 |
 |
| Additional Executive Departments | | Agriculture And Animals | | Alcoholic Beverages | | Business And Financial Institutions | | Cities, Towns And Villages | | Civil Procedure And Limitations | | Codes And Standards | | Conduct Of Public Business | | Conservation, Resources And Development | | Contracts And Contractual Relations | | Corporations, Associations And Partnerships | | Correctional And Penal Institutions | | County, Township And Political Subdivision Government | | Courts | | Crimes And Punishment; Peace Officers And Public Defenders | | Criminal Procedure | | Debtor-creditor Relations | | Domestic Relations | | Education And Libraries | | Evidence And Legal Advertisements | | Executive Branch | | Incorporation And Regulation Of Certain Utilities And Carriers | | Juries | | Labor And Industrial Relations | | Lands, Levees, Drainage, Sewers And Public Water Supply | | Laws And Statutes | | Legislative Branch | | Military Affairs And Police | | Motor Vehicles, Watercraft And Aviation | | Occupations And Professions | | Ownership And Conveyance Of Property | | Public Health And Welfare | | Public Officers And Employees, Bonds And Records | | Public Safety And Morals | | Roads And Waterways | | Sovereignty, Jurisdiction And Emblems | | Statutory Actions And Torts | | Suffrage And Elections | | Taxation And Revenue | | Trade And Commerce | | Trusts And Estates Of Decedents And Persons Under Disability |
|
|
|
|
| search a lawyer |
|
|
| ACTS, STATUTES |
|
|
|
|
|
|
|
|
|
|
|
|
| Home > Statutes > Usa Missouri |
|
USA Statutes : missouri
Title : PUBLIC OFFICERS AND EMPLOYEES, BONDS AND RECORDS
Chapter : Chapter 103 Health Plan for State Employees
|
|
As used in sections 103.003 to 103.175, the following terms mean:
(1) "Actuarial reserves", the necessary funding required to pay all the
medical expenses for services provided to members of the plan but for
which the claims have not yet been received by the claims administrator;
(2) "Actuary", a member of the American Academy of Actuaries or who is an
enrolled actuary under the Employee Retirement Income Security Act of
1974;
(3) "Agency", a state-sponsored institution of higher learning, political
subdivision or governmental entity or instrumentality;
(4) "Alternative delivery health care program", a plan of covered
benefits that pays medical expenses through an alternate mechanism rather
than on a fee-for-service basis. This includes, but is not limited to,
health maintenance organizations and preferred provider organizations,
all of which shall include chiropractic physicians licensed under chapter
331, RSMo, in the provider networks or organizations;
(5) "Board", the board of trustees of the Missouri consolidated health
care plan;
(6) "Claims administrator", an agency contracted to process medical
claims submitted from providers or members of the plan and their
dependents;
(7) "Coordination of benefits", to work with another group-sponsored
health care plan which also covers a member of the plan to ensure that
both plans pay their appropriate amount of the health care expenses
incurred by the member;
(8) "Covered benefits", a schedule of covered services, including
chiropractic services, which are payable under the plan;
(9) "Employee", any person employed full time by the state or a
participating member agency, or a person eligible for coverage by a
state-sponsored retirement system or a retirement system sponsored by a
participating member agency of the plan;
(10) "Evidence of good health", medical information supplied by a
potential member of the plan that is reviewed to determine the financial
risk the person represents to the plan and the corresponding
determination of whether or not he or she should be accepted into the
plan;
(11) "Health care plan", any group medical benefit plan providing
coverage on an expense-incurred basis, any HMO, any group service or
indemnity contract issued by a health plan of any type or description;
(12) "Medical benefits coverages" shall include services provided by
chiropractic physicians as well as physicians licensed under chapter 334,
RSMo;
(13) "Medical expenses", costs for services performed by a provider and
covered under the plan;
(14) "Missouri consolidated health care plan benefit fund account", the
benefit trust fund account containing all payroll deductions, payments,
and income from all sources for the plan;
(15) "Officer", an elected official of the state of Missouri;
(16) "Participating member agency", a state-sponsored institution of
higher learning, political subdivision or governmental entity that has
elected to join the plan and has been accepted by the board;
(17) "Plan year", a twelve-month period designated by the board which is
used to calculate the annual rate categories and the appropriate coverage;
(18) "Provider", a physician, hospital, pharmacist, psychologist,
chiropractic physician or other licensed practitioner who or which
provides health care services within the respective scope of practice of
such practitioner pursuant to state law and regulation;
(19) "Retiree", a person who is not an employee and is receiving or is
entitled to receive an annuity benefit from a state-sponsored retirement
system or a retirement system of a participating member agency of the
plan or becomes eligible for retirement benefits because of service with
a participating member agency. (L. 1992 H.B. 1574 § 1 subsec. 1, A.L.
