ENROLLED
Senate Bill No. 702
(Originating in the Committee on Finance)
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[Passed March 13, 1999; in effect from passage.]
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AN ACT to amend and reenact sections two, four, five, nine, twelve
and twenty-four, article sixteen, chapter five of the code of
West Virginia, one thousand nine hundred thirty-one, as
amended; and to further amend said article by adding thereto
two new sections, designated sections twelve-a and twelve-b,
all relating to the West Virginia public employees insurance
act; defining terms; increasing the membership of the finance
board; providing for appointment of the new members; revising
requirements regarding preparation of annual financial plans
and long-range plans; realigning duties of the finance board
and the actuary; changing time of submission for revenue
estimates; requiring submission of prospective financial plan;
removing requirement that types and levels of costs to
employers, employees and retired employees in effect remain in
effect; providing criminal penalties for knowingly obtaining
benefits, payments or anything of value to which the person is
not entitled or greater than those to which the person is entitled; upon a finding of probable cause, authorizing the
director to refer alleged violations fraud and abuse to the
insurance commissioner for investigation and, where
appropriate, prosecution; providing penalties for violations
not otherwise specifically provided; authorizing the director
to negotiate and contract directly with health care providers;
providing immunity for reporting fraudulent activities; and
requiring that the retirees last employer be a participating
employer to be eligible for public employees insurance agency
programs upon retirement.
Be it enacted by the Legislature of West Virginia:
That sections two, four, five, nine, twelve and twenty-four,
article sixteen, chapter five of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended and
reenacted; and that said article be further amended by adding
thereto two new sections, designated sections twelve-a and twelve- b, all to read as follows:
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-2. Definitions.
The following words and phrases as used in this article, unless a different meaning is clearly indicated by the context,
have the following meanings:
(1) "Agency" means the public employees insurance agency
created by this article.
(2) "Director" means the director of the public employees
insurance agency created by this article.
(3) "Employee" means any person, including elected officers,
who works regularly full time in the service of the state of West
Virginia and, for the purpose of this article only, the term
"employee" also means any person, including elected officers, who
works regularly full time in the service of a county board of
education; a county, city or town in the state; any separate
corporation or instrumentality established by one or more counties,
cities or towns, as permitted by law; any corporation or
instrumentality supported in most part by counties, cities or
towns; any public corporation charged by law with the performance
of a governmental function and whose jurisdiction is coextensive
with one or more counties, cities or towns; any comprehensive
community mental health center or comprehensive mental retardation
facility established, operated or licensed by the secretary of
health and human resources pursuant to section one, article two-a,
chapter twenty-seven of this code, and which is supported in part by state, county or municipal funds; any person who works regularly
full time in the service of the university of West Virginia board
of trustees or the board of directors of the state college system;
and any person who works regularly full time in the service of a
combined city-county health department created pursuant to article
two, chapter sixteen of this code. On and after the first day of
January, one thousand nine hundred ninety-four, and upon election
by a county board of education to allow elected board members to
participate in the public employees insurance program pursuant to
this article, any person elected to a county board of education
shall be deemed to be an "employee" during the term of office of
the elected member: Provided, That the elected member shall pay
the entire cost of the premium if he or she elects to be covered
under this article. Any matters of doubt as to who is an employee
within the meaning of this article shall be decided by the
director.
On or after the first day of July, one thousand nine hundred
ninety-seven, a person shall be considered an "employee" if that
person meets the following criteria:
(i) Participates in a job-sharing arrangement as defined in
section one, article one, chapter eighteen-a of this code;
(ii) Has been designated, in writing, by all other participants in that job-sharing arrangement as the "employee" for
purposes of this section; and
(iii) Works at least one third of the time required for a
full-time employee.
(4) "Employer" means the state of West Virginia, its boards,
agencies, commissions, departments, institutions or spending units;
a county board of education; a county, city or town in the state;
any separate corporation or instrumentality established by one or
more counties, cities or towns, as permitted by law; any
corporation or instrumentality supported in most part by counties,
cities or towns; any public corporation charged by law with the
performance of a governmental function and whose jurisdiction is
coextensive with one or more counties, cities or towns; any
comprehensive community mental health center or comprehensive
mental retardation facility established, operated or licensed by
the secretary of health and human resources pursuant to section
one, article two-a, chapter twenty-seven of this code, and which is
supported in part by state, county or municipal funds; and a
combined city-county health department created pursuant to article
two, chapter sixteen of this code. Any matters of doubt as to who
is an "employer" within the meaning of this article shall be
decided by the director. The term "employer" does not include within its meaning the national guard.
