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.
Contribution Ratios for Retried Municipal Teachers (RMTs) and Elderly Governmental
The contribution ratios that apply to RMTs and EGRs after a municipality joins the GIC
Premium contribution ratios for those who transfer from the GIC’s RMT or EGR coverage to its Municipal Employer health coverage under Section 19 may not be more than 25% of premium, however the agreement to join the GIC may provide for payment of less than 25%. This limitation is an exception to the general rule under Section 19 that contribution ratios may differ only by type of plan (i.e., HMO, PPO, or Indemnity; Medicare or non-Medicare).
Under Section 23, the maximum health premium contribution for those who transfer from the GIC’s EGR and RMT coverage to the GIC’s Municipal Employer health coverage can be no more than 25% (and may be less than 25%). As with all retirees, survivors, and their dependents under Section 23, RMTs’ and EGRs’ contribution ratios generally may not be increased prior to July 1, 2014, with limited exceptions.
How CIC impacts contribution ratios for former RMTs and EGRs
At the state level, CIC is an enrollee-pay-all benefit. Therefore, RMTs who chose the UniCare State Indemnity Plan/Basic with CIC pay their share of the Basic premium, plus 100% of the CIC premium. Municipalities transferring to the GIC may maintain that structure for former RMTs. 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. This structure is also acceptable to the GIC, for all subscribers, or for all subscribers except RMTs, provided that RMTs are not required to pay more than 25% of premiums.
If you decide to leave GIC health coverage after joining it, your Retired Municipal Teachers and Elderly Governmental Retirees may not return to the GIC’s RMT and EGR coverage
According to the law, they cannot transfer back to the RMT or EGR program when their Municipal Employer withdraws from GIC coverage.