1995 S.B. 410, A.L. 1996 H.B. 1400, A.L. 2000 S.B. 885)
For the purpose of covering medical expenses of the officers,
employees and retirees, the eligible dependents of officers, employees
and retirees and to the surviving spouses and children of deceased
officers, employees and retirees of the state and participating member
agencies of the state, there is hereby created and established a health
care plan which shall be a body corporate, which shall be under the
management of the board of trustees herein described, and shall be known
as the "Missouri Consolidated Health Care Plan". Notwithstanding any
provision of law to the contrary, such plan may sue and be sued, transact
business, contract, invest funds and hold cash, securities and other
property and shall be vested with such other powers as may be necessary
or proper to enable it, its officers, employees, and agents to carry out
fully and effectively all the purposes of sections 103.003 to 103.175.
(L. 1992 H.B. 1574 § 1 subsec. 2)
1. The general administration and the responsibility for the
proper operation of the plan is vested in a board of trustees of thirteen
persons, as follows: the director of the department of health and senior
services, the director of the department of insurance, the commissioner
of the state office of administration serving ex officio, one member of
the senate from the majority party appointed by the president pro tem of
the senate and one member of the senate from the minority party appointed
by the president pro tem of the senate with the concurrence of the
minority floor leader of the senate, one member of the house of
representatives from the majority party appointed by the speaker of the
house of representatives and one member of the house of representatives
from the minority party appointed by the speaker of the house of
representatives with the concurrence of the minority floor leader of the
house of representatives, and six members appointed by the governor with
the advice and consent of the senate. Of the six members appointed by the
governor, three shall be citizens of the state of Missouri who are not
members of the plan, but who are familiar with medical issues. The
remaining three members shall be members of the plan and may be selected
from any state agency or any participating member agency.
2. Except for the legislative members, the director of the department of
health and senior services, the director of the department of insurance,
and the commissioner of the office of administration, trustees shall be
chosen for terms of four years from the first day of January next
following their election or appointment. Any vacancies occurring in the
office of trustee shall be filled in the same manner the office was
filled previously. (L. 1992 H.B. 1574 § 1 subsecs. 3, 4, A.L. 1996 H.B.
1400, A.L. 2000 S.B. 885)
MOSERS medical staff will serve jointly on both boards. All
decisions on rates and services for dates prior to January 1, 1994, shall
be determined by the MOSERS board. All decisions after that date shall be
determined by the Missouri consolidated health care plan board. (L. 1992
H.B. 1574 § 1 subsec. 5)
The board shall elect by secret ballot one member as chairman
and one member as vice chairman in January of each year. The chairman
shall preside over the meetings of the board and perform such other
duties as may be required by action of the board. The vice chairman shall
perform the duties of the chairman in the absence of the latter or upon
the chairman's inability or refusal to act. (L. 1992 H.B. 1574 § 1
subsec. 6)
The board shall appoint an executive director, not one of their
number, who shall be the executive officer of the board and shall have
charge of the offices, records and employees of the plan, subject to the
direction of the board. (L. 1992 H.B. 1574 § 1 subsec. 7)
The executive director and all other employees of the plan shall
be state employees and eligible for all corresponding benefits. Except by
the unanimous vote of the board, no person who has served as a trustee of
the board may become an employee of the plan until four years have
expired between the date of his or her resignation, termination, or other
removal as trustee and the date of his or her appointment as an employee
of the plan. (L. 1992 H.B. 1574 § 1 subsec. 8)
1. Employees of the plan shall receive such salaries and
necessary expenses as shall be fixed by the board.
