BILL REQ. #: S-1828.1
State of Washington | 62nd Legislature | 2011 Regular Session |
Read first time 03/08/11. Referred to Committee on Health & Long-Term Care.
AN ACT Relating to requiring insurance benefits with wellness incentives for public employees; amending RCW 41.05.065 and 28A.400.350; and creating a new section.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 The legislature recognizes the value of
strategies that improve employee health and encourage long-term cost
containment. Employee wellness projects in state agencies and with
private employers have demonstrated use of health assessments to
identify and monitor health improvement opportunities, improvements in
employee productivity, weight reduction, and cholesterol and blood
pressure management. It is the intent of the legislature that the
wellness demonstrations move to a more population-based approach with
implementation, incorporating worksite efforts with further expansion
of high value services encouraged through the health benefit design to
improve the health of all state, higher education, and school district
employees.
Sec. 2 RCW 41.05.065 and 2009 c 537 s 7 are each amended to read
as follows:
(1) The board shall study all matters connected with the provision
of health care coverage, life insurance, liability insurance,
accidental death and dismemberment insurance, and disability income
insurance or any of, or a combination of, the enumerated types of
insurance for employees and their dependents on the best basis possible
with relation both to the welfare of the employees and to the state.
However, liability insurance shall not be made available to dependents.
(2) The board shall develop employee benefit plans that include
comprehensive health care benefits for employees. In developing these
plans, the board shall consider the following elements:
(a) Methods of maximizing cost containment while ensuring access to
quality health care;
(b) Development of provider arrangements that encourage cost
containment and ensure access to quality care, including but not
limited to prepaid delivery systems and prospective payment methods;
(c) ((Wellness incentives that focus on proven strategies, such as
smoking cessation, injury and accident prevention, reduction of alcohol
misuse, appropriate weight reduction, exercise, automobile and
motorcycle safety, blood cholesterol reduction, and nutrition
education;)) Utilization review procedures including, but not limited to
a cost-efficient method for prior authorization of services, hospital
inpatient length of stay review, requirements for use of outpatient
surgeries and second opinions for surgeries, review of invoices or
claims submitted by service providers, and performance audit of
providers;
(d)
(((e))) (d) Effective coordination of benefits; and
(((f))) (e) Minimum standards for insuring entities.
(3) The employee benefit design shall incorporate wellness
incentives that encourage health-focused activities such as better
nutrition and physical activity, use of health screening services, and
routine completion of health assessments.
(a) Incentives must include, but are not limited to, copayment or
coinsurance adjustments, or other rebates established to meet defined
health indicators such as body mass index, blood pressure, cholesterol
levels, and smoking cessation;
(b) Whenever possible, incentives must be actuarially based and
reflect the true costs associated with obesity, smoking, and high blood
pressure;
(c) In addition to the health indicator for body mass index, the
program should include an alternative measure for some individuals
using a percentage of body fat test. The cost of the test will be
waived if the alternative measure indicates the enrollee is not obese.
(4) To maintain the comprehensive nature of employee health care
benefits, benefits provided to employees shall be substantially
equivalent to the state employees' health benefits plan in effect on
January 1, 1993. Nothing in this subsection shall prohibit changes or
increases in employee point-of-service payments or employee premium
payments for benefits or the administration of a high deductible health
plan in conjunction with a health savings account. The board may
establish employee eligibility criteria which are not substantially
equivalent to employee eligibility criteria in effect on January 1,
1993.
(((4))) (5) Except if bargained for under chapter 41.80 RCW, the
board shall design benefits and determine the terms and conditions of
employee and retired employee participation and coverage, including
establishment of eligibility criteria subject to the requirements of
this chapter. Employer groups obtaining benefits through contractual
agreement with the authority for employees defined in RCW 41.05.011(6)
(a) through (d) may contractually agree with the authority to benefits
eligibility criteria which differs from that determined by the board.
The eligibility criteria established by the board shall be no more
restrictive than the following:
(a) Except as provided in (b) through (e) of this subsection, an
employee is eligible for benefits from the date of employment if the
employing agency anticipates he or she will work an average of at least
eighty hours per month and for at least eight hours in each month for
more than six consecutive months. An employee determined ineligible
for benefits at the beginning of his or her employment shall become
eligible in the following circumstances:
(i) An employee who works an average of at least eighty hours per
month and for at least eight hours in each month and whose anticipated
duration of employment is revised from less than or equal to six
consecutive months to more than six consecutive months becomes eligible
when the revision is made.
