The Commission shall determine whether a Municipal Employer that has adopted M.G.L. c. 32B, §§ 19 or 23, qualifies for the Commission's Health Coverage. If the Commission approves a Municipal Employer to transfer all of its Insureds whom the Commission determines to be eligible to join the Commission's Health Coverage, it shall do so according to the conditions set forth in M.G.L. c. 32B, §§ 19, 21, and 23.
(1) Notice. Non-unionized cities, town and districts must send a letter from their chief executive officer stating their decision to transfer the Municipal Employer's subscribers to Commission coverage. Unionized Municipal Employers must provide notice as follows:
(a) Section 19 Notice. For the purposes of notice to the Commission of intent to transfer subscribers sufficient to satisfy M.G.L. c. 32B, § 19 (e), Unionized Municipal Employers must provide to the Commission a copy of the signed and executed Public Employee Committee agreement to join the Commission's health coverage and a cover letter from an authorized official of the Municipal Employer confirming the Municipal Employer's intent to join Commission Health Coverage. The notice deadline may be extended up to a maximum of five business days after the statutory deadline for the sole purpose of executing the Public Employee Committee agreements.
(b) Section 23 Notice. For the purposes of notice to the Commission of intent to transfer subscribers sufficient to satisfy M.G.L. c. 32B, § 23 (a), Unionized Municipal Employers must provide to the Commission a copy of the signed and executed Public Employee Committee agreement, or the order of the three-person panel, under M.G.L. c. 32B, § 21, to join the Commission's health coverage, a copy of the proposal underlying the order of the three-person panel, where applicable, and a cover letter from an authorized official of the Municipal Employer that gives notice of a decision to transfer to the Commission. The agreement or the order and supporting proposal shall include the premium contribution details.
(2) A Municipal Employer's transfer agreement or order whose terms alter the Commission's Health Coverage benefit levels from those determined by the Commission or subsidize Municipal Insureds' health coverage are prohibited, with the exception of Municipal Employers funding pre-tax program start-up costs and annual administrative fees, Medicare Part B premium refunds and such other exceptions as are expressly authorized by law. Prohibited alterations include but are not limited to the following:
(a) Alteration of its subscribers' choice of health carriers, health benefits, or out-of-pocket costs;
(b) Offering non-Commission health insurance coverage;
(c) Making contributions to offset Commission health premium or specific health benefits, including compensating the difference between current municipal benefits and Commission benefits, except as expressly authorized by law, including as authorized by M.G.L. c. 32B, §§ 15(b), 24, and 25;
(d) Obligating the Commission's municipal coverage to pay for health claims that were incurred before the Municipal Insureds' Commission coverage became effective.
Such alterations or subsidies are grounds for rejection or termination from Commission coverage after a 90-day termination notice. In the event that the Commission learns of the violation after Commission coverage has begun, termination shall be retroactive to the initial subsidy or alteration.
(3) Scope of Transfer. Upon the Municipal Employer’s coverage effective date and for the duration of its coverage with the Commission, the Municipal Employer shall not provide any non-Commission health coverage to its employees.
(4) Coverage Effective Date. Health Coverage for Municipal Insureds shall begin on the effective date of transfer as determined by the Commission. The Commission's Health Coverage shall consider only health care claims that are incurred after the Commission's effective date of transfer. The Municipal Employer shall be solely responsible for continuing its Municipal Insureds' health coverage until the effective date of transfer to Municipal Coverage, including coverage of any costs or claims incurred but not reported prior to the effective date of transfer.
(5) Enrollment, Choice of Plans. As of the effective date of transfer to the Commission's Health Coverage, the Municipal Employer shall provide the Commission's forms for Health Coverage enrollment to all prospective insureds, including those who currently are not enrolled in the Municipal Employer's health coverage. Municipal Employer Insureds shall be offered all of the health plan choices as are offered to other Insureds who live in the same geographic area.
(6) Data Required with Notice. A Municipal Employer that has given notice as defined in clause (1) of this section of its decision to transfer shall provide the Commission with a completed “Required Municipal Initial Enrollment Data” of its current enrollee population for whom it provides health insurance coverage. These data shall be provided no later than 30 days after the notice deadline for any given enrollment period and be in a format designated by the Commission. The Commission shall provide the file type, file layout, data elements and the Commission's Municipality Software Application upon request of the Municipal Employers. The Commission will publicize initial enrollment data requirements on its website.
(a) Completeness of the aggregated data shall be assessed by use of the Commission's Municipality Software Application and shall be within a five percent error threshold.
(b) The total count of eligible subscribers, including all employees, retirees, and survivors who would be eligible for Commission health insurance whether or not currently enrolled shall be provided by the deadlines as described above.
(c) All Municipal Employers shall provide the Commission with the following contact information:
(i) IT contact and alternate;
(ii) benefits coordinator and alternate;
(iii) fiscal contact and alternate; and
(iv) authorized official and alternate.
Contact information shall include mailing address, phone number and email address.
(d) All Municipal Employers shall provide their benefits coordinator staff with internet access to utilize the Commission's eligibility system (known as the MAGIC system). The Commission shall provide authentication certificates, user IDs and passwords to allow access to the MAGIC system.
(7) The Municipal Employer shall provide, in advance, a draft to the Commission of the initial subscriber communication, which will be subject to the Commission's review. The Commission shall provide a template for this communication. Future communications regarding the Commission shall be cleared by the Commission in advance of their distribution. The Commission shall provide a master premium contribution chart for the Municipal Employer to use in developing a customized rate chart for its own contribution ratios as well as all benefit related materials. The Municipal Employer shall produce customized rate charts for its subscribers and shall provide them to the Commission in an Americans with Disability Act (ADA) accessible format for the Commission's website.
(8) Municipal Employers that do not meet the Commission's required deadlines during the implementation period may, at the Commission's sole discretion, have their coverage effective date delayed until the next scheduled enrollment period.
(9) If a Municipal Employer chooses to transfer to Commission coverage and its retired teachers currently receive insurance through the Commission's Retired Municipal Teachers program under M.G.L. c. 32A, § 12, all said retired teachers shall transfer from the Commission's fully insured Pool 2 to Pool 1 and may re-enroll in Commission benefits for which they are eligible. Retired Municipal Teachers who transfer to the Commission through their respective Municipal Employers may receive through the Commission only those benefits for which they are eligible under c. 32B, §§ 19 or 23, as applicable, and are no longer eligible for Commission life insurance.
(10) Municipal Employers whose teachers have participated in the Commission's Retired Municipal Teacher program immediately prior to transferring to the Commission' Municipal Insureds' Health Coverage must offer their Retired Municipal Teachers basic life insurance upon transfer to Municipal Health Coverage.
This information provided by the Group Insurance Commission .
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