(5) "Finance board" means the public employees insurance
agency finance board created by this article.
(6) "Person" means any individual, company, association,
organization, corporation or other legal entity, including, but not
limited to, hospital, medical, or dental service corporations;
health maintenance organizations or similar organization providing
pre-paid health benefits; or individuals entitled to benefits under
the provisions of this article.
(7) "Plan" means the medical indemnity plan or a managed care
plan option offered by the agency.
(8) "Retired employee" means an employee of the state who
retired after the twenty-ninth day of April, one thousand nine
hundred seventy-one, and an employee of the university of West
Virginia board of trustees or the board of directors of the state
college system or a county board of education who retires on or
after the twenty-first day of April, one thousand nine hundred
seventy-two, and all additional eligible employees who retire on or
after the effective date of this article, meet the minimum
eligibility requirements for their respective state retirement
system and whose last employer immediately prior to retirement
under the state retirement system is a participating employer: Provided, That for the purposes of this article, the employees who
are not covered by a state retirement system shall, in the case of
education employees, meet the minimum eligibility requirements of
the state teachers retirement system, and in all other cases, meet
the minimum eligibility requirements of the public employees
retirement system.
§5-16-4. Public employees insurance agency finance board created;
qualifications, terms and removal of members; quorum;
compensation and expenses; termination date.
(a) There is hereby continued the public employees insurance
agency finance board, which consists of the director and six
members appointed by the governor with the advice and consent of
the Senate for terms of four years and until the appointment of
their successors: Provided, That of the two members added to the
board by the amendment of this section, enacted during the regular
legislative session, one thousand nine hundred ninety-nine, the at- large member shall be appointed for an initial term of two years
and the member representing organized labor shall be appointed for
a term of four years. Members may be reappointed for successive
terms. No more than four members (including the director) may be
of the same political party.
(b) Of the six members appointed by the governor, one member shall represent the interests of education employees, one shall
represent the interests of public employees, one shall represent
the interests of organized labor and three shall be selected from
the public at large. The governor shall appoint the member
representing the interests of education employees from a list of
three names submitted by the largest organization of education
employees in this state. The governor shall appoint the member
representing the interests of organized labor from a list of three
names submitted by the state's largest organization representing
labor affiliates. The three members appointed from the public
shall each have experience in the financing, development or
management of employee benefit programs. All new appointments made
after the first day of July, one thousand nine hundred ninety-four,
shall be selected to represent the different geographical areas
within the state and all members shall be residents of West
Virginia. No member may be removed from office by the governor
except for official misconduct, incompetence, neglect of duty,
neglect of fiduciary duty or other specific responsibility imposed
by this article, or gross immorality.
(c) The director shall serve as chairperson of the finance
board, which shall meet at times and places specified by the call
of the director or upon the written request to the director of at least two members. Notice of each meeting shall be given in
writing to each member by the director at least three days in
advance of the meeting. Four members constitutes a quorum. The
board shall pay each member the same compensation and expense
reimbursement as is paid to members of the Legislature for their
interim duties, as recommended by the citizens legislative
compensation commission and authorized by law for each day or
portion of a day engaged in the discharge of official duties.
(d) Pursuant to the provisions of article ten, chapter four of
this code, the finance board shall terminate on the first day of
July, two thousand one, unless extended by legislation enacted
before the termination date.
(e) Upon termination of the board and notwithstanding any
provisions in this article to the contrary, the director is
authorized to assess monthly employee premium contributions and to
change the types and levels of costs to employees only in
accordance with this subsection. Any assessments or changes in
costs imposed pursuant to this subsection shall be implemented by
legislative rule proposed by the director for promulgation pursuant
to the provisions of article three, chapter twenty-nine-a of this
code; any employee assessments or costs previously authorized by
the finance board shall then remain in effect until amended by rule of the director promulgated pursuant to this subsection.
§5-16-5. Purpose, powers and duties of the finance board; initial
financial plan; financial plan for following year; and annual financial plans.
(a) The purpose of the finance board created by this article
is to bring fiscal stability to the public employees insurance
agency through development of annual financial plans and long-range
plans designed to meet the agency's estimated total financial
requirements, taking into account all revenues projected to be made
available to the agency, and apportioning necessary costs equitably
among participating employers, employees and retired employees and
providers of health care services.