(ii) An employee who works an average of at least eighty hours per
month over a period of six consecutive months and for at least eight
hours in each of those six consecutive months becomes eligible at the
first of the month following the six-month averaging period.
(b) A seasonal employee is eligible for benefits from the date of
employment if the employing agency anticipates that he or she will work
an average of at least eighty hours per month and for at least eight
hours in each month of the season. A seasonal employee determined
ineligible at the beginning of his or her employment who works an
average of at least half-time, as defined by the board, per month over
a period of six consecutive months and at least eight hours in each of
those six consecutive months becomes eligible at the first of the month
following the six-month averaging period. A benefits-eligible seasonal
employee who works a season of less than nine months shall not be
eligible for the employer contribution during the off season, but may
continue enrollment in benefits during the off season by self-paying
for the benefits. A benefits-eligible seasonal employee who works a
season of nine months or more is eligible for the employer contribution
through the off season following each season worked.
(c) Faculty are eligible as follows:
(i) Faculty who the employing agency anticipates will work
half–time or more for the entire instructional year or equivalent nine-month period are eligible for benefits from the date of employment.
Eligibility shall continue until the beginning of the first full month
of the next instructional year, unless the employment relationship is
terminated, in which case eligibility shall cease the first month
following the notice of termination or the effective date of the
termination, whichever is later.
(ii) Faculty who the employing agency anticipates will not work for
the entire instructional year or equivalent nine-month period are
eligible for benefits at the beginning of the second consecutive
quarter or semester of employment in which he or she is anticipated to
work, or has actually worked, half-time or more. Such an employee
shall continue to receive uninterrupted employer contributions for
benefits if the employee works at least half-time in a quarter or
semester. Faculty who the employing agency anticipates will not work
for the entire instructional year or equivalent nine-month period, but
who actually work half-time or more throughout the entire instructional
year, are eligible for summer or off-quarter coverage. Faculty who
have met the criteria of this subsection (((4))) (5)(c)(ii), who work
at least two quarters of the academic year with an average academic
year workload of half-time or more for three quarters of the academic
year, and who have worked an average of half-time or more in each of
the two preceding academic years shall continue to receive
uninterrupted employer contributions for benefits if he or she works at
least half-time in a quarter or semester or works two quarters of the
academic year with an average academic workload each academic year of
half-time or more for three quarters. Eligibility under this section
ceases immediately if this criteria is not met.
(iii) Faculty may establish or maintain eligibility for benefits by
working for more than one institution of higher education. When
faculty work for more than one institution of higher education, those
institutions shall prorate the employer contribution costs, or if
eligibility is reached through one institution, that institution will
pay the full employer contribution. Faculty working for more than one
institution must alert his or her employers to his or her potential
eligibility in order to establish eligibility.
(iv) The employing agency must provide written notice to faculty
who are potentially eligible for benefits under this subsection (((4)))
(5)(c) of their potential eligibility.
(v) To be eligible for maintenance of benefits through averaging
under (c)(ii) of this subsection, faculty must provide written
notification to his or her employing agency or agencies of his or her
potential eligibility.
(d) A legislator is eligible for benefits on the date his or her
term begins. All other elected and full-time appointed officials of
the legislative and executive branches of state government are eligible
for benefits on the date his or her term begins or they take the oath
of office, whichever occurs first.
(e) A justice of the supreme court and judges of the court of
appeals and the superior courts become eligible for benefits on the
date he or she takes the oath of office.
(f) Except as provided in (c)(i) and (ii) of this subsection,
eligibility ceases for any employee the first of the month following
termination of the employment relationship.
(g) In determining eligibility under this section, the employing
agency may disregard training hours, standby hours, or temporary
changes in work hours as determined by the authority under this
section.
(h) Insurance coverage for all eligible employees begins on the
first day of the month following the date when eligibility for benefits
is established. If the date eligibility is established is the first
working day of a month, insurance coverage begins on that date.