2. Subject to the provisions of the constitution, the board of trustees
shall have exclusive jurisdiction and control over the funds and property
of the plan and may employ and fix the compensation of necessary
employees. (L. 1992 H.B. 1574 § 1 subsecs. 9, 27)
Any summons or other writ issued by the courts of the state
shall be served upon the executive director. (L. 1992 H.B. 1574 § 1
subsec. 10)
The board shall employ or contract with an actuary or firm of
actuaries familiar with health care financing as technical advisor to the
board on matters regarding the operation and funding of the plan from an
actuarial basis and shall perform such duties as are from time to time
required by the board. (L. 1992 H.B. 1574 § 1 subsec. 11)
The board shall arrange for annual audits of the records and
accounts of the plan by a certified public accountant or firm of
certified public accountants. The state auditor shall examine such audits
at least once every three years and report to the board and the governor.
(L. 1992 H.B. 1574 § 1 subsec. 12)
The board shall keep a record of its proceedings, which shall be
open to public inspection. The board shall prepare annually and make
available a report showing the financial condition of the plan which
shall contain, but not be limited to, a financial balance sheet, a
statement of income and disbursements, a detailed statement of
investments acquired and disposed of during the year, together with a
detailed statement of the annual rates on investment return from all
assets and from each type of investment, a listing of all advisors and
consultants retained by the board and such other data as the board shall
deem necessary or desirable for a proper understanding of the condition
of the plan. (L. 1992 H.B. 1574 § 1 subsec. 13)
The board may employ or contract with an attorney at law or firm
of attorneys to be the legal advisor of the board and to represent the
board in all legal proceedings. (L. 1992 H.B. 1574 § 1 subsec. 14)
The board may employ or contract with an investment counselor or
counselors to be the investment advisor to the board. The board may
delegate to such investment counselor authority to act in place of the
board in the investment and reinvestment of all or part of the moneys of
the plan, and may also delegate to such counselor the authority to act in
place of the board in the holding, purchasing, selling, assigning,
transferring or disposing of any or all securities and investments in
which such moneys have been invested, as well as the proceeds of such
investments. Such investment counselor or counselors shall be registered
as an investment advisor with the United States Securities and Exchange
Commission. In exercising or delegating its investment powers and
authority, members of the board shall exercise ordinary business care
prudence under the facts and circumstances prevailing at the time of the
action or decision. In so doing, the board shall consider long- and
short-term needs of the plan in carrying out its purposes, the plan's
present and anticipated financial requirements, the expected total return
on the plan's investment, general economic conditions, income, growth,
long-term net appreciation, and probable safety of funds. No member of
the board shall be liable for any action taken or omitted with respect to
the exercise of or delegation of these powers and authority if such
member shall have discharged the duties of his or her position in good
faith and with that degree of diligence, care, and skill which prudent
men and women would ordinarily exercise under similar circumstances in a
like position. (L. 1992 H.B. 1574 § 1 subsec. 15)
The board shall set up and maintain a benefit trust fund account
in which shall be placed all payroll deductions, payments, and income
from all sources. All property, money, funds, investments, and rights
which shall belong to or be available for expenditure or use by the plan
shall be dedicated to and held in trust for the members and for the
purposes herein set out and no other. The board shall have power, in the
name and on behalf of the plan, to purchase, acquire, hold, invest, lend,
lease, sell, assign, transfer, and dispose of all property, rights, and
securities, and enter into written contracts as may be necessary and
proper to carry out its duties. (L. 1992 H.B. 1574 § 1 subsec. 16)
All moneys received by or belonging to the plan shall be paid to
the executive director and promptly deposited by the executive director
to the credit of the plan in one or more banks or trust companies or
other financial institutions as selected by the board. No such money
shall be deposited in or be retained by any bank or trust company which
does not have on deposit with and for the board at the time, the kind and
value of collateral required by sections 30.240 and 30.270, RSMo, for
depositories of the state treasurer. These moneys are funds of the plan
and shall not be commingled with any funds in the state treasury. The
executive director shall be responsible for all funds, securities, and
property belonging to the plan and shall be provided with such corporate
surety bond for the faithful handling of the same as the board shall
require. (L. 1992 H.B. 1574 § 1 subsec. 17)
The board shall serve without compensation for their services as
such, but shall be paid for any necessary expenses incurred in attending
meetings of the board or committees thereof or in the performance of
other duties authorized by the board. Duties performed for the plan by
any member of the board shall be considered duties in connection with the
regular employment of the individual, and he or she shall suffer no loss
in regular compensation by reason of the performance of such duties. (L.
