES AND LOCAL GOVERNMENT EMPLOYEES THAT PARTICIPATE IN THE PLAN; TO REPEAL SECTIONS 25-15-251 THROUGH 25-15-265, MISSISSIPPI CODE OF 1972, WHICH PROVIDE FOR A GROUP HEALTH INSURANCE PLAN FOR EMPLOYEES OF SCHOOL DISTRICTS AND COMMUNITY/JUNIOR COLLEGE DISTRICTS AND SECTIONS 37-9-151 AND 37-9-153, MISSISSIPPI CODE OF 1972, WHICH PROVIDE FOR THE DESIGN OF A PLAN OF GROUP HEALTH INSURANCE FOR SCHOOL DISTRICT PERSONNEL; TO AMEND SECTIONS 25-15-301 AND 25-15-303, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE PROVISIONS OF THIS ACT; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 25-15-3, Mississippi Code of 1972, is amended as follows:
25-15-3. For the purposes of this article, the words and phrases used in this section shall have the following meanings:
(a) "Employee" means any person who works full time for the State of Mississippi and receives his compensation in a direct payment from a department, agency or institution of the state government, and any person who works full time for a political subdivision or instrumentality of the state and who is a member of the Public Employees' Retirement System or any other retirement system administered by the Board of Trustees of the Public Employees' Retirement System. This term includes legislators, employees of the legislative branch and the judicial branch of the state, full-time salaried judges and full-time district attorneys and their staff and full-time compulsory school attendance officers. The term does not include independent contractors who work full time for the state or for a political subdivision or instrumentality of the state as contract employees. For the purposes of this article:
(i) Any "employee" making contributions to the Public Employees' Retirement System or any other retirement system administered by the Board of Trustees of the Public Employees' Retirement System shall be considered a full-time employee;
(ii) The term "any other retirement system administered by the Board of Trustees of the Public Employees' Retirement System" means the Mississippi Highway Safety Patrol Retirement System, the municipal disability and relief funds for firemen and policemen, the general municipal employees retirement systems, the optional retirement program for state institutions of higher learning and the Supplemental Legislative Retirement Plan, but does not include the Government Employees Deferred Compensation Program;
(iii) The term "political subdivision" means any governmental subdivision of the state and includes public school districts and public community/junior college districts;
(iv) The term "instrumentality of the state" means an instrumentality or juristic entity of the state or of a political subdivision.
(b) "Board" means the Public Employees Health Insurance Management Board as provided in Section 25-15-303.
(c) "Plan" means the Public Employees Life and Health Insurance Plan created under this article.
(d) "Fund" means the Public Employees Insurance Fund set up under this article.
(e) "Retired employee" means any person who is retired and receiving a retirement allowance under the Public Employees' Retirement System or any other retirement system administered by the Board of Trustees of the Public Employees' Retirement System.
SECTION 2. Section 25-15-5, Mississippi Code of 1972, is amended as follows:
25-15-5. (1) Each agency, department and institution of the state, and each political subdivision and instrumentality of the state that participates in the Public Employees' Retirement System or any other retirement system administered by the Board of Trustees of the Public Employees' Retirement System, shall be a participant in the plan under this article.
(2) The board shall administer the plan for * * * employees * * * and is authorized to adopt and promulgate rules and regulations for its administration, subject to the terms and limitations contained in this article. * * *
(3) The board shall develop a five-year strategic plan for the insurance plan established by Section 25-15-3 et seq. * * * The strategic plan shall address, but not be limited to:
(a) Changing trends in the health care industry, and how they effect delivery of services to members of the plans.
(b) Alternative service delivery systems.
(c) Any foreseeable problems with the present system of delivering and administering health care benefits in Mississippi.
(d) The development of options and recommendations for changes in the plan.
(4) To carry out the requirements of subsection (3) of this section, the board shall:
(a) Conduct formal research, including questionnaires and attitudinal surveys of members' needs and preferences with respect to service delivery.
(b) Determine whether members of the plans would prefer a simplified plan without options or a more complex plan with multiple options for services.
(5) After the board has complied with all provisions of Section 25-15-9 * * * regarding the establishment of the plans, it shall be responsible for fully disclosing to plan members the provisions of the plan. Such disclosure shall consist of the dissemination of educational material on the plan and any proposed changes thereto. The board shall provide members with complete educational materials at least thirty (30) days before the date upon which the plans' members must select a plan option for health care services. The board shall further use the resources of the Mississippi Authority for Educational Television or other state agency, university or college to provide information on proposed changes. The board may also use other state-owned media, as well as public service announcements on private media to disseminate information regarding proposed changes in the plan.
(6) The board shall develop and make available for public review at its offices a comprehensive plan document which documents all benefits for which members of the plan created by Section 25-15-3 et seq. * * * are eligible. This document shall be typed and maintained also at the offices of any administrator contracted with in accordance with Section 25-15-301.