(i) Eligibility for an employee whose work circumstances are
described by more than one of the eligibility categories in (a) through
(e) of this subsection shall be determined solely by the criteria of
the category that most closely describes the employee's work
circumstances.
(j) Except for an employee eligible for benefits under (b) or
(c)(ii) of this subsection, an employee who has established eligibility
for benefits under this section shall remain eligible for benefits each
month in which he or she is in pay status for eight or more hours, if
(i) he or she remains in a benefits-eligible position and (ii) leave
from the benefits-eligible position is approved by the employing
agency. A benefits-eligible seasonal employee is eligible for the
employer contribution in any month of his or her season in which he or
she is in pay status eight or more hours during that month.
Eligibility ends if these conditions are not met, the employment
relationship is terminated, or the employee voluntarily transfers to a
noneligible position.
(k) For the purposes of this subsection:
(i) "Academic year" means summer, fall, winter, and spring quarters
or semesters;
(ii) "Half-time" means one-half of the full-time academic workload
as determined by each institution, except that half-time for community
and technical college faculty employees shall have the same meaning as
"part-time" under RCW 28B.50.489;
(iii) "Benefits-eligible position" shall be defined by the board.
(((5))) (6) The board may authorize premium contributions for an
employee and the employee's dependents in a manner that encourages the
use of cost-efficient managed health care systems.
(((6))) (7) The board shall develop a health savings account option
for employees that conform to section 223, Part VII of subchapter B of
chapter 1 of the internal revenue code of 1986. The board shall comply
with all applicable federal standards related to the establishment of
health savings accounts.
(((7))) (8) Notwithstanding any other provision of this chapter,
the board shall develop a high deductible health plan to be offered in
conjunction with a health savings account developed under subsection
(((6))) (7) of this section.
(((8))) (9) Employees shall choose participation in one of the
health care benefit plans developed by the board and may be permitted
to waive coverage under terms and conditions established by the board.
(((9))) (10) The board shall review plans proposed by insuring
entities that desire to offer property insurance and/or accident and
casualty insurance to state employees through payroll deduction. The
board may approve any such plan for payroll deduction by insuring
entities holding a valid certificate of authority in the state of
Washington and which the board determines to be in the best interests
of employees and the state. The board shall adopt rules setting forth
criteria by which it shall evaluate the plans.
(((10))) (11) Before January 1, 1998, the public employees'
benefits board shall make available one or more fully insured long-term
care insurance plans that comply with the requirements of chapter 48.84
RCW. Such programs shall be made available to eligible employees,
retired employees, and retired school employees as well as eligible
dependents which, for the purpose of this section, includes the parents
of the employee or retiree and the parents of the spouse of the
employee or retiree. Employees of local governments, political
subdivisions, and tribal governments not otherwise enrolled in the
public employees' benefits board sponsored medical programs may enroll
under terms and conditions established by the administrator, if it does
not jeopardize the financial viability of the public employees'
benefits board's long-term care offering.
(a) Participation of eligible employees or retired employees and
retired school employees in any long-term care insurance plan made
available by the public employees' benefits board is voluntary and
shall not be subject to binding arbitration under chapter 41.56 RCW.
Participation is subject to reasonable underwriting guidelines and
eligibility rules established by the public employees' benefits board
and the health care authority.
(b) The employee, retired employee, and retired school employee are
solely responsible for the payment of the premium rates developed by
the health care authority. The health care authority is authorized to
charge a reasonable administrative fee in addition to the premium
charged by the long-term care insurer, which shall include the health
care authority's cost of administration, marketing, and consumer
education materials prepared by the health care authority and the
office of the insurance commissioner.
(c) To the extent administratively possible, the state shall
establish an automatic payroll or pension deduction system for the
payment of the long-term care insurance premiums.
(d) The public employees' benefits board and the health care
authority shall establish a technical advisory committee to provide
advice in the development of the benefit design and establishment of
underwriting guidelines and eligibility rules. The committee shall
also advise the board and authority on effective and cost-effective
ways to market and distribute the long-term care product. The
technical advisory committee shall be comprised, at a minimum, of
representatives of the office of the insurance commissioner, providers
of long-term care services, licensed insurance agents with expertise in
long-term care insurance, employees, retired employees, retired school
employees, and other interested parties determined to be appropriate by
the board.