1992 H.B. 1574 § 1 subsec. 18)
The board shall meet within the state of Missouri not less than
once per calendar quarter, at a time set at a previously scheduled
meeting or at the request of the chairman or any four trustees acting
jointly. Notice of the meeting shall be delivered to all trustees in
person or by depositing notice in a United States Post Office in a
properly stamped and addressed envelope not less than six days prior to
the date fixed for the meeting. The board may meet at any time by
unanimous consent. (L. 1992 H.B. 1574 § 1 subsec. 19)
Each trustee shall be entitled to one vote. Six trustees shall
constitute a quorum for the transaction of business and any official
action of the board shall be based on the majority vote of the trustees
present. Unless otherwise expressly provided in sections 103.003 to
103.175, a meeting need not be called or held to make any decision on a
matter before the board. Each member must be sent by the executive
director a copy of the matter to be decided with full information on the
question from the files of the plan. The concurring decisions of six
trustees may decide the issue by signing a document declaring their
decision and sending the written document to the executive director
within fifteen days after the document and information was mailed to the
trustee. If any trustee is not in agreement with the six trustees, the
matter is to be passed on at a regular board meeting or a special meeting
called for that purpose. (L. 1992 H.B. 1574 § 1 subsec. 20)
The principal office of the plan shall be in Jefferson City. The
plan shall have a seal bearing the inscription "Missouri Consolidated
Health Care Plan", which shall be in the custody of its executive
director. The courts of the state shall take judicial notice of the seal,
and all copies of records, books, and written instruments which are kept
in the office of the system and are certified by the director under the
seal shall be proved or admitted in any court or proceeding as provided
by section 109.130, RSMo. (L. 1992 H.B. 1574 § 1 subsec. 21)
Should any error result in any member or provider receiving more
or less than he or she would have been entitled to receive had the error
not occurred, the board shall correct such error, and to this end may
recover any overpayments. (L. 1992 H.B. 1574 § 1 subsec. 22)
A person who knowingly makes a false statement, or falsifies or
permits to be falsified a record of the plan, in an attempt to defraud
the plan is subject to fine or imprisonment under the laws of this state.
(L. 1992 H.B. 1574 § 1 subsec. 23)
Subject to the limitations of law, the board shall formulate and
adopt rules and regulations for the government of its own proceedings and
for the administration of the plan, and its decisions as to all questions
of fact shall be final and conclusive on all persons except for the right
of review as provided by law and except for fraud or such gross mistake
of fact as to have an effect equivalent to fraud. (L. 1992 H.B. 1574 § 1
subsec. 24)
The accounts and records of any state department, agency,
institution, political subdivision or governmental entity participating
in the plan or requesting participation shall be open to inspection by
the board of trustees and its employees for the purpose of obtaining
information necessary in the performance of the duties of the board. (L.
1992 H.B. 1574 § 1 subsec. 25)
The board shall have the power to subpoena witnesses or obtain
the production of records when necessary for the performance of its
duties. (L. 1992 H.B. 1574 § 1 subsec. 26)
1. No trustee or employee of the plan shall receive any gain or
profit from any funds or transaction of the plan, except benefits common
to all members, if entitled thereto.
2. Any trustee or employee accepting any gratuity or compensation for the
purpose of influencing his action with respect to the investment of the
funds of the plan shall thereby forfeit his office and in addition
thereto be subject to the penalties prescribed by law. (L. 1992 H.B. 1574
§ 1 subsecs. 28, 29)
The assets of the plan shall be exempt from state, county,
municipal or other political subdivision taxes. (L. 1992 H.B. 1574 § 1
subsec. 30)
The plan shall become effective on January 1, 1994. The Missouri
state employees' retirement system medical care plan available for state
employees, retirees, and their dependents together with all assets and
liabilities shall be incorporated into the plan by June 30, 1994. Prior
to January, 1994, all statutory provisions governing the Missouri state
employees' retirement system medical care plan shall remain in effect.