(7) (a) The board may enter into contracts with accountants, actuaries and other persons from the private sector whose skills are necessary to carry out the purposes of Section 25-15-3 et seq.
(b) Before the board enters into any contract for services as provided in paragraph (a) of this subsection, the board shall first determine that the services are required, and that the staff of the board and personnel of other state agencies are not sufficiently experienced to provide the services. The board shall request the assistance of the Joint Legislative Budget Committee in developing a cost analysis of any such contracts. Then the board may enter into contracts with qualified persons to render the service.
(c) If the service is to be rendered for a period of in excess of six (6) months, the board shall seek and obtain bids for the service in a manner identical to that provided for in Section 25-15-301, subsection (1)(a) and (b) except for those provisions which specifically state criteria which are applicable only to third-party administrators contracted with in accordance with Section 25-15-3 et seq.
(d) The board is also authorized to procure legal services if it deems these services to be necessary to carry out its responsibilities under Section 25-15-3 et seq.
SECTION 3. Section 25-15-7, Mississippi Code of 1972, is amended as follows:
25-15-7. Such health insurance plan shall not include expense incurred by or on account of an individual prior to the effective date of the plan as to him; dental care and treatment, except dental surgery and appliances to the extent necessary for the correction of damage caused by accidental injury while covered by the plan, or as a direct result of disease covered by the plan; eyeglasses, hearing aids, and examinations for the prescription or fitting thereof; cosmetic surgery or treatment, except to the extent necessary for correction of damage by accidental injury while covered by the plan or as a direct result of disease covered by the plan; services received in a hospital owned or operated by the United States Government for which no charge is made; services received for injury or sickness due to war or any act of war, whether declared or undeclared, which war or act of war shall have occurred after the effective date of the plan; expense for which the individual is not required to make payment; expenses to the extent of benefits provided under any employer group plan other than this plan, in which the state or a political subdivision or instrumentality of the state participates in the cost thereof; and such other expenses as may be excluded by regulations of the board.
SECTION 4. Section 25-15-13, Mississippi Code of 1972, is amended as follows:
25-15-13. (1) Each eligible employee may participate in the plan, subject to the requirements of the board, by signing up for the plan at the time of employment. After acceptance in the plan, the employee may cease his or her participation by filing a specific disclaimer with the board. Forms for this purpose shall be prescribed and issued by the board. All eligible employees will be eligible to participate in the plan on the effective date of the plan or on the date on which they are employed by the state or a political subdivision or instrumentality of the state, whichever is later, provided they sign up for the plan within the time set by the board and make the necessary contributions as provided in this article. Spouses of employees, unmarried dependent children from birth to age nineteen (19) years, unmarried dependent children who are full-time students up to age twenty-three (23) years, and physically or mentally handicapped children, regardless of age, are eligible under the plan as of the date the employee becomes eligible.
(2) Each eligible employee of a political subdivision or instrumentality of the state is eligible to participate in the plan, subject to the requirements of the board, on January 1, 1999, or on the date he or she is employed by the political subdivision or instrumentality, whichever is later, provided he or she signs up for the plan within the time set by the board and makes the necessary contributions as provided in this article. Each retired employee of a political subdivision or instrumentality of the state on January 1, 1999, is eligible to participate in the plan, subject to the requirements of the board, on January 1, 1999, provided he or she signs up for the plan within the time set by the board and makes the necessary contributions as provided in this article.
(3) Each active and retired participant in the Public School Employees Health Insurance Plan on December 30, 1998, shall become a participant in the Public Employees Life and Health Insurance Plan on January 1, 1999, unless a participant files a specific written disclaimer with the board.
(4) Retired employees may participate in the plan, subject to the requirements of the board, by electing at the time of retirement to continue to participate in the plan or by signing up for the plan initially within ninety (90) days after retirement, and paying the necessary contributions under this article. Retired employees' spouses, unmarried dependent children from birth to age nineteen (19) years, unmarried dependent children who are full-time students up to age twenty-three (23) years, and physically or mentally handicapped children, regardless of age, may participate in the plan during such time as the retired employee participates in the plan by paying the necessary contributions under this article.
(5) The surviving spouse and dependent children of any deceased active or retired employee, who are eligible to receive a retirement allowance or survivor's annuity benefits as a result of the deceased employee's membership in the Public Employees' Retirement System or any other retirement system administered by the board, or who are maintained as dependents on any insurance plan of the employee or retired employee, may participate in the plan, subject to the requirements of the board, by electing at the time of the employee's death to continue to participate in the plan or by signing up for the plan initially within ninety (90) days after the employee's death, and paying the necessary contributions under this article.
