RCW 41.05.065
Public employees' benefits board -- Duties.
(Effective until January 1, 2009.)
(1) The board shall study all
matters connected with the provision of health care coverage,
life insurance, liability insurance, accidental death and
dismemberment insurance, and disability income insurance or any
of, or a combination of, the enumerated types of insurance for
employees and their dependents on the best basis possible with
relation both to the welfare of the employees and to the state.
However, liability insurance shall not be made available to
dependents.
(2) The board shall develop employee benefit plans that
include comprehensive health care benefits for all employees. In
developing these plans, the board shall consider the following
elements:
(a) Methods of maximizing cost containment while ensuring
access to quality health care;
(b) Development of provider arrangements that encourage cost
containment and ensure access to quality care, including but not
limited to prepaid delivery systems and prospective payment
methods;
(c) Wellness incentives that focus on proven strategies,
such as smoking cessation, injury and accident prevention,
reduction of alcohol misuse, appropriate weight reduction,
exercise, automobile and motorcycle safety, blood cholesterol
reduction, and nutrition education;
(d) Utilization review procedures including, but not limited
to a cost-efficient method for prior authorization of services,
hospital inpatient length of stay review, requirements for use of
outpatient surgeries and second opinions for surgeries, review of
invoices or claims submitted by service providers, and
performance audit of providers;
(e) Effective coordination of benefits;
(f) Minimum standards for insuring entities; and
(g) Minimum scope and content of public employee benefit
plans to be offered to enrollees participating in the employee
health benefit plans. To maintain the comprehensive nature of
employee health care benefits, employee eligibility criteria
related to the number of hours worked and the benefits provided
to employees shall be substantially equivalent to the state
employees' health benefits plan and eligibility criteria in
effect on January 1, 1993. Nothing in this subsection (2)(g)
shall prohibit changes or increases in employee point-of-service
payments or employee premium payments for benefits or the
administration of a high deductible health plan in conjunction
with a health savings account.
(3) The board shall design benefits and determine the terms
and conditions of employee and retired employee participation and
coverage, including establishment of eligibility criteria subject
to the requirements of RCW 41.05.066. The same terms and
conditions of participation and coverage, including eligibility
criteria, shall apply to state employees and to school district
employees and educational service district employees.
(4) The board may authorize premium contributions for an
employee and the employee's dependents in a manner that
encourages the use of cost-efficient managed health care systems.
During the 2005-2007 fiscal biennium, the board may only
authorize premium contributions for an employee and the
employee's dependents that are the same, regardless of an
employee's status as represented or nonrepresented by a
collective bargaining unit under the personnel system reform act
of 2002. The board shall require participating school district
and educational service district employees to pay at least the
same employee premiums by plan and family size as state employees
pay.
(5) The board shall develop a health savings account option
for employees that conform to section 223, Part VII of subchapter
B of chapter 1 of the internal revenue code of 1986. The board
shall comply with all applicable federal standards related to the
establishment of health savings accounts.
(6) Notwithstanding any other provision of this chapter, the
board shall develop a high deductible health plan to be offered
in conjunction with a health savings account developed under
subsection (5) of this section.
(7) Employees shall choose participation in one of the
health care benefit plans developed by the board and may be
permitted to waive coverage under terms and conditions
established by the board.
(8) The board shall review plans proposed by insuring
entities that desire to offer property insurance and/or accident
and casualty insurance to state employees through payroll
deduction. The board may approve any such plan for payroll
deduction by insuring entities holding a valid certificate of
authority in the state of Washington and which the board
determines to be in the best interests of employees and the
state. The board shall promulgate rules setting forth criteria
by which it shall evaluate the plans.
(9) Before January 1, 1998, the public employees' benefits
board shall make available one or more fully insured long-term
care insurance plans that comply with the requirements of chapter 48.84 RCW. Such programs shall be made available to eligible
employees, retired employees, and retired school employees as
well as eligible dependents which, for the purpose of this
section, includes the parents of the employee or retiree and the
parents of the spouse of the employee or retiree. Employees of
local governments and employees of political subdivisions not
otherwise enrolled in the public employees' benefits board
sponsored medical programs may enroll under terms and conditions
established by the administrator, if it does not jeopardize the
financial viability of the public employees' benefits board's
long-term care offering.
