Revised on November 10, 2015
Who determines health premium contribution ratios?
Municipal Employers determine the premium contribution ratios through collective bargaining with their unions where applicable.
May health premium contribution ratios differ by the type of subscriber (actives vs. retirees vs. survivors)?
Not under Section 19; the law requires that contribution ratios differ only by type of plan (i.e., HMO, PPO, POS, or Indemnity; Medicare or non-Medicare).
Under Section 23, different rules apply: contribution ratios are fixed by collective bargaining and may vary by type of subscriber. However, the percentage contributed by retirees, surviving spouses, and their dependents generally may not increase before July 1, 2014, unless the increase was approved before July 1, 2011.
Do premiums vary by number of dependents?
For all employee/non-Medicare plans, the GIC sets premium rates for individual (no dependents) and for family (one or more dependents) coverage. The GIC does not offer “plus one” employee/non-Medicare rates. For Medicare plans the GIC sets premiums per individual.
Is there a minimum or maximum premium contribution percentage that Municipal Employers must pay for GIC health coverage?
Under Section 19: Municipal Employers must pay between 50% and 99% of their subscribers’ health premium. Municipal Employers’ premium contribution for The Indemnity Plan’s Medicare Extension plan cannot be less than the minimum percentage that it contributes to any other health plan offered by the GIC.
Under Section 21/23: Under Sections 21 and 23, contribution ratios are a matter for collective bargaining. However, the first time a Municipal Employer implements plan design changes under Section 22 or 23, the percentage contributed by retirees, survivors, and their dependents may not change before July 1, 2014, unless the secretary of administration and finance confirms that the increase was already approved prior to July 1, 2011.
What are our options for premium contribution ratios for GIC Medicare Plans under Section 19?
The GIC offers two types of Medicare plan options:
- HMO: Fallon Senior Plan, Health New England MedPlus, Tufts Health Plan Medicare Complement and Tufts Health Plan Medicare Preferred
- Indemnity: The UniCare State Indemnity Plan/Medicare Extension and Harvard Pilgrim Medicare Enhance
Section 19 requires that health premium contributions be determined by the type of plan, NOT by type of enrollee. Acceptable contribution ratios are:
- one ratio for all Medicare plans;
- one for Medicare HMO Plans and one for Medicare Indemnity Plans; or
- one ratio for the Medicare HMO plans and one or two Indemnity Plan Medicare ratios.
Note that these parameters for contribution ratios do not apply if a Municipal Employer is transferring subscribers per Sections 21 and 23. Per Sections 21 and 23, contribution ratios remain a matter for collective bargaining, subject to the limitation addressed in the prior question for changes prior to July 1, 2014.
What is CIC and how does it impact contribution ratios?
CIC supplements the UniCare State Indemnity Plan/Basic, and UniCare State Indemnity Plan/Medicare Extension (OME). CIC increases the benefits for most covered services to 100%, subject to deductibles and copayments. Enrollees without CIC receive only 80% coverage for some services and pay higher deductibles. CIC is an optional part of the UniCare State Indemnity Plan for historical reasons; other plans do not have a similar structure.
At the state level, CIC is an enrollee-pay-all benefit. In joining the GIC, many communities have opted to roll together CIC coverage with the underlying UniCare plans, and pay a fixed share of the combined plan. Either structure is acceptable to the GIC.
This information provided by the Group Insurance Commission.