(6) Any active employee, retired employee, spouse, surviving spouse or dependent child who does not elect to participate or continue to participate in the plan at the time he or she initially is eligible to do so under this section, and any active employee, retired employee, spouse, surviving spouse or dependent child who ceases participation in the plan, will not be eligible to participate in the plan until an open enrollment period of the plan. The board periodically shall provide for open enrollment periods of the plan, during which time active employees, retired employees, spouses, surviving spouses and dependent children who are not participants in the plan may elect to participate in the plan, subject to the requirements of the board.
SECTION 5. Section 25-15-14, Mississippi Code of 1972, is amended as follows:
25-15-14. Any elected * * * official who is participating in the plan and has participated in the plan for at least four (4) years, and who does not run for reelection, who resigns from or otherwise leaves office, or who is defeated before being entitled to receive a retirement allowance, and any employee who is participating in the plan and who terminates employment with his or her employer or whose employment with his or her employer is otherwise terminated before being entitled to receive a retirement allowance, shall be eligible to continue to participate in the * * * plan under the same conditions and coverages for retired employees.
SECTION 6. Section 25-15-15, Mississippi Code of 1972, is amended as follows:
25-15-15. (1) * * * The state shall provide fifty percent (50%) of the cost of the above life insurance plan for all active full-time employees of the state and agencies, departments and institutions of the state, and one hundred percent (100%) of the cost of the above health insurance plan for all active full-time employees of the state and agencies, departments and institutions of the state, for all active full-time employees of public school districts and all active regular nonstudent school bus drivers employed by public school districts, for all active full-time employees of public community/junior college districts, and for all active full-time library staff members of public libraries. All such employees shall be given the opportunity to purchase coverage for their eligible dependents, with the premiums for such dependent coverage and the employee's * * * share of the premiums for his life insurance coverage to be deductible from the employee's salary by the agency, department, * * * institution, school district, community/junior college district or public library, which deductions, together with the * * * share of * * * life insurance premiums of such employing agency, department, * * * institution, school district, community/junior college district or public library from funds appropriated to or authorized to be expended by such employing agency, department, * * * institution, school district, community/junior college district or public library, shall be deposited directly into a * * * special fund in the State Treasury, as determined by the board. These funds and interest earned on these funds may be used for the disbursement of claims and shall be exempt from the appropriation process.
(2) The cost of the life insurance, health insurance and dependent coverage for employees of political subdivisions and instrumentalities of the state shall be the same cost as that for state employees. Each political subdivision or instrumentality, in its discretion, may pay any part of the cost for its participating active employees up to one hundred percent (100%) of the cost, except for the cost of health insurance for school district employees, school bus drivers, community/junior college district employees and public library staff members that is paid by the state. Any part of the cost that is not paid by the political subdivision or instrumentality, or by the state in the case of school district employees, school bus drivers, community/junior college district employees and public library staff members, shall be paid by the participating employees. The employee's share of the cost shall be deducted from the employee's salary by the political subdivision or instrumentality, which deductions, together with the share of the cost paid by the political subdivision or instrumentality, shall be paid into the special fund along with the employer and employee payments of state employees.
(3) Where the use of federal funding is allowable to defray, in full or in part, the cost of participation in the plan by full-time school district employees and by regular nonstudent school bus drivers whose salaries are paid, in full or in part, by federal funds, the amount of the cost of health insurance for those persons that is to be paid by the state under this section shall be reduced to the extent of the federal funding. Where the use of federal funding is allowable but not available, as determined by the superintendent of each school district, it is the intent of the Legislature that school districts contribute the cost of participation for such persons from local funds, except that parent fees for child nutrition programs shall not be increased to cover such cost. Where the use of federal funding is allowable to defray, in full or in part, the cost of participation in the plan by full-time community/junior college district employees whose salaries are paid, in full or in part, by federal funds, the amount of the cost of health insurance for those persons that is to be paid by the state under this section shall be reduced to the extent of the federal funding. Where the use of federal funding is allowable but not available, as determined by the president of each community/junior college district, it is the intent of the Legislature that community/junior college districts contribute the cost of participation for such employees from local funds.
(4) The board may establish and enforce late charges and interest penalties or other penalties for the purpose of requiring the prompt payment of all premiums for life and health insurance permitted under this article. If any premiums for health insurance and/or late charges and interest penalties are not paid by a school district in a timely manner, as defined by the board, the Department of Education shall withhold minimum program payments to that district in accordance with Section 37-19-34. If any premiums for health insurance and/or late charges and interest penalties are not paid by a community/junior college in a timely manner, as defined by the board, the Mississippi Board for Community and Junior Colleges, upon notice by the board, shall immediately withhold all subsequent disbursement of funds. If any premiums for health insurance and/or late charges and interest penalties are not paid by a public library system in a timely manner, as defined by the board, the Mississippi Library Commission, upon notice by the board, shall immediately withhold all subsequent disbursement of funds to that public library.
(5) If the board contracts with a third-party administrator for the administration and/or service of the self-insured program, the board may authorize the third-party administrator to collect premiums, provide late payment notices and charge late payment charges and interest penalties on behalf of the board, in the same manner that the board is authorized to perform those functions under this section.