(b) The finance board shall retain the services of an
impartial, professional actuary, with demonstrated experience in
analysis of large group health insurance plans, to estimate the
total financial requirements of the public employees insurance
agency for each fiscal year and to review and render written
professional opinions as to financial plans proposed by the finance
board. The actuary shall also assist in the development of
alternative financing options and perform any other services
requested by the finance board or the director. All reasonable
fees and expenses for actuarial services shall be paid by the public employees insurance agency. Any financial plan or
modifications to a financial plan approved or proposed by the
finance board pursuant to this section shall be submitted to and
reviewed by the actuary, and may not be finally approved and
submitted to the governor and to the Legislature without the
actuary's written professional opinion that the plan may be
reasonably expected to generate sufficient revenues to meet all
estimated program and administrative costs of the agency, including
incurred but unreported claims, for the fiscal year for which the
plan is proposed. The actuary's opinion on the financial plan for
each fiscal year shall allow for no more than thirty days of
accounts payable to be carried over into the next fiscal year. The
actuary's opinion for any fiscal year shall not include a
requirement for establishment of a reserve fund.
(c) All financial plans required by this section shall
establish:
(1) Maximum levels of reimbursement which the public employees
insurance agency makes to categories of health care providers;
(2) Any necessary cost containment measures for implementation
by the director;
(3) The levels of premium costs to participating employers;
and
(4) The types and levels of cost to participating employees
and retired employees.
The financial plans may provide for different levels of costs
based on the insureds' ability to pay. The finance board may
establish different levels of costs to retired employees based upon
length of employment with a participating employer, ability to pay,
or other relevant factors. The financial plans may also include
optional alternative benefit plans with alternative types and
levels of cost. The finance board may develop policies which
encourage the use of West Virginia health care providers.
In addition, the finance board may allocate a portion of the
premium costs charged to participating employers to subsidize the
cost of coverage for participating retired employees, on such terms
as the finance board determines are equitable and financially
responsible.
(d) (1) The finance board shall prepare an annual financial
plan for each fiscal year during which the finance board remains in
existence. The finance board chairman shall request the actuary to
estimate the total financial requirements of the public employees
insurance agency for the fiscal year.
(2) The finance board shall prepare a proposed financial plan
designed to generate revenues sufficient to meet all estimated program and administrative costs of the public employees insurance
agency for the fiscal year. The proposed financial plan shall
allow for no more than thirty days of accounts payable to be
carried over into the next fiscal year. Before final adoption of
the proposed financial plan, the finance board shall request the
actuary to review the plan and to render a written professional
opinion stating whether the plan will generate sufficient revenues
to meet all estimated program and administrative costs of the
public employees insurance agency for the fiscal year. The
actuary's report shall explain the basis of its opinion. If the
actuary concludes that the proposed financial plan will not
generate sufficient revenues to meet all anticipated costs, then
the finance board shall make necessary modifications to the
proposed plan to ensure that all actuarially-determined financial
requirements of the agency will be met.
(3) Upon obtaining the actuary's opinion, the finance board
shall conduct one or more public hearings in each congressional
district to receive public comment on the proposed financial plan,
shall review such comments, and shall finalize and approve the
financial plan.
(4) Any financial plan shall be designed to allow thirty days
or less of accounts payable to be carried over into the next fiscal year. For each fiscal year, the governor shall provide his or her
estimate of total revenues to the finance board no later than the
fifteenth day of October of the preceding fiscal year: Provided,
That for the prospective financial plans required by this section,
the governor shall estimate the revenues available for each fiscal
year of the plans, based on the estimated percentage of growth in
general fund revenues. The finance board shall submit its final,
approved financial plan, after obtaining the necessary actuary's
opinion and conducting one or more public hearings in each
congressional district, to the governor and to the Legislature no
later than the first day of January preceding the fiscal year. The
financial plan for a fiscal year becomes effective and shall be
implemented by the director on the first day of July of the fiscal
year. In addition to each final, approved financial plan required
under this section, the finance board shall also simultaneously
submit financial statements based on generally accepted accounting
practices (GAAP) and the final, approved plan restated on an
accrual basis of accounting, which shall include allowances for
incurred but not reported claims: Provided, however, That the
financial statements and the accrual-based financial plan
restatement shall not affect the approved financial plan.