(L. 1992 H.B. 1574 § 1 subsec. 31)
The health care programs sponsored by the departments of
transportation and conservation shall become a part of this plan only
upon request to and acceptance by the board of trustees by the highways
and transportation commission or the conservation commission and any such
transfer into this plan shall be deemed reviewable by such department
every three years. Such department may withdraw from the plan upon
approval by such department's commission and by providing the board a
minimum of six months' notice prior to the end of the then current plan
year and termination of coverage will become effective at the end of the
then current plan year. For any of the foregoing state agencies choosing
to participate, the plan shall not assume responsibility for any
liabilities incurred by the agency or its eligible employees, retirees,
or dependents prior to its effective date. (L. 1992 H.B. 1574 § 1 subsec.
32, A.L. 1996 H.B. 1400)
The board shall develop and submit to the general assembly by
September 1, 2000, a plan to offer to state employees located in counties
in which HMO coverage is not available, a medical benefits plan for
calendar year 2001 with benefits coverage substantially identical to HMO
benefits coverage, at a cost to employees not to exceed the average cost
to employees for HMO coverage in counties where such coverage is
available. (L. 2000 S.B. 885)
The board shall provide or contract, or both, on its own behalf,
for medical benefits coverage and services for persons covered under
sections 103.003 to 103.175 and enrolled in the plan. The board may
contract for medical benefits coverage with alternative delivery health
care programs where available. Medical expenses shall also include
expenses for comparable benefits for employees who rely solely on
spiritual means through prayer for healing. (L. 1992 H.B. 1574 § 2
subsec. 1)
Due to the differences between the appropriations process and
the current contract methodology used by the board, the general assembly
hereby recommends that the board, with respect to health care provider
contracts, implement a plan year based upon a fiscal year beginning
October first rather than the calendar year period currently employed by
the board. (L. 2000 S.B. 885 § 1)
Except as otherwise provided by sections 103.003 to 103.175,
medical benefits coverage as provided by sections 103.003 to 103.175
shall terminate when the member ceases to be an active employee; except
persons receiving or entitled to receive an annuity or retirement benefit
or disability benefit or the spouse of or unemancipated children of
deceased persons receiving or entitled to receive an annuity or
retirement benefit or disability benefit from the state, participating
member agency, institution, political subdivision or governmental entity
may elect to continue coverage, provided the individuals to be covered
have been continuously covered for health care benefits:
(1) Under a separate group or individual policy for the six-month period
immediately preceding the member's date of death or disability or
eligibility for normal or early retirement; or
(2) Pursuant to sections 103.003 to 103.175, since the effective date of
the most recent open enrollment period prior to the member's date of
death or disability or eligibility for normal or early retirement; or
(3) From the initial date of eligibility for the benefits provided by
sections 103.003 to 103.175.
Cost for coverage continued pursuant to this section shall be determined
by the board. If an eligible person does not elect to continue the
coverage within thirty-one days of the first day of the month following
the date on which the eligible person ceases to be an employee, he or she
may not later elect to be covered pursuant to this section. (L. 1992 H.B.
1574 § 2 subsec. 2, A.L. 2000 H.B. 1808 merged with S.B. 885)
Effective 7-1-2000 (H.B. 1808) 8-28-2000 (S.B. 885)
Participants in the program of medical benefits coverage
provided by sections 103.003 to 103.175 who are eligible for Medicare
benefits and who are not eligible for the program of medical benefits
coverage provided under sections 103.083 to 103.098 to be their primary
plan of coverage benefits shall be provided the same benefits provided
participants who are not eligible for Medicare benefits. Medical benefits
coverage provided under sections 103.003 to 103.175 shall be coordinated
with Medicare benefits for participants covered by part A or part B, or
both, of Medicare benefits, or reduced by an amount determined by the
claims administrator to provide a benefit equivalent to the amount which
would be provided on a coordination of benefit basis for participants not
covered by part A or part B, or both, of Medicare benefits. As used in
sections 103.083 to 103.098, the term "Medicare benefits" shall include
those medical benefits provided by Title XVIII, A and B, Public Law
89-97, 1965 amendments to the federal Social Security Act (42 U.S.C.