(6) The board may authorize or require state agencies, departments and institutions and political subdivisions and instrumentalities of the state that participate in the plan to pay premiums and other charges required in connection with the plan by electronic funds transfer plan and to electronically transmit reports and other information, in accordance with procedures established by rules and regulations of the board.
(7) All funds in excess of the amount needed for disbursement of claims shall be deposited in a special fund in the State Treasury which shall be known as the Public Employees Insurance Account. The board shall invest all funds in the Public Employees Insurance Account and all interest and other income earned shall be credited to the Public Employees Insurance Account. Such funds shall be invested as authorized by law for the investment of Public Employees' Retirement System funds * * *. The board shall have the authority to draw from this fund periodically such funds as are necessary to operate the self-insurance program or to pay to the insurance carrier the cost of operation of the plan for covered employees.
(8) It is the purpose of this section to limit the amount of participation by the state to fifty percent (50%) of the cost of the life insurance plan for state employees and not to limit the contracting for additional benefits where the cost will be paid in full by the employee. The state and political subdivisions and instrumentalities of the state shall not share in the cost of coverage for retired employees or surviving spouses or dependent children.
(9) The board shall also provide for the creation of an Insurance Reserve Account, and funds therein shall be invested by the State Treasurer with all interest and other income earned credited to the Public Employees Insurance Account.
(10) Any retired employee electing to purchase retired life and health insurance shall have the full cost of such insurance deducted monthly from his * * * retirement * * * check or shall be direct billed for the cost of the premium. Surviving spouses and dependent children of deceased employees who elect to purchase health insurance shall have the full cost of such insurance deducted monthly from their retirement allowance or survivor's annuity benefits or shall be direct billed for the cost of the premium. The cost of the life and health insurance for retired employees, spouses and dependent children of retired employees, and surviving spouses and dependent children of deceased active or retired employees who are under age sixty-five (65) years shall be the same cost as that for active employees.
SECTION 7. Section 25-15-23, Mississippi Code of 1972, is amended as follows:
25-15-23. No agency, board, institution or authority of the state shall withdraw, or authorize any agency or institution under its management and control to withdraw, from the * * * plan. * * * No political subdivision or instrumentality of the state that participates in the plan shall be authorized to withdraw from the plan.
SECTION 8. Section 25-15-101, Mississippi Code of 1972, is amended as follows:
25-15-101. The governing board of any county, municipality, municipal separate school district, other school district or junior college district, and the governing board or head of any institution, department or agency of any county or municipality may negotiate for and secure for all or specified groups of employees and their dependents of such county or municipality, or institution, department or agency of such county or municipality, or municipal separate school district, other school district or junior college district, a policy or policies of group insurance covering the life, (except as hereinafter provided), salary protection, health, accident and hospitalization, as well as a group contract or contracts covering hospital and/or medical and/or surgical services or benefits (including surgical costs, so-called "hospital extras," medical expenses, allied coverages, and major medical costs) of such of its employees and their dependents as may desire such insurance and other coverage under such service or benefit contracts, and who shall authorize in writing the deduction from the salary or wages of such employees of the proportionate part of the costs thereof attributable to such employees. However, the insurance coverage authorized under this section shall not be authorized for employees and their dependents who are covered by the Public Employees Life and Health Insurance Plan. Any employee who desires to reallocate or reduce any part of his or her salary or wages for a cafeteria fringe benefit plan in accordance with current requirements of Section 125 et seq. of the Internal Revenue Code for himself or herself and/or for his or her dependent(s) shall authorize, in writing, the deduction from the salary or wages of such employee the proportionate part of the costs thereof attributable to such employee. Any amount so deducted shall be transferred into the general fund or contingent fund of such county or municipality, or the operating fund of such institution, department or agency of the county or municipality, or the maintenance fund of such municipal separate school district, other school district or junior college district, as the case may be, and shall be supplemented by funds from the general fund, contingent fund, maintenance fund, or operating fund, as the case may be, in an amount to be determined by the governing board or head of such political subdivision, school district, junior college district, institution, department or agency, in their discretion, in order to pay the full costs. In no instances shall the amount of contributions by any governing board or head of a political subdivision, school district, junior college district, institution, department or agency hereinabove mentioned exceed an average of one hundred percent (100%) of the cost of all such group coverages for employees.
The governing board or head of such political subdivision, school district, junior college district, institution, department or agency is authorized to pay such full costs direct to the insurance company and to the hospital and/or medical and/or surgical service association from the general fund, contingent fund, or the maintenance fund of such county or municipality, or the operating fund of such institution, department, or agency of the county or municipality, or the maintenance fund of such municipal separate school district, other school district or junior college district, as the case may be, and to do all acts necessary and proper for the purpose of carrying out the provisions of Sections 25-15-101 and 25-15-103 and of effectuating the purposes hereof. The rates for any and all costs covered by those sections shall be in keeping with promulgated schedules, and the rates for such costs shall be approved by the Insurance Commissioner of the State of Mississippi. This section shall not be construed to prevent changes in rates based on experience, nor the granting of dividends or rate reductions or credits.
