PRINTER'S NO. 2593
No. 1841 Session of 2007
INTRODUCED BY SURRA, NICKOL, SHIMKUS, McILVAINE SMITH, WANSACZ, DePASQUALE, McILHATTAN, McCALL, ARGALL, BELFANTI, BENNINGHOFF, BEYER, BIANCUCCI, BUXTON, CAPPELLI, COSTA, CRUZ, DeWEESE, FREEMAN, GIBBONS, GILLESPIE, GINGRICH, GODSHALL, GRUCELA, HARKINS, JAMES, JOSEPHS, KING, KORTZ, KOTIK, LENTZ, MACKERETH, MICOZZIE, R. MILLER, MOUL, PETRONE, RAMALEY, SAINATO, SAYLOR, SOLOBAY, SONNEY, THOMAS, WALKO, WATSON, YOUNGBLOOD AND YUDICHAK, OCTOBER 4, 2007
REFERRED TO COMMITTEE ON EDUCATION, OCTOBER 4, 2007
AN ACT 1 Amending Title 24 (Education) of the Pennsylvania Consolidated 2 Statutes, further providing for taxation, attachment and 3 assignment of funds; establishing the Public School 4 Employees' Benefit Board and providing for its powers and 5 duties; requiring a school employee benefits study and 6 evaluation; providing for a Statewide health benefits program 7 for public school employees, for alternative measures for 8 cost reduction and for a retirement health savings plan; and 9 establishing the Public School Employees' Benefit Trust Fund. 10 The General Assembly of the Commonwealth of Pennsylvania 11 hereby enacts as follows: 12 Section 1. Section 8533(a) of Title 24 of the Pennsylvania 13 Consolidated Statutes is amended to read: 14 § 8533. Taxation, attachment and assignment of funds. 15 (a) General rule.--Except as provided in subsections (b), 16 (c) and (d)[,] and section 9337(c) (relating to 17 misrepresentation, refusal to cooperate and fraud), the right of 18 a person to a member's annuity, a State annuity, or retirement
1 allowance, to the return of contributions, any benefit or right 2 accrued or accruing to any person under the provisions of this 3 part, and the moneys in the fund are hereby exempt from any 4 State or municipal tax, and exempt from levy and sale, 5 garnishment, attachment, or any other process whatsoever, and 6 shall be unassignable. 7 * * * 8 Section 2. Title 24 is amended by adding a chapter to read: 9 CHAPTER 93 10 SCHOOL EMPLOYEE BENEFITS 11 Subchapter 12 A. Preliminary Provisions 13 B. Public School Employees' Benefit Board 14 C. Study and Options Election 15 D. Statewide Health Benefits Program 16 E. Alternative Measures for Cost Reduction 17 F. Retirement Health Savings Plan 18 SUBCHAPTER A 19 PRELIMINARY PROVISIONS 20 Sec. 21 9301. Short title of chapter. 22 9302. Definitions. 23 § 9301. Short title of chapter. 24 This chapter shall be known and may be cited as the Public 25 School Employees' Benefit Act. 26 § 9302. Definitions. 27 The following words and phrases when used in this chapter 28 shall have the meanings given to them in this section unless the 29 context clearly indicates otherwise: 30 "Alternate health care plan." A plan or plan design 20070H1841B2593 - 2 -
1 established by the Public School Employees' Benefit Board 2 pursuant to section 9331(f)(2)(ii) (relating to health benefits 3 program) which the board in its exclusive authority determines 4 to contain benefits equivalent to the standard benefit package. 5 "Alternative measures program." A program created by the 6 Public School Employees' Benefit Board in accordance with the 7 provisions of Subchapter E (relating to alternative measures for 8 cost reduction). 9 "Annuitant." Any "annuitant" or "disability annuitant" as 10 defined in section 8102 (relating to definitions). 11 "Best practices." Standards of criteria, measures and 12 results developed by the Public School Employees' Benefit Board 13 that may be reflective of such standards developed by broadly 14 accepted organizations such as the National Committee for 15 Quality Assurance (NCQA) and the Centers for Medicare and 16 Medicaid Services (CMS), consulting firm benchmarks and medical 17 and industry journals that promote the precisions of efficient 18 delivery and design of employee benefits. 19 "Board." The Public School Employees' Benefit Board created 20 in section 9311 (relating to Public School Employees' Benefit 21 Board). 22 "Board member." A person designated or appointed to the 23 Public School Employees' Benefit Board pursuant to section 24 9311(a) (relating to Public School Employees' Benefit Board). 25 "Consortium." A coalition of two or more geographically 26 defined public school entities, or a coalition of one or more 27 geographically defined public school entities and one or more 28 political subdivisions as defined by 61 Pa. Code § 315.2 29 (relating to definitions), formed for the purpose of pooling 30 combined purchasing of the individual participants in order to 20070H1841B2593 - 3 -