section 301, et seq.) and amendments thereto. Any participating member
agency having employees or eligible retirees not covered by Medicare
shall authorize the plan at its option to enroll those individuals for
medical benefits as provided by Title XVIII, A and B, Public Law 89-97,
1965 amendments to the federal Social Security Act whenever they become
eligible for such benefits and the plan shall pay the premium for such
enrollment on behalf of that person. The Medicare premium amounts shall
be included in the rate established by the actuary for providing medical
benefits coverage to such a participating member agency. Anyone not
authorizing this Medicare enrollment shall be denied coverage. (L. 1992
H.B. 1574 § 2 subsec. 3)
Notwithstanding any other provision of law to the contrary, any
member of the general assembly and any elected state official holding a
statewide elective state office, who ceases to hold elective office, or
any person employed by the elected official or employed by a member of
the general assembly, whose employment is terminated because such elected
official or member of the general assembly ceases to hold elective
office, may elect to continue insurance benefits to cover medical
expenses provided under sections 103.003 to 103.175, by paying the cost
of such benefits as determined by the board. If an eligible person does
not elect to continue the coverage within thirty-one days from the last
day of the month in which the eligible person ceases to be an employee,
he may not later elect to be covered under this section. (L. 1992 H.B.
1574 § 2 subsec. 4)
There shall be a thirty-day enrollment period, at a time
designated by the board, during which retirees and surviving dependents
of retirees or employees of state agencies participating in the plan but
not then covered by the medical care plan shall be able to enroll in the
plan upon provision, at their* own expense, of evidence of good health
satisfactory to the board. A preexisting condition will not be covered
until a person has been a plan participant for twelve consecutive months.
(L. 1992 H.B. 1574 § 2 subsec. 5)
*Word "his" appears in original rolls.
1. Before each October first, the board shall separately certify
to each participating member agency an actuarially determined estimate of
the amount which will be necessary during the next plan year to pay all
the liabilities for that individual state-sponsored plan or participating
member agency plan, including the costs of administration, which shall
exist or accrue pursuant to providing the medical benefits of the plan.
The estimate shall be computed based on the medical benefit program or
programs adopted by the board and shall be certified in total expected
expenditures, including the expected expenditures per person for each
separately rated category of coverage.
2. Before August first of each year, beginning with August 1, 1996, the
board shall notify the state division of budget and planning of the
medical benefit options authorized by the board. In addition, the board
shall provide the cost of funding each category for each medical benefit
option the plan offers.
3. Before September first of each year, beginning September 1, 1996, the
entity designated by the governor to make recommendations on a total
compensation package for state employees shall analyze the medical
benefit options authorized by the board and the costs of each such
option, and shall make recommendations to the state division of budget
and planning on the portion of such costs, if any, to be paid by the
state and the portion to be paid by each state employee for each
recommended option. The extent of the recommendation shall be limited to
the total state contribution amount as it pertains to the basic covered
benefit packages available and any new ancillary benefits that may be
available in addition to the basic covered benefit packages. The Missouri
consolidated health care plan board of trustees shall maintain
responsibility for the pricing strategy regarding how the covered benefit
packages are offered to state employees who are members of the plan. The
entity shall also notify the board of the recommended state contribution.
4. The commissioner of administration shall request appropriations for
payments to the plan for covered state employees. Subject to
appropriation, the commissioner of administration monthly shall
requisition and certify the payment to the executive director of the plan
who shall promptly deposit such amounts to the benefit trust fund
account. (L. 1992 H.B. 1574 § 3 subsecs. 1, 2, A.L. 1995 S.B. 410)
The employing participating member agency of the members of the
plan who are not paid out of funds that have been deposited in the state
treasury shall promptly pay monthly to the executive director an amount
equal to the amount which the board has certified based upon the
actuarial study for that participating member agency. The executive
director shall promptly deposit such amounts to the benefit trust fund
account. (L. 1992 H.B. 1574 § 3 subsec. 3)
Before each October first, the board shall certify to the state
division of budget and planning an actuarially determined amount which
will be necessary during the next plan year to pay all the liabilities,
including the cost of administration, and any necessary actuarial
reserves which shall exist or accrue pursuant to providing the medical
benefits options as recommended by the entity. All such premium amounts
shall be paid to the executive director at the time that each employee's
wages or salary would normally be paid, but not later than the fifteenth
day of the month following. The premium amounts so remitted will be
promptly placed by the executive director in the benefit trust fund
account. In lieu of the availability of premium deductions the board may
establish alternative methods for the collection of premium amounts. (L.