(e) The provisions of chapter twenty-nine-a of this code shall
not apply to the preparation, approval and implementation of the
financial plans required by this section.
(f) Beginning on the first day of January, two thousand, and
every year thereafter, the finance board shall submit to the
governor and the Legislature, a prospective financial plan, for a
period not to exceed five years, for the programs provided for in
this article. Factors that the board shall consider include, but
shall not be limited to, the trends for the program and the
industry; the medical rate of inflation; utilization patterns; cost
of services; and, state specific information such as average age of
employee population, active to retiree ratios, the service delivery
system and health status as these relate to the employees and
retirees insured by the public employees insurance agency, their
spouses and their dependents of the population.
(g) The prospective financial plans shall be based on the
estimated revenues submitted in accordance with subdivision (4) of
subsection (d) of this section, and shall include an average of
the projected cost-sharing percentages of premiums and an average
of the projected deductibles and co-pays for the various programs.
except in the event of a true emergency as provided for in this
section: Provided, That if the board invokes the emergency provisions, the cost shall be borne between the employers and
employees in proportion to the cost-sharing ratio for that plan
year: Provided, however, That for purposes of this section,
"emergency" means that the most recent projections demonstrate that
plan expenses will exceed plan revenues by more than one percent in
any plan year.
(h) The finance board shall meet on at least a quarterly basis
to review implementation of its current financial plan in light of
the actual experience of the public employees insurance agency.
The board shall review actual costs incurred, any revised cost
estimates provided by the actuary, expenditures, and any other
factors affecting the fiscal stability of the plan, and may make
any additional modifications to the plan necessary to ensure that
the total financial requirements of the agency for the current
fiscal year are met. The financial board may not increase the
types and levels of cost to employees during its quarterly review
except in the event of a true emergency.
(i) For any fiscal year in which legislative appropriations
differ from the governor's estimate of general and special revenues
available to the agency, the finance board shall, within thirty
days after passage of the budget bill, make any modifications to
the plan necessary to ensure that the total financial requirements of the agency for the current fiscal year are met.
§5-16-9. Authorization to execute contracts for group hospital and
surgical insurance, group major medical insurance, group prescription drug insurance, group life and accidental death insurance and other accidental death insurance; mandated benefits; limitations; awarding of contracts; reinsurance; certificates for covered employees; discontinuance of contracts.
(a) The director is hereby given exclusive authorization to
execute such contract or contracts as are necessary to carry out
the provisions of this article and to provide the plan or plans of
group hospital and surgical insurance coverage, group major medical
insurance coverage, group prescription drug insurance coverage and
group life and accidental death insurance coverage selected in
accordance with the provisions of this article, such contract or
contracts to be executed with one or more agencies, corporations,
insurance companies or service organizations licensed to sell group
hospital and surgical insurance, group major medical insurance,
group prescription drug insurance and group life and accidental
death insurance in this state.
(b) The group hospital or surgical insurance coverage and
group major medical insurance coverage herein provided for shall include coverages and benefits for X- ray and laboratory services in
connection with mammogram and pap smears when performed for cancer
screening or diagnostic services and annual checkups for prostate
cancer in men age fifty and over. Such benefits shall include, but
not be limited to, the following:
(1) Baseline or other recommended mammograms for women age
thirty-five to thirty-nine, inclusive;
(2) Mammograms recommended or required for women age forty to
forty-nine, inclusive, every two years or as needed;
(3) A mammogram every year for women age fifty and over;
(4) A pap smear annually or more frequently based on the
woman's physician's recommendation for women age eighteen and over;
and
(5) A checkup for prostate cancer annually for men age fifty
or over.
(c) The group life and accidental death insurance herein
provided for shall be in the amount of ten thousand dollars for
every employee. The amount of the group life and accidental death
insurance to which an employee would otherwise be entitled shall be
reduced to five thousand dollars upon such employee attaining age
sixty-five.
(d) All of the insurance coverage to be provided for under this article may be included in one or more similar contracts
issued by the same or different carriers.