(e) The health care authority shall offer employees, retired
employees, and retired school employees the option of purchasing long-term care insurance through licensed agents or brokers appointed by the
long-term care insurer. The authority, in consultation with the public
employees' benefits board, shall establish marketing procedures and may
consider all premium components as a part of the contract negotiations
with the long-term care insurer.
(f) In developing the long-term care insurance benefit designs, the
public employees' benefits board shall include an alternative plan of
care benefit, including adult day services, as approved by the office
of the insurance commissioner.
(g) The health care authority, with the cooperation of the office
of the insurance commissioner, shall develop a consumer education
program for the eligible employees, retired employees, and retired
school employees designed to provide education on the potential need
for long-term care, methods of financing long-term care, and the
availability of long-term care insurance products including the
products offered by the board.
(((11))) (12) The board may establish penalties to be imposed by
the authority when the eligibility determinations of an employing
agency fail to comply with the criteria under this chapter.
Sec. 3 RCW 28A.400.350 and 2001 c 266 s 2 are each amended to
read as follows:
(1) The board of directors of any of the state's school districts
or educational service districts may make available liability, life,
health, health care, accident, disability and salary protection or
insurance or any one of, or a combination of the enumerated types of
insurance, or any other type of insurance or protection, for the
members of the boards of directors, the students, and employees of the
school district or educational service district, and their dependents.
Such coverage may be provided by contracts with private carriers, with
the state health care authority after July 1, 1990, pursuant to the
approval of the authority administrator, or through self-insurance or
self-funding pursuant to chapter 48.62 RCW, or in any other manner
authorized by law.
(2) Whenever funds are available for these purposes the board of
directors of the school district or educational service district may
contribute all or a part of the cost of such protection or insurance
for the employees of their respective school districts or educational
service districts and their dependents. The premiums on such liability
insurance shall be borne by the school district or educational service
district.
After October 1, 1990, school districts may not contribute to any
employee protection or insurance other than liability insurance unless
the district's employee benefit plan conforms to RCW 28A.400.275 and
28A.400.280.
(3) For school board members, educational service district board
members, and students, the premiums due on such protection or insurance
shall be borne by the assenting school board member, educational
service district board member, or student. The school district or
educational service district may contribute all or part of the costs,
including the premiums, of life, health, health care, accident or
disability insurance which shall be offered to all students
participating in interschool activities on the behalf of or as
representative of their school, school district, or educational service
district. The school district board of directors and the educational
service district board may require any student participating in
extracurricular interschool activities to, as a condition of
participation, document evidence of insurance or purchase insurance
that will provide adequate coverage, as determined by the school
district board of directors or the educational service district board,
for medical expenses incurred as a result of injury sustained while
participating in the extracurricular activity. In establishing such a
requirement, the district shall adopt regulations for waiving or
reducing the premiums of such coverage as may be offered through the
school district or educational service district to students
participating in extracurricular activities, for those students whose
families, by reason of their low income, would have difficulty paying
the entire amount of such insurance premiums. The district board shall
adopt regulations for waiving or reducing the insurance coverage
requirements for low-income students in order to assure such students
are not prohibited from participating in extracurricular interschool
activities.
(4) All contracts for insurance or protection written to take
advantage of the provisions of this section shall provide that the
beneficiaries of such contracts may utilize on an equal participation
basis the services of those practitioners licensed pursuant to chapters
18.22, 18.25, 18.53, 18.57, and 18.71 RCW.
(5) All contracts for employee health benefits shall incorporate
wellness incentives that encourage health-focused activities such as
better nutrition and physical activity, use of health screening
services, and routine completion of health assessments.
(a) Incentives must include, but are not limited to, copayment or
coinsurance adjustments, or other rebates established to meet defined
health indicators such as body mass index, blood pressure, cholesterol
levels, and smoking cessation;
(b) Whenever possible, incentives must be actuarially based and
reflect the true costs associated with obesity, smoking, and high blood
pressure;
(c) In addition to the health indicator for body mass index, the
program should include an alternative measure for some individuals
using a percentage of body fat test. The cost of the test will be
waived if the alternative measure indicates the enrollee is not obese.