1 increase bargaining power to obtain health care benefits. 2 "Contribution rate." The rate established by the Public 3 School Employees' Benefit Board in accordance with section 4 9334(b) and (c) (relating to partnership for stable benefits 5 funding) used to determine contributions by the Commonwealth and 6 public school entities for the funding of the standard benefit 7 package for eligible individuals in each health care region. 8 "Cost-sharing." The fee paid by the member that covers a 9 share of the cost of providing group health benefits under the 10 Statewide health benefits program or the fee paid by a school 11 employee or annuitant that covers a share of the cost of 12 providing health care coverage in a plan sponsored by the public 13 school entity. The term shall not include: 14 (1) any fee paid by the member, school employee or 15 annuitant at the time of service, such as copayments or 16 deductibles, in order to obtain prescription drugs or other 17 specific health care services; or 18 (2) any additional cost paid by the member, school 19 employee or annuitant for optional benefit packages. 20 "Eligible individual." An individual who is a member or the 21 health care dependent of a member. 22 "Employee benefits account." A ledger account of the Public 23 School Employees' Benefit Trust Fund created in section 24 9336(a)(1) (relating to Public School Employees' Benefit Trust 25 Fund). 26 "Employer contribution account." A ledger account of the 27 Public School Employees' Benefit Trust Fund created in section 28 9336(a)(3) (relating to Public School Employees' Benefit Trust 29 Fund). 30 "Health care dependent." An individual who is eligible to 20070H1841B2593 - 4 -
1 receive health care coverage under the Statewide health benefits 2 program due to the individual's relation to the member, as 3 determined by the Public School Employees' Benefit Board. 4 "Health care region." The geographic regions determined by 5 the Public School Employees' Benefit Board to be appropriate for 6 providing health benefits for eligible individuals based on the 7 availability of insurance carriers, benefit administrators, 8 health care providers, health care provider networks, costs and 9 any other factors related to health care or the financing of the 10 benefits. 11 "IRC." The Internal Revenue Code of 1986, as designated and 12 referred to in section 2 of the Tax Reform Act of 1986 (Public 13 Law 99-514, 100 Stat. 2085, 2095). A reference in this chapter 14 to "IRC § " shall be deemed to refer to the identically numbered 15 section and subsection or other subdivision of such section in 16 26 United States Code (relating to Internal Revenue Code). 17 "Long-term substitute." A school employee who is 18 substituting for a professional or temporary professional 19 employee of a public school entity for a qualifying period of 20 time to be determined by the Public School Employees' Benefit 21 Board. 22 "Medicare." The programs established by Title XVIII of the 23 Social Security Act (49 Stat. 620, 42 U.S.C. § 1395 et seq.) 24 which include: Part A, Hospital Insurance Benefits for the Aged 25 and Disabled; Part B, Supplementary Medical Insurance Benefits 26 for the Aged and Disabled; Part C, Medicare+ Choice Program; and 27 Part D, Voluntary Prescription Drug Benefit Program; and 28 including any subsequent changes or additions to those programs. 29 "Member." An eligible individual who is so specified for 30 enrollment in the Statewide health benefits program and in whose 20070H1841B2593 - 5 -
1 name the identification card is issued. A member can be: 2 (1) A school employee. 3 (2) An annuitant. 4 (3) A transfer employee. 5 (4) An individual separated from employment with a 6 public school entity who the Public School Employees' Benefit 7 Board determines is eligible to purchase continuation of 8 coverage in the Statewide health benefits program. 9 (5) Others as approved by the Public School Employees' 10 Benefit Board. 11 "Optional benefit package." A plan or plan design 12 established by the Public School Employees' Benefit Board 13 pursuant to section 9331(f)(2)(iii) (relating to health benefits 14 program) which includes specific health care services that are 15 not part of the standard benefit package. 16 "Participant account holder." A school employee 17 participating in a retirement health savings plan or a school 18 employee who retires or otherwise terminates employment with a 19 public school entity and becomes eligible to be reimbursed from 20 the employee's retirement health savings plan account for the 21 Internal Revenue Code of 1986 qualified health-related expenses. 22 The term shall also include the health care dependent of a 23 school employee who succeeds in interest to a deceased school 24 employee and becomes eligible to be reimbursed for health- 25 related expenses from the school employee's account. 26 "Phase-in period." The period of program operation in any 27 health care region from the time the Public School Employees' 28 Benefit Board begins implementation of mandatory participation 29 under section 9332 (relating to mandatory participation and 30 optional membership) until the commencement of the first plan 20070H1841B2593 - 6 -