1992 H.B. 1574 § 3 subsec. 4, A.L. 1995 S.B. 410)
Any former employee or any surviving spouse who is receiving
retirement benefits from the Missouri state employees' retirement system
or the transportation department employees' and highway patrol retirement
system; or any former judge or surviving spouse of a former judge who is
receiving retirement benefits pursuant to the provisions of sections
287.812 to 287.856, RSMo, or sections 476.450 to 476.686, RSMo; or any
former teacher or surviving spouse of a former teacher who elected to
remain in the public school retirement system pursuant to the provisions
of section 104.342, RSMo, and who is receiving retirement benefits from
the public school retirement system and is, or becomes, a member of the
Missouri consolidated health care plan or an alternative delivery health
care program provided by the board on behalf of the state shall, upon
application with the board of trustees, be made, constituted, appointed
and employed by the board as a special consultant on the problems of
retiree health and, in addition to duties prescribed in section 104.610,
RSMo, or any other law, and upon request of the board of trustees, give
the board, orally or in writing, a short detailed statement of physical,
medical and health problems affecting retirees. As compensation for the
extra duty imposed by this section, each such special consultant as
defined above shall receive, in addition to all other compensation
provided by law, an amount contributed toward medical benefits coverage
provided by the above-referenced plan or plans as appropriated by law.
(L. 1992 H.B. 1574 § 3 subsec. 5, A.L. 1994 H.B. 1149, A.L. 1995 S.B. 410)
Effective 5-16-95
Each participating member agency may elect by majority vote of
its governing body, to join the plan and cover its employees, retirees,
and their dependents under the plan as follows:
(1) The clerk or secretary of the participating member agency shall
certify the election to the board within ten working days after the vote
of the governing body;
(2) The board shall establish a procedure for considering the election of
the agencies. Acceptance of the agency into the plan shall be by action
of the board and shall be based upon an actuarial analysis or any other
determination that the board deems appropriate;
(3) The agency shall supply all available information requested by the
board that is necessary to complete an actuarial analysis of the agency
and make a determination of the fiscal impact that inclusion of the
agency would have on the plan;
(4) The effective date of the participating member agency's coverage will
be the first day of the month so requested by the agency and approved by
the board;
(5) The participating member agency must offer coverage under the plan to
all of its eligible employees, retirees, and dependents. (L. 1992 H.B.
1574 § 4 subsec. 1)
A participating member agency may elect to withdraw from the
plan by certifying such election of its governing body to the board. Such
certification must be received by the board at least ninety days prior to
the end of the then current plan year and termination of the agency's
coverage under the plan will become effective at the end of the then
current plan year. (L. 1992 H.B. 1574 § 4 subsec. 2)
Any participating member agency terminating its coverage under
the plan will not be eligible for participation in the plan for a period
of two years after its termination date.
(L. 1992 H.B. 1574 § 4 subsec. 3, A.L. 2000 S.B. 885)
The plan shall not assume responsibility for any liabilities
incurred by the participating member agency or its eligible employees,
retirees, or dependents prior to its effective date. (L. 1992 H.B. 1574 §
4 subsec. 4)
The persons in each participating member agency eligible for
coverage by the plan shall include, subject to the limitations contained
in sections 103.003 to 103.175:
(1) All employees, retirees, former employees entitled to a retirement
benefit because of service with the participating member agency,
employees eligible for a disability benefit from the participating member
agency, employees on a leave of absence, and their dependents;
(2) All persons, and their dependents, who become employees of a
participating member agency on or after the date such agency becomes
covered under the plan, and who wish to enroll in the plan; and
(3) All persons who become eligible for retirement benefits because of
service with the participating member agency, persons who become eligible
for a disability benefit from the participating member agency, and their
unemancipated dependents, on or after the date such participating member
agency becomes covered under the plan, and who have been continuously
covered by the benefits under sections 103.003 to 103.175 for at least
the shorter of:
(a) Two years prior to the date of disability of the employee or his
eligibility for normal or early retirement; or
(b) From the initial date of eligibility for the benefits provided by
sections 103.003 to 103.175. (L. 1992 H.B. 1574 § 4 subsec. 5)
There shall be a thirty-day enrollment period, at a time
designated by the board, during which retirees and surviving dependents
of retirees or employees of a participating member agency who are not
then covered by any health care plan offered by the participating member
agency shall be able to enroll in the plan upon provision, at their* own
expense, of evidence of good health satisfactory to the board. A
preexisting condition will not be covered until a person has been a plan
participant for a period of twelve consecutive months. (L. 1992 H.B. 1574
§ 4 subsec. 6)
*Word "his" appears in original rolls.
