Revised on May 10, 2012
Once the municipality transfers to the GIC, what are the responsibilities of the municipality and the GIC?
The municipality is responsible for ensuring their employees, retirees and survivors pay their share of the premium of the health plan in which they enrolled through payroll and pensions deductions, or through billing. The municipality reconciles its monthly GIC reports and remits the enrollee and employer share of the premium, including the administrative fee, no later than the due date. The municipality is responsible for disseminating the GIC’s communications to its employees; the GIC will send communications to the municipal retirees and survivors. The municipality also processes and notifies the GIC of all new hire and employee status changes using the GIC’s forms and procedures.
The GIC will administer COBRA benefits, dependent age 19 to 26 status changes, retirees turning age 65, and the transition to a Medicare plan. The GIC will also determine eligibility and effective dates, and send out HIPAA notifications. The GIC will determine the effective date for all matters pertaining to insureds' and eligible dependents' health coverage, including but not limited to effective dates of coverage, termination, and status changes. The GIC will also determine whether persons are eligible for Commission coverage, and its eligibility decisions are final and binding.
Is the GIC responsible for the biannual health insurance eligibility audits mandated by Section 26 of Chapter 32B?
No; that responsibility rests with the Municipal Employer. However, if a Municipal Employer makes a written request to the GIC’s municipal coordinator by November 15 of a particular year, the GIC will make available to the municipality a list of current enrollees, including all dependents, on or before the following January 15. In addition, a list of insureds (though not dependents) is sent each month as part of the municipality’s bill. These rosters must be reconciled monthly by the municipality to identify any discrepancies between the GIC’s enrollment files and the municipality’s list of eligible enrollee to ensure billing accuracy.
This information provided by the Group Insurance Commission.