The governing board or head of any political subdivision or other entity set forth in this section may elect to become a self-insurer with respect to all or any portion of group life, salary protection, health, accident and hospitalization benefits on terms and conditions deemed advisable, in its discretion. The administration and service of any such self-insurance program shall be contracted to a third party approved by the Commissioner of Insurance and benefits provided in excess of the self-insurance plan shall be covered by a policy or policies of group insurance or a group contract or contracts issued by a company licensed to do business in this state.
The governing board of any political subdivision or other entity set forth in this section may join with any one or more other such political subdivision or entity to pool the risks authorized to be insured or self-insured under this section or to act as a self-insurer, or to contract for a policy or policies of insurance, or to contract with a third party administrator for a self-insurance plan; however, in order to qualify as a self-insurer a group, whether consisting of one or more employers, shall consist of not less than one hundred fifty (150) employees. The governing board of any political subdivision or other entity set forth in this section having at least fifty (50) employees but less than one hundred fifty (150) employees may self-insure all or any part of a benefit program with benefits authorized to be insured or self-insured under this section in an amount not to exceed Two Thousand Dollars ($2,000.00) per year per employee; and any such political subdivision or other entity may join with any one or more other such political subdivisions or entities, such political subdivisions and entities having at least fifty (50) employees but less than one hundred fifty (150) employees in the aggregate, to pool the risks authorized to be insured or self-insured under this section. However, any such self-insurance plan or pooled risk plan involving at least fifty (50) employees but less than one hundred fifty (150) employees shall be certified by the Mississippi Department of Insurance as being actuarially sound.
Any political subdivision or other entity that provides any plan of group insurance or other coverage under this section does not waive, but expressly reserves, its sovereign immunity under the laws of the State of Mississippi; and all plans and agreements executed by political subdivisions and other entities providing insurance or other coverage under this section shall contain a provision expressly limiting liability for the payment of all benefits for single or multiple claims to the extent of the insurance carried or to the extent of funds available under the self-insurance fund.
Nothing in Sections 25-15-101 and 25-15-103 shall be construed to apply to agencies financed entirely by federally granted administrative funds.
The restrictions in this section on the amount which employers may pay for group insurance and other coverage for their employees shall not be applicable to municipalities.
Any governing board or head of any political subdivision or other entity that provides any plan of group insurance or other coverage under this section, and any person with whom such governing board, head of a political subdivision or other entity contracts in the performance of any duty or authority prescribed under this section, shall be liable civilly for the loss or misappropriation of any public funds resulting from their failure to comply with any provision of this section, such funds to be recovered in the manner provided under Section 7-7-211.
SECTION 9. Section 27-104-31, Mississippi Code of 1972, is amended as follows:
27-104-31. (1) The State Fiscal Officer shall have the following powers and duties, acting through the Insurance Division:
(a) To implement and administer a comprehensive risk management program for all state agencies, including but not limited to the areas of * * * liability insurance and workers' compensation insurance;
* * *
(b) To coordinate and administer the Employment Compensation Revolving Fund for state agencies as directed in Section 71-5-359(2)(c);
(c) To coordinate and administer the liability plans authorized in Section 11-46-17;
(d) To coordinate and administer the workers' compensation plan for state agencies as a self-insured program and to determine the feasibility of other self-insured programs for state agencies;
(e) To require of state agencies premium payments or contributions to self-insurance funds or both necessary to meet the obligations created by the comprehensive risk management program. Such self-insurance fund created shall be maintained as separate special funds in the State Treasury or in authorized bank accounts. Such funds as required shall be used to pay claims under the workers' compensation self-insurance fund. All such funds shall be exempt from the appropriation process. All interest earned from the investment of monies in the funds shall be credited to the appropriate special fund. Monies remaining in such special funds at the end of the fiscal year shall not lapse into the State General Fund;
(f) To promulgate and adopt rules and regulations necessary to effect the provisions of a comprehensive risk management program; and
(g) To pay such administrative costs necessary to insure the successful operation of each program administered by the insurance division. Such administrative costs shall include the operating expenses of the division. Each program shall be assessed their proportionate share of those operating expenses.
* * *
(2) The State Fiscal Officer shall not have the power or authority to request that bonds be issued or any funds borrowed in order to implement a comprehensive risk management program or plan of self-insurance for the state, or any of its political subdivisions, or to contribute to the Tort Claims Fund.