1 year in which 75% of school districts in that region are 2 participating in the program. 3 "Program." The Statewide health benefits program sponsored 4 by the Public School Employees' Benefit Board in accordance with 5 the provisions of Subchapter D (relating to Statewide health 6 benefits program). 7 "Public School Code." The act of March 10, 1949 (P.L.30, 8 No.14), known as the Public School Code of 1949. 9 "Public school entity." A school district of any class, 10 intermediate unit, area vocational-technical school, charter 11 school or other school, as provided for under the act of March 12 10, 1949 (P.L.30, No.14), known as the Public School Code of 13 1949. The term shall also include the Scotland School for 14 Veterans' Children and the Scranton State School for the Deaf. 15 "Qualified majority vote." A vote by the Public School 16 Employees' Benefit Board requiring the support of a majority of 17 the members of the board present and voting, with the support of 18 at least two board members described in section 9311(a)(1) 19 (relating to Public School Employees' Benefit Board), at least 20 two board members appointed under section 9311(a)(2) and at 21 least two board members appointed under section 9311(a)(3) to 22 pass. 23 "Qualifying event." A change in marital status, death of a 24 member or the change in a health care dependent's status, 25 subsequent to the commencement of coverage under this chapter, 26 or the involuntary termination of health plan coverage that was 27 obtained through a health care dependent. 28 "Reserve account." A ledger account of the Public School 29 Employees' Benefit Trust Fund created in section 9336(a)(2) 30 (relating to Public School Employees' Benefit Trust Fund). 20070H1841B2593 - 7 -
1 "Retirement system." The Public School Employees' Retirement 2 System of Pennsylvania as established by the act of July 18, 3 1917 (P.L.1043, No.343). 4 "School employee." Any person regularly employed by or in a 5 public school entity for which work the person is receiving 6 regular remuneration as an officer, administrator, employee or 7 long-term substitute. The term excludes any independent 8 contractor, person compensated on a fee basis or, unless 9 otherwise determined by the Public School Employees' Benefit 10 Board, any part-time hourly school employee. The term includes 11 any employee of a public school entity who has a position for 12 which eligibility in a health care plan sponsored by the public 13 school entity is in effect as of the effective date of this 14 chapter. 15 "Standard benefit package." The benefit package established 16 by the Public School Employees' Benefit Board pursuant to 17 section 9331(f)(1) (relating to health benefits program). 18 "Transfer employee." A person who is not a school employee 19 who is regularly employed at a worksite in a public school 20 entity, regardless of who actually employs the person, if the 21 person is performing services previously performed by a school 22 employee. 23 "Trust fund." The Public School Employees' Benefit Trust 24 Fund created in section 9336 (relating to Public School 25 Employees' Benefit Trust Fund). 26 SUBCHAPTER B 27 PUBLIC SCHOOL EMPLOYEES' BENEFIT BOARD 28 Sec. 29 9311. Public School Employees' Benefit Board. 30 9312. Administrative duties of board. 20070H1841B2593 - 8 -
1 § 9311. Public School Employees' Benefit Board. 2 (a) Status and membership.--The board shall be an 3 independent administrative board and shall consist of the 4 following board members: 5 (1) The Secretary of the Budget, the Secretary of 6 Education, the Secretary of Administration and the Insurance 7 Commissioner, all of whom shall serve ex officio. 8 (2) Four persons representing school employees who are 9 covered by the program in an approximate proportion to the 10 percentage of actual members of those unions working as 11 school employees in public school entities that will be 12 covered by the program when it is fully operational, 13 appointed by the Governor and chosen from a list of 14 candidates submitted by those school employee unions. The 15 proportional calculation of membership under this paragraph 16 shall not include members of those unions working as school 17 employees in a school district of the first class, as 18 classified pursuant to section 202 of the Public School Code, 19 until such school district opts to participate in the program 20 under the terms provided pursuant to section 9332(d) 21 (relating to mandatory participation and optional 22 membership). 23 (3) Four persons representing public school entity 24 employers appointed by the Governor and chosen from a list of 25 candidates submitted by the Pennsylvania School Boards 26 Association. At least one of the school entity employer 27 representatives initially named to the board shall be a 28 member of a consortium board. 29 The school employee unions and the Pennsylvania School Boards 30 Association shall provide the Governor with their respective 20070H1841B2593 - 9 -
