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Coverage and Eligibility for Municipal Group Insurance

The entities that may join, the specifics of coverage under particular sections of Chapter 32B, who is covered, the coverage offered, health premium contributions and Medicare information. Find eligibility information and coverage options under Section 19 and Sections 21-23 of Chapter 32B for different members of Municipalities.
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32B Section 22 Benchmark Plans

GIC non-Medicare Plan with largest subscriber enrollment - Tufts Health Plan Navigator

GIC Medicare Plan with largest subscriber enrollment - UniCare State Indemnity Plan/Medicare Extension (OME)

The Entities That May Join, and the Specifics of Coverage Under Particular Sections of Chapter 32B

The local entities that can join GIC coverage

Any local entity that offers health insurance under Chapter 32B – meaning, most cities, towns, regional school districts, and surviving counties – may transfer eligible enrollees (employees, retirees, survivors, and their dependents) to the GIC.  In this document, the term “Municipal Employer” applies to local entities that offer health insurance under Chapter 32B.

Certain other local entities that do not provide insurance under Chapter 32B, including regional councils of government, regional planning agencies, education collaboratives, and charter schools, can join the GIC through Chapter 32A, but the specifics of the process for joining the GIC and contribution ratios once enrolled are different.  If you have questions about those processes, contact the GIC’s Municipal Coordinator. 

The key differences between Section 19 and Section 23

Both Section 19 and Section 23 provide a means by which Municipal Employers may offer health coverage through the GIC.  There are, however, some key differences:

  Section 19 Section 21/23
Decision to transfer Must be negotiated with Public Employee Committee (PEC) made up of representatives of local unions and retirees May be negotiated with PEC or may be ordered by municipal health insurance review panel (for more details on the panel process, see below)
Mitigation None required Panel must require 25% of year one saving go to mitigation fund to offset impact of transfer on  those who would be disproportionately affected
Timelines   Negotiation / panel timelines apply
Contribution ratios Ratios may vary only by type of plan (e.g. non-Medicare HMO, PPO, POS, Indemnity, Medicare) Contribution ratios fully subject to collective bargaining
Duration Three or six years Three years
Revocation Must be negotiated with PEC Municipal Employer may unilaterally withdraw (but PEC Agreement may require other procedures)
Dispute Resolution Certain disputes over PEC Agreements may be submitted to binding arbitration Arbitration not addressed in statute

Renewals and Withdrawals from Municipal Health Insurance with the GIC

Renewal

After entering the GIC, a municipal employer (city, town, or district administration) has the option to renew for no less than two years after the term of the initial agreement ends.  Please send a new PEC Section 19 Agreement (if you joined under Section 19) or a confirmation of renewal (if you joined under Section 23) outlining the terms of your renewal (two or more years) to the attention of the GIC’s Executive Director.  Please send by December 1 preceding your July 1 renewal date.

When a Municipal Employer can withdraw from the GIC

A Municipal Employer may withdraw from the GIC after an initial three year term or after the renewal term (a minimum of 2 yr interval as stated in the agreement to join the GIC) from the date on which it transferred subscribers to the GIC.  For Municipal Employers who joined the GIC off-cycle (that is, other than on July 1 of any year) the initial partial year does not count toward the three years.  In other words, a Municipal Employer that joined effective January 1, 2013 may withdraw effective July 1, 2016.

How Municipal Employer would withdraw from the GIC

A Municipal Employer (city, town, or district administration) must notify the GIC of its decision to withdraw by December 1 in order to withdraw the following July 1.  Except as otherwise indicated in a Section 19 Agreement, withdrawal revokes acceptance of Section 19.  After withdrawal, the Municipal Employer and public employee unions return to governance of  negotiations of health insurance under chapter 32B and chapter 150E. Send a signed letter on municipal letterhead from the appropriate public authority of a political subdivision as defined in 32B, §2 - ''Appropriate public authority'', as to a county, except Worcester county, the county commissioners; as to a city, the mayor; as to a town, the selectmen; as to a district, the governing board of the district and for the purposes of this chapter if a collective bargaining agreement is in place, as to a commonwealth charter school as defined by section 89 of chapter 71, the board of trustees; and as to an education collaborative, as defined by section 4E of chapter 40, the board of directors,send to the GIC’s Executive Director's attention.

Who Municipal Employers Must Cover

Municipal Employers must transfer all of their subscribers to GIC health coverage, and may not enroll only certain groups

Section 19 and Section 23 both require that Municipal Employers enroll all of their GIC-eligible subscribers, including Retired Municipal Teachers and Elderly Governmental Retirees already covered by the GIC through the RMT and EGR programs, in GIC health coverage.  For further information relevant to municipalities with RMTs or EGRs, please see Section IV, Retired Municipal Teacher (RMT) And Elderly Governmental Retiree (EGR) Programs, below.

Municipal Employers must cover their retirees, survivors and dependents if they decide to join GIC coverage

All GIC eligible active employees, retired employees, survivors and their dependents, including all Retired Municipal Teachers and Elderly Governmental Retirees, must be offered GIC health insurance coverage.

Eligibility as an “Employee” may change if a municipality joins the GIC

The GIC’s regulations require that all retirees and all employees other than elected officials enrolled via Section 19 must participate in a qualifying public pension system.  Participating Municipal Employers must generally offer insurance to pension-eligible municipal employees who work more than 20 hours in a 40 hour work week, or 18.75 in a 37.5 hour work week.  In no case is someone eligible if they work less than 18.75 hours. These requirements may impact eligibility for some participating municipalities.