(a) Participation of eligible employees or retired employees
and retired school employees in any long-term care insurance plan
made available by the public employees' benefits board is
voluntary and shall not be subject to binding arbitration under
chapter 41.56 RCW. Participation is subject to reasonable
underwriting guidelines and eligibility rules established by the
public employees' benefits board and the health care authority.
(b) The employee, retired employee, and retired school
employee are solely responsible for the payment of the premium
rates developed by the health care authority. The health care
authority is authorized to charge a reasonable administrative fee
in addition to the premium charged by the long-term care insurer,
which shall include the health care authority's cost of
administration, marketing, and consumer education materials
prepared by the health care authority and the office of the
insurance commissioner.
(c) To the extent administratively possible, the state shall
establish an automatic payroll or pension deduction system for
the payment of the long-term care insurance premiums.
(d) The public employees' benefits board and the health care
authority shall establish a technical advisory committee to
provide advice in the development of the benefit design and
establishment of underwriting guidelines and eligibility rules.
The committee shall also advise the board and authority on
effective and cost-effective ways to market and distribute the
long-term care product. The technical advisory committee shall
be comprised, at a minimum, of representatives of the office of
the insurance commissioner, providers of long-term care services,
licensed insurance agents with expertise in long-term care
insurance, employees, retired employees, retired school
employees, and other interested parties determined to be
appropriate by the board.
(e) The health care authority shall offer employees, retired
employees, and retired school employees the option of purchasing
long-term care insurance through licensed agents or brokers
appointed by the long-term care insurer. The authority, in
consultation with the public employees' benefits board, shall
establish marketing procedures and may consider all premium
components as a part of the contract negotiations with the
long-term care insurer.
(f) In developing the long-term care insurance benefit
designs, the public employees' benefits board shall include an
alternative plan of care benefit, including adult day services,
as approved by the office of the insurance commissioner.
(g) The health care authority, with the cooperation of the
office of the insurance commissioner, shall develop a consumer
education program for the eligible employees, retired employees,
and retired school employees designed to provide education on the
potential need for long-term care, methods of financing long-term
care, and the availability of long-term care insurance products
including the products offered by the board.
(h) By December 1998, the health care authority, in
consultation with the public employees' benefits board, shall
submit a report to the appropriate committees of the legislature,
including an analysis of the marketing and distribution of the
long-term care insurance provided under this section.
[2007 c 156 § 10; 2006 c 299 § 2. Prior: 2005 c 518 § 920; 2005 c 195 § 1; 2003 c 158 § 2; 2002 c 142 § 3; 1996 c 140 § 1; 1995 1st sp.s. c 6 § 5; 1994 c 153 § 5; prior: 1993 c 492 § 218; 1993 c 386 § 9; 1988 c 107 § 8.]
NOTES:
Severability -- Effective date -- 2005 c 518: See notes following RCW 28A.500.030.
Effective date -- 2005 c 195: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2005." [2005 c 195 § 4.]
Effective date -- 1995 1st sp.s. c 6: See note following RCW 28A.400.410.
Intent -- Effective dates -- 1994 c 153: See notes following RCW 41.05.011.
Findings -- Intent -- 1993 c 492: See notes following RCW 43.20.050.
Short title -- Severability -- Savings -- Captions not law -- Reservation of legislative power -- Effective dates -- 1993 c 492: See RCW 43.72.910 through 43.72.915.
Intent -- 1993 c 386: See note following RCW 28A.400.391.
Effective date -- 1993 c 386 §§ 1, 2, 4-6, 8-10, and 12-16: See note following RCW 28A.400.391.
RCW 41.05.065
Public employees' benefits board -- Duties.