1 lists of candidates within 15 days following the effective date 2 of this section. The Governor shall make his appointments within 3 45 days following receipt of the lists. 4 (b) Terms.-- 5 (1) Two board members appointed under subsection (a)(2), 6 as designated by the Governor, shall serve a term of two 7 years, and two board members appointed under subsection 8 (a)(2), as designated by the Governor, shall serve a term of 9 four years. 10 (2) Two board members appointed under subsection (a)(3), 11 as designated by the Governor, shall serve a term of two 12 years, and two board members appointed under subsection 13 (a)(3), as designated by the Governor, shall serve a term of 14 four years, except that the Pennsylvania School Boards 15 Association shall designate for which initial term the 16 representative who is a member of a consortium board shall 17 serve. 18 (3) Successors for all board members shall be appointed 19 for terms of four years, except as provided in subsection 20 (d). Board members shall be eligible for reappointment. 21 (c) Meetings.--The board shall meet as needed to fulfill its 22 duties, and seven board members shall constitute a quorum. Board 23 members shall elect the chairman of the board. Except in 24 instances where a qualified majority is required under this 25 chapter, a majority of the board members present and voting 26 shall have authority to act upon any matter. The board is 27 authorized to establish rules of its operation, including a 28 provision for the removal of board members for nonattendance. 29 (d) Vacancies.--A vacancy occurring during the term of any 30 board member shall be filled for the unexpired term by a 20070H1841B2593 - 10 -
1 successor appointed in the same manner as his predecessor. The 2 school employee unions and the Pennsylvania School Boards 3 Association shall provide the Governor with their respective 4 lists of candidates within 60 days of the end of a member's term 5 or within 15 days of any other vacancy. 6 (e) Oath of office.--Each board member shall take an oath of 7 office that the member will, so far as it devolves upon the 8 member, diligently and honestly administer the affairs of the 9 board and that the member will not knowingly violate or 10 willfully permit to be violated any of the provisions of law 11 applicable to this chapter. The oath shall be subscribed by the 12 board member making it and certified by the officer before whom 13 it is taken and shall be immediately filed in the office of the 14 Secretary of the Commonwealth. 15 (f) Compensation and expenses.--Board members who are 16 members of the retirement system or the State Employees' 17 Retirement System shall serve without compensation. Board 18 members who are members of the retirement system and who are 19 employed by a public school entity shall not suffer loss of 20 salary or wages through serving on the board. The board, on 21 request of the employer of any board member who is an active 22 professional or nonprofessional member of the retirement system, 23 may reimburse the employer for the salary or wages of the member 24 or for the cost of employing a substitute for the board member 25 while the board member is necessarily absent from employment to 26 execute the duties of the board. The board members who are not 27 members of either the retirement system or the State Employees' 28 Retirement System may be paid $100 per day when attending 29 meetings, and all board members shall be reimbursed for any 30 necessary expenses. When, however, the duties of the board as 20070H1841B2593 - 11 -
1 mandated are not executed, no compensation or reimbursement for 2 expenses of board members shall be paid or payable during the 3 period in which the duties are not executed. 4 (g) Corporate power and legal advisor.--For the purposes of 5 this chapter, the board shall possess the power and privileges 6 of a corporation. The Office of General Counsel shall be the 7 legal advisor of the board. 8 (h) Duties of the board.--The board shall have the power and 9 authority to carry out the duties established by this chapter, 10 including the design, implementation and administration of the 11 school employee health benefits study pursuant to Subchapter C 12 (relating to study and options election) and either the 13 Statewide health benefits program if approved pursuant to 14 section 9323 (relating to plan adoption) or the alternative 15 measures program if created pursuant to section 9351 (relating 16 to alternative measures program). 