SECTION 10. Section 37-19-34, Mississippi Code of 1972, is amended as follows:
37-19-34. * * * The State Department of Education, in accordance with rules and regulations established by the State Board of Education, may withhold a school district's minimum program funds for failure of the district to timely report student, fiscal and personnel data necessary to meet state and/or federal requirements. The rules and regulations promulgated by the State Board of Education shall require the withholding of minimum program funds for those districts that fail to remit premiums, interest penalties and/or late charges under the Public * * * Employees Life and Health Insurance Plan. Noncompliance with such rules and regulations shall result in a violation of compulsory accreditation standards as established by the State Board of Education and Commission on School Accreditation.
SECTION 11. Section 41-95-7, Mississippi Code of 1972, is amended as follows:
41-95-7. (1) The Mississippi Health Finance Authority Board shall formulate and carry out all policies regarding services within the jurisdiction of the authority, and shall adopt, modify, repeal and promulgate necessary rules and regulations after due notice and hearing and where not otherwise prohibited by federal or state law. It shall be the duty of the Mississippi Health Finance Authority to provide, to the fullest extent possible, that basic health care benefits are available to all Mississippians. Toward this end, the Mississippi Health Finance Authority Board shall conduct the following activities:
(a) The Mississippi Health Finance Authority shall conduct such research as is necessary to analyze current expenditures for health care for Mississippians, patterns of utilization of health resources, accessibility of providers and services, as well as other factors including, but not limited to, the demography and geography of Mississippi, which affect the quality and cost of health services. Potential savings through such measures as preventive and primary care, managed care, reduction of cost shifting and group purchasing shall be identified and analyzed. The Mississippi Health Finance Authority is authorized to obtain, collect and preserve such information as determined by the authority to be needed to conduct this research and carry out all other duties. No health care provider, health care facility, state agency, insurance company or related entity may refuse to provide the information required by the authority, but may charge a reasonable cost for the collection and reporting of the information. Information received by the authority shall not be disclosed publicly in such manner as to identify individuals or specific facilities. Information collected by the authority that identifies specific individuals or facilities is exempt from disclosure under the Mississippi Public Records Act. Information obtained by the Mississippi Health Finance Authority shall be governed by state and federal laws, and regulations applicable to the agency from whom information is received.
(b) The Mississippi Health Finance Authority shall determine what basic health services will best serve the needs of the citizens of the State of Mississippi, and in conjunction with such determination, shall identify such additional measures as are desirable to encourage employer participation, promote competition, contain costs and otherwise increase the availability of health benefits to Mississippians.
(c) In conjunction with paragraph (b) of this subsection, the board shall develop a plan for the provision of basic health services to * * * persons currently receiving Medicaid benefits and as many additional persons with no other health benefits as the Mississippi Health Finance Authority Board determines economically feasible, as specifically provided in subsection (2) of this section. The Mississippi Health Finance Authority Board, in developing the plan, may propose graduated levels of participation proportionate to the participant's level of economic circumstances. This plan should include realization of savings identified through paragraphs (a) and (b) of this subsection.
(d) If different health plans are proposed, the Mississippi Health Finance Authority shall require written disclosure of treatment policies, practice standards or practice parameters, and any restrictions or limits on normal health services, including, but not limited to physical services, clinical laboratory tests, hospital and surgical procedures, prescription drugs and biologics, and radiological examinations, by each health plan, unless the authority specifically determines it inadvisable to do so.
(e) The Mississippi Health Finance Authority shall determine what criteria are appropriate for certification of purchasing alliances, to protect the health and safety of the beneficiaries of health services provided pursuant to this chapter.
(f) Effective upon approval of the plan by the Legislature, the Mississippi Health Finance Authority shall establish procedures for the solicitation of bids and subsequent purchase of benefits for persons listed in paragraph (c) of this subsection. In contracting for health benefits, the Mississippi Health Finance Authority shall require such information gathering, reports and other measures as are necessary to monitor the provisions of health benefits and the accounting of all financial transactions therein. These shall include any data to continue the research and analysis set forth in paragraph (a) of this subsection.
(2) (a) From and after July 1, 1999, the Mississippi Health Finance Authority Board shall establish the Mississippi Health Care Purchasing Pool for the purpose of coordinating and enhancing the purchasing power of health care benefit plans of the groups identified under this section. It is not the intent of the Legislature to exacerbate cost shifting or adverse selection in the Mississippi health care system through the creation of the Health Care Purchasing Pool. In offering and administering the purchasing pool, the board shall not discriminate against individuals or groups based on age, gender, geographic area, industry and medical history. The board may include in the purchasing pool all employees, retirees and dependents covered by the group health insurance plans of the following entities:
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(i) Any political subdivision or municipality which does not participate in the Public Employees Life and Health Insurance Plan that chooses to participate in the pool;
(ii) Such portions of the Medicaid caseload as the board deems proper. Access to medical care or benefit levels for Medicaid recipients shall not diminish as a result of participation or nonparticipation in the pool;
(iii) Such portions of the uninsured caseload as the board deems proper; and
(iv) Any private entity that chooses to participate in the pool.
