Bill Summary for S 865 (2015-2016)

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Summary date: 

May 11 2016

Bill Information:

View NCGA Bill Details2015-2016 Session
Senate Bill 865 (Public) Filed Tuesday, May 10, 2016
AN ACT TO MAKE ADMINISTRATIVE CHANGES TO THE STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES STATUTES, TO INCREASE THE NUMBER OF LOCAL GOVERNMENTS ABLE TO PARTICIPATE IN THE STATE HEALTH PLAN, AND TO MAKE CHANGES TO STATE HEALTH PLAN PREMIUMS PAID BY LOCAL GOVERNMENT EMPLOYEES.
Intro. by Sanderson.

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Bill summary

Amends GS 135-48.32 that requires benefits under the State Health Plan for Teachers and State Employees (Plan) to be provided under contracts between the Plan and the claims processors selected by the Plan. Requires claims processor contractors to provide all claims processing data elements to the Plan including the identification of providers and the allowed amounts paid. Eliminates provisions that allow the State Treasurer to contract with a pharmacy benefits manager to administer pharmacy benefits under the Plan, and eliminates provisions concerning the required content and administration of those contracts.

Amends GS 135-48.34 by changing the title to Contract exemptions. Establishes that contracts to provide benefits, contracts with providers or provider networks, and contracts for the design, adoption, and implementation of health benefit plans and programs available under health benefits plans, as authorized under GS 135-48.2, as amended, are not subject to the requirements of Article 3 of GS Chapter 143 (purchases and contracts by State departments, institutions or commissions), or to the requirements of Part 3 or 4 of Article 15 of GS Chapter 143B (information technology projects, management, and procurement). Provides that the contracts are subject to the requirements of GS 135-48.33. Makes conforming changes.

Amends GS 135-47(c) (recodified as GS 135-48.47(c) by SL 2011-85 Section 2.7) to allow local governments to elect to participate in the State Health Plan until the number of employees and dependents of employees of local governments enrolled in the Plan reaches 20,000 (currently, 10,000) after which time no additional local governments may join the Plan.

Amends GS 135-48.47(b)(3) to change one of the six provisions governing participation by a local government unit in the State Health Plan to require the local government unit to determine the eligibility of its employees and employees' dependents. Further, provides new language to establish that the portion of the employee and employees' dependents premiums paid to the local government unit may be determined be the local government unit but cannot exceed the premiums in the structure set by the Plan. Makes technical changes.  Effective January 1, 2017 and applies to premiums paid on or after that date.

Enacts new subsection GS 135-48.47(d) to allow local governments participating in the Plan as of April 1, 2016, to elect to withdraw from participating in the Plan effective January 1, 2017.  Requires the local government unit to give notice of withdrawal to the Plan no later than October 1, 2016.

Enacts new GS 135-48.49 to establish that the Plan is responsible for reporting coverage for retirees and coverage for direct bill members, except for individuals participating in Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage, as required by section 6055 of the Internal Revenue Code. Also requires the Plan to provide employing units with access to Plan data necessary for employing units to meet filing requirements under sections 6055 and 6056 of the Internal Revenue Code. Provides that the Plan may facilitate the availability of a reporting solution, however, the employing unit is responsible for paying all costs associated with the use of any reporting solution made available by the Plan.

Applies to contracts entered into, renewed, or amended on or after the date that the act becomes law.