Additionally, when a Municipal Employer transfers subscribers to the GIC, the GIC takes on the role of making final eligibility determinations.  If the GIC concludes that a person is not eligible, that decision is final.  This may result in the denial of eligibility for people who have been covered in the past. 

Coverage Offered for Municipal Health Insurance

The types of plans the GIC currently offers employees and Non-Medicare retirees and survivors

There are four types of plans: HMO, PPO-type, POS and Indemnity. The current plan options are as follows:

  • HMOs and HMO-type plans: Fallon Health Direct, Fallon Health Select, Harvard Pilgrim Primary Choice Plan, Health New England, NHP Prime (Neighborhood Health Plan), and Tufts Spirit.
  • PPO Type: UniCare State Indemnity Plan/Community Choice and UniCare State Indemnity Plan/PLUS.
  • POS Plans: Harvard Pilgrim Independence Plan and Tufts Health Plan Navigator.
  • Indemnity: The UniCare State Indemnity Plan/Basic.

The types of plans the GIC offers Medicare-eligible retirees

  • HMO: Tufts Health Plan Medicare Preferred
  • Indemnity: Harvard Pilgrim Medicare Enhance, Health New England MedPlus, Tufts Health Plan Medicare Complement and The UniCare State Indemnity Plan/Medicare Extension

Please note that the GIC is in the midst of a new health plan procurement; new plans may be added in 2018, and some of the current plans could change or end at that time.

Municipal Employers’ subscribers are not eligible for other GIC benefits

Sections 19 and 23 address only health coverage. Other non-health benefits currently provided by Municipal Employers will continue to be their responsibility.

Since non-union charter schools and education collaborative subscribers join GIC health coverage through chapter 32A, not Chapter 32B, Section 19 or 23, they are eligible for other GIC benefits

Certain local or regional entities – Commonwealth charter schools and non-union education collaboratives, regional planning agencies and regional councils of government may join the GIC by adopting chapter 32A.  Entities that join GIC coverage through chapter 32A are eligible to receive other GIC state employee and retiree benefits.

Health Premium Contributions for Municipal Health Insurance

Municipal Employers determine the premium contribution ratios through collective bargaining with their unions where applicable

Health premium contribution ratios may differ by the type of subscriber (actives vs. retirees vs. survivors)

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.

Premiums do not 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. 

There may be 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.

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.

CIC and how it impacts 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.

Medicare Enrollees in Municipalities

Thing to do in order to join GIC health coverage for Medicare-age retirees

If they are not already enrolled in Medicare, Medicare age retirees (65 years and older) must contact their local Social Security Office to determine if they are eligible to join Medicare.  They may be eligible due to their own work history or through a spouse.

All retirees age 65 years and older who seek to join GIC health coverage must obtain a letter from the Social Security Administration stating whether they are or are not Medicare eligible, and they must give a copy of the letter to the Municipal Employer. If they are Medicare eligible but not enrolled, they must enroll in Medicare during the next federal government open enrollment period. They must enroll in Medicare before the following July 1 in order to have GIC coverage at that time. Medicare annual enrollment runs from January 1 to March 31 of each year.

We have not adopted the local option in Chapter 32B requiring all Medicare-eligible retirees to join Medicare. Your Medicare-eligible subscribers need to enroll in Medicare before joining the GIC

As of July 1, 2011, the question of whether to require Medicare-eligible retirees to join the GIC is no longer a matter of local option, but is generally mandated.  An exception in c. 32B, § 18A for retirees with non-Medicare eligible family members does not apply to communities that have opted to transfer subscribers to the GIC.  All retirees, spouses, and dependents insured or eligible to be insured under chapter 32B must enroll in Medicare Part B if they are eligible to enroll in Medicare Part A for free. 

Other documents relevant to Medicare over-65 retirees and spouses need to provide

In the context of Section 19 and Section 23,  immediately after providing notice of intention to join the GIC coverage,  Municipal Employers must contact their retirees who are 65 years or older to inform them that:

  • All retirees age 65 or older, except those already enrolled in Medicare, are required to contact the Social Security Administration to determine whether or not they are eligible for Medicare Part A for free;
  • Retirees, spouses, and dependents must sign up for Medicare Part B if they are eligible for Part A for free in order to have GIC health coverage by the following July 1.  Medicare-eligible enrollees and spouses must provide the GIC with:
    • a photocopy of their Medicare card(s) for the enrollee, and for the spouse, if applicable)
    • a photocopy of their latest 1099 or Benefit Verification letter from Social Security stating how the monthly Part B premium is paid (e.g. direct-billed or deducted), and the same for the spouse, if applicable; 
  • Retirees and spouses who are over age 65 and not eligible for Medicare must provide the GIC with a Social Security Denial letter stating that the enrollee or spouse is not eligible for Medicare Part A for free

The Federal Government’s open annual enrollment period for Medicare Part B begins January 1 and ends March 31 for health coverage effective July 1.

Who pays the Medicare Part B premium penalty, if any, for persons enrolling in Medicare Part B

By law, Municipal Employers must pay any Part B premium penalty assessed by the federal government on the retiree, spouse, or dependent as a result of enrollment in Medicare Part B at the time of transfer.

Contact

Phone

Main Phone (617) 727-2310

M-F 8:45 a.m.-5 p.m.

TDD/TTY 711

Online

Fax

Operations (617) 227-2681
Executive (617) 227-5181
Fiscal (617) 367-9874

Address

Street Address
19 Staniford St
Boston, MA 02114
Mailing Address
P.O. Box 8747
Boston, MA 02114
Image credits:  George Headley

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