(Effective January 1, 2009.)
(1) The board shall study all
matters connected with the provision of health care coverage,
life insurance, liability insurance, accidental death and
dismemberment insurance, and disability income insurance or any
of, or a combination of, the enumerated types of insurance for
employees and their dependents on the best basis possible with
relation both to the welfare of the employees and to the state.
However, liability insurance shall not be made available to
dependents.
(2) The board shall develop employee benefit plans that
include comprehensive health care benefits for all employees. In
developing these plans, the board shall consider the following
elements:
(a) Methods of maximizing cost containment while ensuring
access to quality health care;
(b) Development of provider arrangements that encourage cost
containment and ensure access to quality care, including but not
limited to prepaid delivery systems and prospective payment
methods;
(c) Wellness incentives that focus on proven strategies,
such as smoking cessation, injury and accident prevention,
reduction of alcohol misuse, appropriate weight reduction,
exercise, automobile and motorcycle safety, blood cholesterol
reduction, and nutrition education;
(d) Utilization review procedures including, but not limited
to a cost-efficient method for prior authorization of services,
hospital inpatient length of stay review, requirements for use of
outpatient surgeries and second opinions for surgeries, review of
invoices or claims submitted by service providers, and
performance audit of providers;
(e) Effective coordination of benefits;
(f) Minimum standards for insuring entities; and
(g) Minimum scope and content of public employee benefit
plans to be offered to enrollees participating in the employee
health benefit plans. To maintain the comprehensive nature of
employee health care benefits, employee eligibility criteria
related to the number of hours worked and the benefits provided
to employees shall be substantially equivalent to the state
employees' health benefits plan and eligibility criteria in
effect on January 1, 1993. Nothing in this subsection (2)(g)
shall prohibit changes or increases in employee point-of-service
payments or employee premium payments for benefits or the
administration of a high deductible health plan in conjunction
with a health savings account.
(3) The board shall design benefits and determine the terms
and conditions of employee and retired employee participation and
coverage, including establishment of eligibility criteria subject
to the requirements of RCW 41.05.066. The same terms and
conditions of participation and coverage, including eligibility
criteria, shall apply to state employees and to school district
employees and educational service district employees.
(4) The board may authorize premium contributions for an
employee and the employee's dependents in a manner that
encourages the use of cost-efficient managed health care systems.
During the 2005-2007 fiscal biennium, the board may only
authorize premium contributions for an employee and the
employee's dependents that are the same, regardless of an
employee's status as represented or nonrepresented by a
collective bargaining unit under the personnel system reform act
of 2002. The board shall require participating school district
and educational service district employees to pay at least the
same employee premiums by plan and family size as state employees
pay.
(5) The board shall develop a health savings account option
for employees that conform to section 223, Part VII of subchapter
B of chapter 1 of the internal revenue code of 1986. The board
shall comply with all applicable federal standards related to the
establishment of health savings accounts.
(6) Notwithstanding any other provision of this chapter, the
board shall develop a high deductible health plan to be offered
in conjunction with a health savings account developed under
subsection (5) of this section.
(7) Employees shall choose participation in one of the
health care benefit plans developed by the board and may be
permitted to waive coverage under terms and conditions
established by the board.
(8) The board shall review plans proposed by insuring
entities that desire to offer property insurance and/or accident
and casualty insurance to state employees through payroll
deduction. The board may approve any such plan for payroll
deduction by insuring entities holding a valid certificate of
authority in the state of Washington and which the board
determines to be in the best interests of employees and the
state. The board shall adopt rules setting forth criteria by
which it shall evaluate the plans.
(9) Before January 1, 1998, the public employees' benefits
board shall make available one or more fully insured long-term
care insurance plans that comply with the requirements of chapter 48.84 RCW. Such programs shall be made available to eligible
employees, retired employees, and retired school employees as
well as eligible dependents which, for the purpose of this
section, includes the parents of the employee or retiree and the
parents of the spouse of the employee or retiree. Employees of
local governments, political subdivisions, and tribal governments
not otherwise enrolled in the public employees' benefits board
sponsored medical programs may enroll under terms and conditions
established by the administrator, if it does not jeopardize the
financial viability of the public employees' benefits board's
long-term care offering.