Notwithstanding any other law to the contrary and with the
exception of a retiree of the participating member agency or a former
employee of the participating member agency who is entitled to retirement
benefits from the participating member agency, when a person is no longer
an employee of a participating member agency covered by the plan, that
person and his dependents shall thereupon cease to be covered by the
plan. (L. 1992 H.B. 1574 § 4 subsec. 7)
If so determined by the board, a participating member agency
shall reimburse the plan for any initial start-up costs that are incurred
by the plan solely on behalf of the participating member agency and
necessary in order for the participating member agency to be included in
the plan. (L. 1992 H.B. 1574 § 4 subsec. 8)
Monthly, in accordance with a schedule developed by the board,
or its designee, each participating member agency shall pay all
applicable premium amounts to the executive director. The premium amounts
so remitted will be promptly deposited by the executive director in the
benefit trust fund account. (L. 1992 H.B. 1574 § 4 subsec. 9, A.L. 1996
H.B. 1400)
If any participating member agency fails to make any payment due
the plan for a period of sixty days after the payment is due, the
participating member agency shall become delinquent and the amount of the
delinquency shall constitute a first lien of the funds of the
participating member agency, and the board is authorized to compel
payment by application for a writ of mandamus; and, in addition, such
delinquency shall be certified by the board to the state treasurer. Until
such delinquency, together with regular interest, is satisfied, the state
treasurer shall withhold all moneys due the participating member agency
from the state. (L. 1992 H.B. 1574 § 4 subsec. 10)
If any participating member agency fails to make any payment due
the plan, the board may terminate the agency's participation in the plan
and stop paying claims accrued during the period of nonpayment. (L. 1992
H.B. 1574 § 4 subsec. 11)
If there is a deficiency in any year, participating member
agencies withdrawing from the plan during that year will be assessed a
prorated amount determined by the actuary. (L. 1992 H.B. 1574 § 4 subsec.
12)
The board shall study and report to the general assembly, on or
before December 15, 2003, on the feasibility of including in this plan
individuals who are employees of eligible agencies which have not elected
to join the plan or who are retirees of school districts. (L. 1992 H.B.
1574 § 4 subsec. 13, A.L. 2003 S.B. 317)
1. Beginning on a date specified by the board of trustees of the
Missouri consolidated health care plan but not later than July 1, 1995,
the Missouri consolidated health care plan established under section
103.005 shall implement a pilot project to make available to those
residing in the pilot project area who are covered by the plan an
alternative system of benefits for the treatment of chemical dependency
added* to those benefits regularly available to plan participants. The
benefits provided under the pilot project shall be similar in scope and
comprehensiveness, but not limited to, the benefits provided for the
treatment and rehabilitation of persons who are chemically dependent
under the department of mental health's comprehensive substance treatment
and rehabilitation program, popularly described as the C-STAR program.
Such a pilot project shall operate for a period not to exceed four years.
To the extent that participation in the pilot project incurs additional
cost to a person covered under the plan, participation shall be
voluntary. If no additional cost is incurred, the alternative system of
benefits may be made in lieu of the regular benefits for the services in
the pilot project area.
2. The Missouri state employees' retirement system or the Missouri health
care plan, as appropriate, shall in cooperation with the department of
mental health and the department of insurance design the pilot project so
as to generate data to evaluate the costs and benefits of providing
coverage of chemical dependency using an alternative set of benefits as
provided in this section. The Missouri consolidated health care plan
shall at the completion of the pilot project submit to the governor and
the members of the general assembly a report which describes the results
of the evaluation of this pilot project. As authorized by appropriations
made for that purpose, the Missouri state employees' retirement system or
the Missouri consolidated health care plan may contract with persons to
conduct an independent evaluation of the pilot project established in
this section. (L. 1993 H.B. 564 § 16)
*Word "added" does not appear in original rolls.
|
|
|
|