On and after July 1, 1999, the board may make the purchasing pool available to any employer, group, association or trust that chooses to participate in the pool on behalf of the employees or members of the group, association or trust.
(b) In administering the purchasing pool the authority may:
(i) Contract on behalf of participants in the pool with health care providers, health care facilities and health insurers for the delivery of health care services, including agreements securing discounts for regular, bulk payments to providers and agreements establishing uniform provider reimbursement;
(ii) Consolidate administrative functions on behalf of participants in the pool, including claims, processing, utilization review, management reporting, benefit management and bulk purchasing;
(iii) Create a health care cost and utilization data base for participants in the pool, and evaluate potential cost savings; and
(iv) Establish incentive programs to encourage pool participants to use health care services judiciously and to improve their health status.
(c) On or before December 15 of each year, the authority shall report to the Legislature on the operation of the purchasing pool, including the number and types of groups and group members participating in the pool, the costs of administering the pool, and the savings attributable to participating groups from the operation of the pool.
(d) This subsection (2) shall not be implemented unless (i) the necessary federal waivers have been granted, or (ii) the Secretary of the federal Department of Health and Human Services certifies that federal law permits this state to implement this program, and (iii) the Secretary of the federal Department of Health and Human Services certifies that full implementation of waiver programs shall receive federal funding at current participation rates, and (iv) further amendment to this section by the Legislature has been enacted and has become law during the 1997 Regular Session or subsequent sessions.
SECTION 12. Sections 25-15-251, 25-15-253, 25-15-255, 25-15-256, 25-15-257, 25-15-259, 25-15-261, 25-15-263 and 25-15-265, Mississippi Code of 1972, which provide for a group health insurance plan for employees of school districts and community/junior college districts, and Sections 37-9-151 and 37-9-153, Mississippi Code of 1972, which provide for the design of a plan of group health insurance for school district personnel, are repealed.
SECTION 13. Section 25-15-301, Mississippi Code of 1972, is amended as follows:
25-15-301. (1) Whenever the board chooses to contract with an administrator for the insurance plans established by Sections 25-15-3 et seq. * * * it shall comply with the procedures set forth in this section:
(a) If the board determines that it should contract out the administration of the plans to an administrator, it shall cause to be prepared a request for proposals. This request for proposals shall be prepared for distribution to any interested party. Notice of the department's intention to seek proposals shall be published in a newspaper of general circulation at least one (1) time per week for three (3) weeks before closing the period for interested parties to respond. Additional forms of notice may also be used. The newspaper notice shall inform the interested parties of the service to be contracted, existence of a request for proposals, how it can be obtained, when a proposal must be submitted, and to whom the proposal must be submitted. All requests for proposals shall describe clearly what service is to be contracted, and shall fully explain the criteria upon which an evaluation of proposals shall be based. The criteria to be used for evaluations shall, at minimum, include:
(i) The administrator's proven ability to handle large group accident and health insurance plans;
(ii) The efficiency of the claims-paying procedures;
(iii) An estimate of the total charges for administering the plans.
(b) All proposals submitted by interested parties shall be evaluated by an internal review committee which shall apply the same criteria to all proposals when conducting an evaluation. The committee shall consist of at least three (3) members of the board. The results and recommendations of the evaluation shall be presented to the board for review. All evaluations presented to the board shall be retained by the board for at least three (3) years. The board may accept or reject any recommendation of the review committee, or it may conduct further inquiry into the proposals. Any further inquiry shall be clearly documented and all methods and recommendations shall be retained by the board and shall spread upon its minutes its choice of administrator and its reasons for making the choice.
(c) (i) The board shall be responsible for preparing a contract that shall be in accordance with all provisions of this section and all other provisions of law. The contract shall also include a requirement that the contractor shall consent to an evaluation of his performance. Such evaluation shall occur after the first six (6) months of the contract, and shall be reviewed at times the board determines to be necessary. The contract shall clearly describe the standards upon which the contractor shall be evaluated. Evaluations shall include, but not be limited to, efficiency in claims processing, including the processing pending claims.
(ii) The PEER Committee, from funds specifically appropriated annually for this purpose, shall contract with an accounting firm or with other professionals to conduct a compliance audit of any administrator responsible for administering the insurance plan established by Section 25-15-3 et seq. * * *. Such audit shall review the administrator's compliance with the performance standards required for inclusion in the administrator's contract. Such audit shall be performed annually, and delivered to the Legislature no later than January 1 of each calendar year.
(2) Contracts for the administration of the insurance plan established in Section 25-15-3 et seq. * * * shall commence at the beginning of the calendar year and shall end on the last day of a calendar year. This shall not apply to contracts provided for in subsection (3) of this section.