(e) The provisions of article three, chapter five-a of this
code, relating to the division of purchases of the department of
finance and administration, shall not apply to any contracts for
any insurance coverage or professional services authorized to be
executed under the provisions of this article. Before entering
into any contract for any insurance coverage, as authorized in this
article, the director shall invite competent bids from all
qualified and licensed insurance companies or carriers, who may
wish to offer plans for the insurance coverage desired: Provided,
That the director shall negotiate and contract directly with health
care providers and other entities, organizations and vendors in
order to secure competitive premiums, prices and other financial
advantages. The director shall deal directly with insurers or
health care providers and other entities, organizations and vendors
in presenting specifications and receiving quotations for bid
purposes. No commission or finder's fee, or any combination
thereof, shall be paid to any individual or agent; but this shall
not preclude an underwriting insurance company or companies, at
their own expense, from appointing a licensed resident agent,
within this state, to service the companies' contracts awarded under the provisions of this article. Commissions reasonably
related to actual service rendered for the agent or agents may be
paid by the underwriting company or companies: Provided, however,
That in no event shall payment be made to any agent or agents when
no actual services are rendered or performed. The director shall
award the contract or contracts on a competitive basis. In
awarding the contract or contracts the director shall take into
account the experience of the offering agency, corporation,
insurance company or service organization in the group hospital and
surgical insurance field, group major medical insurance field,
group prescription drug field and group life and accidental death
insurance field, and its facilities for the handling of claims. In
evaluating these factors, the director may employ the services of
impartial, professional insurance analysts or actuaries or both.
Any contract executed by the director with a selected carrier shall
be a contract to govern all eligible employees subject to the
provisions of this article. Nothing contained in this article
shall prohibit any insurance carrier from soliciting employees
covered hereunder to purchase additional hospital and surgical,
major medical or life and accidental death insurance coverage.
(f) The director may authorize the carrier with whom a primary
contract is executed to reinsure portions of the contract with other carriers which elect to be a reinsurer and who are legally
qualified to enter into a reinsurance agreement under the laws of
this state.
(g) Each employee who is covered under any contract or
contracts shall receive a statement of benefits to which the
employee, his or her spouse and his or her dependents are entitled
under the contract, setting forth the information as to whom the
benefits are payable, to whom claims shall be submitted, and a
summary of the provisions of the contract or contracts as they
affect the employee, his or her spouse and his or her dependents.
(h) The director may at the end of any contract period
discontinue any contract or contracts it has executed with any
carrier and replace the same with a contract or contracts with any
other carrier or carriers meeting the requirements of this article.
(i) The director shall provide by contract or contracts
entered into under the provisions of this article the cost for
coverage of children's immunization services from birth through age
sixteen years to provide immunization against the following
illnesses: Diphtheria, polio, mumps, measles, rubella, tetanus,
hepatitis-b, haemophilus influenzae-b and whooping cough.
Additional immunizations may be required by the commissioner of the
bureau of public health for public health purposes. Any contract entered into to cover these services shall require that all costs
associated with immunization, including the cost of the vaccine, if
incurred by the health care provider, and all costs of vaccine
administration, be exempt from any deductible, per visit charge
and/or copayment provisions which may be in force in these policies
or contracts. This section does not require that other health care
services provided at the time of immunization be exempt from any
deductible and/or copayment provisions.
§5-16-12. Misrepresentation by employer, employee or provider;
penalty.
(a) Any person who knowingly secures or attempts to secure
benefits payable under this article or anything of value to which
the person is not entitled, or who knowingly secures or attempts to
secure greater benefits than those to which the person is entitled,
by willfully misrepresenting the presence or extent of benefits to
which the person is entitled under a collateral insurance source,
or by willfully misrepresenting any material fact relating to any
other information requested by the director or by willfully
overcharging for services provided, or by willfully misrepresenting
the diagnosis or nature of the service provided, may be found to be
overpaid and shall be civilly liable for any overpayment. In
addition to the civil remedy provided herein, the director shall withhold payment of any benefits or other payment due to that
person until any overpayment has been recovered or may directly set
off, after holding internal administrative proceedings to assure
due process, any such overcharges or improperly derived payment
against benefits or other payment due such person hereunder.
Nothing in this section shall be construed to limit any other
remedy or civil or criminal penalty provided by law.
(b) Any person who knowingly secures or attempts to secure
benefits payable under this article or any other thing of value to
which the person is not entitled, or knowingly attempts to secure
greater benefits than those to which the person is entitled, by
willfully misrepresenting, or aiding in the misrepresentation of,
any material fact relating to employment, diagnosis or services
rendered is guilty of a felony and, upon conviction thereof, shall
be fined not more than five thousand dollars, imprisoned for not
longer than two years, or both.
