Public Employees Health Fund
Establishes Employer-Union Trust Fund pilot project to begin in 2003. Allows for the porting of Medicare Part B to employee organizations. Allows Public Employees Health Fund to offer different benefits to retirants.
HOUSE OF REPRESENTATIVES
TWENTY-FIRST LEGISLATURE, 2001
STATE OF HAWAII
A BILL FOR AN ACT
relating to the public employees health fund.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that Act 146, Session Laws of Hawaii (SLH) 1961, established the public employees health fund (health fund), later codified as chapter 87, Hawaii Revised Statutes (HRS). Currently, the health fund provides state and county public employees and their dependents with a health benefits plan, a dental benefits plan for certain children, a group life benefit program, and a long-term care benefits program. The State and the counties as employers, and public employees, share in the cost of the health benefits through the payment of required monthly contributions to the health fund.
The legislature, in Act 309, SLH 1996 (Act 309), stated that: ". . . the present governance structure to determine and fund health benefits for public employees and retirees is not only cumbersome and inflexible, but does not foster cost-efficiency. Benefits are statutorily established and administered by an independent board of trustees within a fixed statutory framework. At the same time, public employer contributions for these health benefits are negotiated separately through collective bargaining agreements with public employee organizations. Consequently, there is little connection between benefit levels and costs, and limited latitude to design benefit packages that minimize costs and better meet the health care needs of employees." Act 309 further stated that ". . . public employers and public employee organizations should be involved in determining health care coverage and costs because health benefits have not only become a significant component of the total compensation package for public employees, but represent a significant cost to public employers. The employer-union trust concept for determining and administering health benefits provides a mechanism for linking benefit levels and costs, as well as the necessary flexibility to establish appropriate health benefits coverage."
Toward this end, Act 309 required the director of finance to establish a committee comprising representatives from state and county public employers and public employee organizations to develop and recommend a proposal to implement an employer-union trust concept for determining and administering public employee and retiree health benefits. The proposal was to include a suggested trust structure and necessary statutory changes to chapters 87 and 89, HRS. Although Act 309 required the director of finance to report to the legislature prior to the convening of the 1997 regular session, no report was submitted. In subsequent years, legislation has been introduced to alter the composition of the committee and to extend its term to allow for continued discussion on the issue with the hope of someday obtaining a recommendation. Meanwhile, the legislature is keenly aware that a large number of "baby boomers" are approaching retirement, the increasing cost of health care, and the retirees' increased life expectancy threatens the future financial stability of the current "pay-as-you-go" funding method. Based on these findings, the legislature believes that the time has come to effectuate significant change in the provision of health care benefits for its employees, retirees, and beneficiaries.
In the meantime, the legislature is committed to making the health benefits plan of the public employees health fund more competitive with other health benefits plans. To accomplish this, the porting of Medicare Part B reimbursements is crucial to evening out the actuarial experience of the public employees health fund's pool of beneficiaries. By authorizing the porting of Medicare Part B reimbursements to employee organizations' health benefits plans, retirees have more of an incentive to switch to employee organization health benefits plans if allowed to retain the Medicare Part B reimbursement.
The purpose of this Act is to establish an employer-union trust fund pilot project and to allow for the porting of Medicare Part B reimbursements to employee organization health benefits plans.
SECTION 2. Section 87-22, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:
"(b) The board may contract for the following health benefits plans[
; provided that benefits provided under any respective plan shall be equally available to all employee-beneficiaries and dependent-beneficiaries selecting the plan regardless of age,] as provided for below:
(1) An indemnity benefit plan or plans under which a carrier agrees to pay certain sums of money not in excess of the actual expenses incurred for health services;
(2) A service benefit plan or plans under which payment is made by a carrier under contracts with physicians, hospitals, or other providers of health services or, under certain conditions, payment is made by a carrier to an employee-beneficiary;
(3) Health maintenance organization plans, which provide or arrange health services for members on a prepaid basis, with professional services provided by physicians practicing individually or as a group in a common center or centers;
(4) Plans to offer dental benefits through an indemnity plan or plans, a service benefit plan or plans, dental maintenance organization plans, or combinations thereof;
(5) Plans to offer prescription drug benefits through an indemnity plan or plans, a service benefit plan or plans, health maintenance organization plans, or combinations thereof;
(6) Plans to offer vision care benefits through an indemnity plan or plans, a service benefit plan or plans, health maintenance organization plans, or combinations thereof; or
(7) A noninsured schedule of benefits similar to any of the schedule of benefits set forth in the health benefits plans authorized in paragraphs (1) to (6)."