(a) Participation of eligible employees or retired employees
and retired school employees in any long-term care insurance plan
made available by the public employees' benefits board is
voluntary and shall not be subject to binding arbitration under
chapter 41.56 RCW. Participation is subject to reasonable
underwriting guidelines and eligibility rules established by the
public employees' benefits board and the health care authority.
(b) The employee, retired employee, and retired school
employee are solely responsible for the payment of the premium
rates developed by the health care authority. The health care
authority is authorized to charge a reasonable administrative fee
in addition to the premium charged by the long-term care insurer,
which shall include the health care authority's cost of
administration, marketing, and consumer education materials
prepared by the health care authority and the office of the
insurance commissioner.
(c) To the extent administratively possible, the state shall
establish an automatic payroll or pension deduction system for
the payment of the long-term care insurance premiums.
(d) The public employees' benefits board and the health care
authority shall establish a technical advisory committee to
provide advice in the development of the benefit design and
establishment of underwriting guidelines and eligibility rules.
The committee shall also advise the board and authority on
effective and cost-effective ways to market and distribute the
long-term care product. The technical advisory committee shall
be comprised, at a minimum, of representatives of the office of
the insurance commissioner, providers of long-term care services,
licensed insurance agents with expertise in long-term care
insurance, employees, retired employees, retired school
employees, and other interested parties determined to be
appropriate by the board.
(e) The health care authority shall offer employees, retired
employees, and retired school employees the option of purchasing
long-term care insurance through licensed agents or brokers
appointed by the long-term care insurer. The authority, in
consultation with the public employees' benefits board, shall
establish marketing procedures and may consider all premium
components as a part of the contract negotiations with the
long-term care insurer.
(f) In developing the long-term care insurance benefit
designs, the public employees' benefits board shall include an
alternative plan of care benefit, including adult day services,
as approved by the office of the insurance commissioner.
(g) The health care authority, with the cooperation of the
office of the insurance commissioner, shall develop a consumer
education program for the eligible employees, retired employees,
and retired school employees designed to provide education on the
potential need for long-term care, methods of financing long-term
care, and the availability of long-term care insurance products
including the products offered by the board.
[2007 c 156 § 10; 2007 c 114 § 5; 2006 c 299 § 2. Prior: 2005 c 518 § 920; 2005 c 195 § 1; 2003 c 158 § 2; 2002 c 142 § 3; 1996 c 140 § 1; 1995 1st sp.s. c 6 § 5; 1994 c 153 § 5; prior: 1993 c 492 § 218; 1993 c 386 § 9; 1988 c 107 § 8.]
NOTES:
Reviser's note: This section was amended by 2007 c 114 § 5 and by 2007 c 156 § 10, each without reference to the other. Both amendments are incorporated in the publication of this section under RCW 1.12.025(2). For rule of construction, see RCW 1.12.025(1).
Intent -- Effective date -- 2007 c 114: See notes following RCW 41.05.011.
Severability -- Effective date -- 2005 c 518: See notes following RCW 28A.500.030.
Effective date -- 2005 c 195: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2005." [2005 c 195 § 4.]
Effective date -- 1995 1st sp.s. c 6: See note following RCW 28A.400.410.
Intent -- Effective dates -- 1994 c 153: See notes following RCW 41.05.011.
Findings -- Intent -- 1993 c 492: See notes following RCW 43.20.050.
Short title -- Severability -- Savings -- Captions not law -- Reservation of legislative power -- Effective dates -- 1993 c 492: See RCW 43.72.910 through 43.72.915.
Intent -- 1993 c 386: See note following RCW 28A.400.391.
Effective date -- 1993 c 386 §§ 1, 2, 4-6, 8-10, and 12-16: See note following RCW 28A.400.391.