(3) If the board determines that it is necessary to not renew the contract of an administrator, or finds it necessary to terminate a contract with or without cause as provided for in the contract of the administrator, the board is authorized to select an administrator without complying with the bid requirements in subsections (1) and (2) of this section. Such contracts shall be for the balance of the calendar year in which the nonrenewal or termination occurred, and may be for an additional calendar year if the board determines that the best interests of the plan members are served by such. Any contract negotiated on an interim basis shall include a detailed transition plan which shall ensure the orderly transfer of responsibilities between administrators and shall include, but not be limited to, provisions regarding the transfer of records, files and tapes.
(4) Except for contracts executed under the authority of subsection (3) of this section, the board shall select administrators at least six (6) months before the expiration of the current administrator's contract. The period between the selection of the new administrator and the effective date of the new contract shall be known as the transition period. Whenever the newly selected administrator is an entity different from the entity performing the administrator's function, it shall be the duty of the board to prepare a detailed transition plan which shall insure the orderly transfer of responsibilities between administrators. This plan shall be effective during the transition period, and shall include, but not be limited to, provisions regarding the transfer of records, files and tapes. Further, the plan shall detail the steps necessary to transfer records and responsibilities and set deadlines for when such steps should be completed. The board shall include in all requests for proposals, contracts with administrators, and all other contracts, provisions requiring the cooperation of administrators and contractors in any future transition of responsibilities, and their cooperation with the board and other contractors with respect to ongoing coordination and delivery of health plan services. The board shall furnish the Legislature, Governor and advisory council with copies of all transition plans and keep them informed of progress on such plans.
(5) No brokerage fees shall be paid for the securing or executing of any contracts pertaining to the insurance plans established by Section 25-15-3 et seq. * * *, whether fully insured or self-insured.
SECTION 14. Section 25-15-303, Mississippi Code of 1972, is amended as follows:
25-15-303. (1) There is created the * * * Public * * * Employees Health Insurance Management Board, which shall administer the Public Employees Life and Health Insurance Plan provided for under Section 25-15-3 et seq. * * *. The * * * Public * * * Employees Health Insurance Management Board, hereafter referred to as the "board," shall also be responsible for administering all procedures for selecting third-party administrators provided for in Section 25-15-301. Whenever the term "department," "Department of Finance and Administration," or "board," appears in Section 25-15-3 et seq., * * * such term means the * * * Public * * * Employees Health Insurance Management Board.
(2) The board shall consist of the following:
(a) The Chairman of the Workers' Compensation Commission;
(b) The Commissioner of Insurance;
(c) The Commissioner of Higher Education;
(d) The State Superintendent of Education;
(e) The Executive Director of the Department of Finance and Administration;
(f) Two (2) appointees of the Governor whose terms shall be concurrent with that of the Governor, one (1) of whom shall have experience in providing actuarial advice to companies that provide health insurance to large groups and one (1) of whom shall have experience in the day-to-day management and administration of a large self-funded health insurance group;
(g) The Chairman of the Senate Insurance Committee or his designee;
(h) The Chairman of the House of Representatives Insurance Committee or his designee;
(i) The Chairman of the Senate Appropriations Committee or his designee; and
(j) The Chairman of the House of Representatives Appropriations Committee or his designee.
The legislators, or their designees, shall serve as ex officio, nonvoting members of the board.
The Executive Director of the Department of Finance and Administration shall be the chairman of the board.
(3) The board shall meet at least monthly and maintain minutes of such meetings. A quorum shall consist of a majority of the authorized voting membership of the board. The board shall have the sole authority to promulgate rules and regulations governing the operations of the insurance plans and shall be vested with all legal authority necessary and proper to perform this function including, but not limited to:
(a) Defining the scope and coverages provided by the insurance plans;
(b) Seeking proposals for services or insurance through competitive processes where required by law and selecting service providers or insurers under procedures provided for by law; and
(c) Developing and adopting strategic plans and budgets for the insurance plans.
The Department of Finance and Administration shall also employ a State Insurance Administrator, who shall be responsible for the day-to-day management and administration of the insurance plan. The board shall employ a Deputy State Insurance Administrator who shall be an actuary and a member of the American Academy of Actuaries. The Deputy State Insurance Administrator shall have experience in providing actuarial services to companies which provide health insurance to large groups. The deputy administrator shall receive a salary set by the board and shall not be subject to the authority of the State Personnel Board for any purpose. The Department of Finance and Administration shall provide to the board on a full-time basis personnel and technical support necessary and sufficient to effectively and efficiently carry out the requirements of this section.
(4) Members of the board shall not receive any compensation or per diem, but may receive travel reimbursement provided for under Section 25-3-41 except that the legislators shall receive per diem and expenses which shall be paid from the contingent expense funds of their respective houses in the same amounts as provided for committee meetings when the Legislature is not in session; however, no per diem and expenses for attending meetings of the board shall be paid while the Legislature is in session.
SECTION 15. This act shall take effect and be in force from and after January 1, 1999.