SECTION 3. Section 87-27, Hawaii Revised Statutes, is
amended to read as follows:
"§87-27 Supplemental plan to federal Medicare. Any other provision of this chapter notwithstanding, the board of trustees shall establish, effective July 1, 1966, a health benefits plan which takes into account benefits available to an employee-beneficiary and spouse under the federal Medicare plan, subject to the following conditions:
(1) There shall be no duplication of benefits payable under federal Medicare but the plan so established by the board shall be supplemental to the federal Medicare plan;
(2) The contribution for voluntary medical insurance coverage under federal Medicare may be paid by the fund, in such manner as the board shall specify, in the case of an employee-beneficiary who is a retired employee, and spouse while the employee-beneficiary is living, including members of the old pension system and after death the employee-beneficiary's spouse provided the spouse qualifies as an employee-beneficiary; provided that the counties, through their respective departments of finance, shall reimburse the fund for any contributions made for county employee- beneficiaries under this paragraph[
;]. In the case of an employee-beneficiary who is a retired employee, and spouse who participates in the supplemental plan to federal Medicare of an employee organization, the employee-beneficiary shall be entitled to the same amount paid by the fund to employee-beneficiaries who participate in the supplemental plan to federal Medicare established by the fund and who have enrolled in the voluntary medical insurance coverage under the federal Medicare plan;
(3) The benefits available under the plan, when taken together with the benefits available under the federal Medicare plan, as nearly as is possible, shall approximate the benefits available under the plans set forth in section 87-22. If, for any reason, a situation develops where the benefits available under the supplemental plan and the federal Medicare plan substantially differ from those that would otherwise be available, the board may correct this inequity to assure substantial equality of benefits;
(4) Notwithstanding any other law to the contrary, all employee-beneficiaries or dependent-beneficiaries who are eligible to enroll in the federal Medicare Part B medical insurance plan shall enroll in that federal plan as a requirement to receive the contributions and to participate in the employee benefit plans described in this chapter. This paragraph shall pertain to retired employees and their spouses and the surviving spouses of deceased retirees and employees killed in the performance of duty; and
(5) The board of trustees shall determine which employee-beneficiaries and dependent-beneficiaries, who are not enrolled in the federal Medicare Part B medical insurance plan, may participate in such other plans as are set forth in section 87-22."
SECTION 4. (a) For the purposes of this section:
"Health fund" means the public employees health fund under chapter 87, HRS.
"Pilot project" means an employer-union trust fund pilot project established by the public employees health fund pursuant to this Act.
(b) There is established an employer-union trust fund pilot project to be administered by the health fund. The pilot project shall commence on July 1, 2003, and shall cease to exist on June 30, 2005, unless otherwise extended by the legislature.
(c) No later than December 31, 2001, the health fund shall establish criteria for the selection of the public sector union for the pilot project and cost-performance guidelines by which the pilot project is to be evaluated. The health fund, prior to selecting a public sector union to participate in the pilot project, shall submit a report containing the selection criteria and cost-performance guidelines to the legislature prior to the convening of the 2002 regular session. By June 30, 2002, the health fund shall select one public sector union to establish the employer-union trust fund under the pilot project.
(d) Upon the selection of the public sector union as provided under subsection (c), the health fund shall allocate to the employer-union trust fund the total sum of money owing to its employee-beneficiaries from any rate credits or reimbursements from any carrier or self-insured plan or any earning or interest derived therefrom. The employee-beneficiaries of the employer-union trust fund shall include all the members of the selected public sector union, including retirees.
(e) Notwithstanding the contribution deposit requirements of chapter 87, HRS, for the purposes of effectuating the pilot project, the health fund, for the time period in which the pilot project is in effect, shall port to the employer-union trust fund all contributions made by public employers and employee-beneficiaries to the health fund for employee-beneficiaries who are members of the selected public sector union.
(f) At least twenty days prior to the 2004 and 2005 regular sessions, the health fund shall report to the legislature on the status and efficacy of the pilot project. These reports shall include information on cost/benefit comparisons between health fund plans and the pilot project plans and employee-beneficiary satisfaction with the health benefits plans offered by the pilot project.
(g) Upon completion of the pilot project, the provision of health benefits of the employee-beneficiaries participating in the pilot project shall revert to the employee-beneficiaries' choice of health benefits plans offered by the health fund.
SECTION 5. Statutory material to be repealed is bracketed
and stricken. New statutory material is underscored.
SECTION 6. This Act shall take effect on July 1, 2001.