Errors in coding for purposes of
billing shall not be presumed to be evidence of criminal conduct in
the absence of other competent evidence to the contrary.
§5-16-12a. Inspections; violations and penalties.
(a) Upon a determination of the director or his or her
designated representative that there is probable cause to believe
that fraud, abuse or other illegal activities involving transactions with the agency has occurred, the director or his or
her designated representative is authorized to refer the alleged
violations to the insurance commissioner for investigation and, if
appropriate, prosecution, pursuant to article forty-one, chapter
thirty-three of this code. For purposes of this section,
"transactions with the agency" includes, but is not limited to,
application by any insured or dependent, any employer, or any type
of health care provider for payment to be made to that person or
any third party by the agency.
(b) Any person who violates any provision of this article for
which no other penalty is specifically provided is guilty of a
misdemeanor and, upon conviction thereof, is subject to a fine of
not less than one hundred dollars but not more than five hundred
dollars, or imprisonment for a period of not less than twenty-four
hours but not more than fifteen days, or both.
§5-16-12b. Privileges and immunity.
(a) Any person who makes a report or furnishes information,
written or oral, concerning suspected, anticipated or fraudulent
activity to secure benefits payable under this article, or to
secure greater benefits than those to which the person or provider
is entitled, is entitled to those privileges and immunities
existing under common or statutory law, as well as the immunity established in this section.
(b) In the absence of fraud, malice or bad faith, no person or
agent, employee or designee of that person shall be subject to
civil liability of any nature arising out of that person's
provision of information related to suspected, anticipated or
fraudulent activity in the securing of benefits payable or securing
greater benefits than those to which the person or provider is
entitled.
(c) Nothing in this section shall be construed to limit,
abrogate or modify existing statutes or case law applicable to the
duties or liabilities of persons acting in a manner that is itself
fraudulent, with malice or in bad faith.
§5-16-24. Rules for administration of article; eligibility of
certain retired employees and dependents of deceased members
for coverage; employees on medical leave of absence entitled
to coverage; life insurance.
The director shall promulgate any necessary rules for the
effective administration of the provisions of this article. Except
as specifically provided in subsection (e), section four of this
article, all rules of the public employees insurance agency and all
hearings held by the public employees insurance agency are exempt
from the provisions of chapter twenty-nine-a of this code. Any rules promulgated by the public employees insurance board or
director shall remain in full force and effect until they are
amended or replaced by the director.
The rules shall provide that any employee of the state who has
been compelled or required by law to retire before reaching the age
of sixty-five years is eligible to participate in the public
employees' health insurance program at the premium contribution
established by the finance board after any extended coverage to
which he or she, his or her spouse and dependents may be entitled
by virtue of his or her accrued annual leave or sick leave,
pursuant to the provisions of section thirteen of this article, has
expired. Any employee who voluntarily retires, as provided by law,
is eligible to participate in the public employees' health
insurance program at the premium contribution established by the
finance board after any extended coverage to which he or she, his
or her spouse and dependents may be entitled by virtue of his or
her accrued annual leave or sick leave, pursuant to the provisions
of section thirteen of this article, has expired: Provided, That
the employee's last employer is a participating employer. The
dependents of any deceased retired employee are entitled to
continue their participation and coverage upon payment of the
premium contribution established by the finance board. In establishing the cost of health insurance coverage for retired
employees and their spouses and dependents, the finance board, in
its discretion, may cause the claims experience of the retired
employees and their spouses and dependents to be rated separately
from that of active employees and their spouses and dependents, or
may cause the claims experience of retired and active employees,
and their spouses and dependents, to be rated together.
Any employee who is on a medical leave of absence, approved by
his or her employer, is subject to the following provisions of this
paragraph, is entitled to continue his or her coverage until he or
she returns to his or her employment, and the employee and employer
shall continue to pay their proportionate share of premium costs as
provided by this article: Provided, That the employer is obligated
to pay its proportionate share of the premium cost only for a
period of one year: Provided, however, That during the period of
the leave of absence, the employee shall, at least once each month,
submit to the employer the statement of a qualified physician
certifying that the employee is unable to return to work.
Any retiree is eligible to participate in the public
employees' life insurance program, including the optional life
insurance coverage as already available to active employees under this article, at his or her own expense for the cost of coverage,
based upon actuarial experience; and the director shall prepare, by
rule, for that participation and coverages under declining term
insurance and optional additional coverage for the retirees.