17 § 9312. Administrative duties of board. 18 (a) Employees.--The compensation of all officers and 19 employees of the board who are not covered by a collective 20 bargaining agreement shall be established by the board 21 consistent with the standards of compensation established by the 22 Executive Board. 23 (b) Secretary.--The board shall select a secretary, who 24 shall not be a board member. The secretary shall act as chief 25 administrative officer for the board. In addition to other 26 powers and duties conferred upon and delegated to the secretary 27 by the board, the secretary shall: 28 (1) Serve as the administrative agent of the board and 29 as liaison between the board and applicable legislative 30 committees. 20070H1841B2593 - 12 -
1 (2) Review and analyze proposed legislation and 2 legislative developments affecting the program and present 3 findings to the board, legislative committees and other 4 interested groups or individuals. 5 (3) Receive inquiries and requests for information 6 concerning the program from the press, Commonwealth 7 officials, public school entities, school employees and the 8 general public and provide information as authorized by the 9 board. 10 (c) Professional personnel.--The board may employ or 11 contract with consultants and other professional personnel as 12 needed to operate the program, including third-party 13 administrators, managed care managers, chief medical examiners, 14 actuaries, investment advisors and managers, legal counsel and 15 other professional personnel as it deems advisable. The board 16 may also contract for the services of any national or State 17 banking corporation or association having trust powers, with 18 respect to carrying out the business and other matters of the 19 program. 20 (d) Expenses.--The board shall, through the Governor, submit 21 to the General Assembly annually a budget covering the 22 administrative expenses of this chapter. The expenses, as 23 approved by the General Assembly in an appropriation bill, shall 24 be paid: 25 (1) from the General Fund; or 26 (2) starting in the first fiscal year after the 27 transition period is complete and every fiscal year 28 thereafter, from reserves and investment earnings of the 29 trust fund. 30 (e) Meetings.--The board shall hold at least four regular 20070H1841B2593 - 13 -
1 meetings annually and other meetings as it may deem necessary. 2 (f) Records.--The board shall keep a record of all its 3 proceedings which shall be open to inspection by the public. 4 (g) Procurement.--The board shall not be subject to 62 5 Pa.C.S. Pt. I (relating to Commonwealth Procurement Code). 6 (h) Temporary regulations.-- 7 (1) Notwithstanding any other provision of law to the 8 contrary and in order to facilitate the prompt implementation 9 of this chapter, regulations promulgated by the board during 10 the two years following the effective date of this chapter 11 shall be deemed temporary regulations which shall expire no 12 later than three years following the effective date of this 13 chapter or upon promulgation of regulations as generally 14 provided by law. The temporary regulations shall not be 15 subject to: 16 (i) Sections 201, 202, 203, 204 and 205 of the act 17 of July 31, 1968 (P.L.769, No.240), referred to as the 18 Commonwealth Documents Law. 19 (ii) The act of June 25, 1982 (P.L.633, No.181), 20 known as the Regulatory Review Act. 21 (2) The authority provided to the board to adopt 22 temporary regulations in this subsection shall expire two 23 years from the effect date of this chapter. Regulations 24 adopted after the two-year period shall be promulgated as 25 provided by law. 26 (i) Postretirement benefits study.--The board shall conduct 27 an assessment of public school entity postretirement health care 28 liability in this Commonwealth and publish a report providing 29 generalized data regarding the scope of the liability to be 30 borne by public school entities and measures implemented by 20070H1841B2593 - 14 -
1 public school entities to prepare for this liability. This 2 assessment may be conducted in conjunction with the study 3 required by section 9321 (relating to school employee health 4 benefits study and evaluation). 5 SUBCHAPTER C 6 STUDY AND OPTIONS ELECTION 7 Sec. 8 9321. School employee health benefits study and evaluation. 9 9322. Board review and election. 10 9323. Plan adoption. 11 § 9321. School employee health benefits study and evaluation. 12 (a) Study.--The board shall conduct a thorough evaluation of 13 existing health care arrangements covering school employees in 14 this Commonwealth, examine future cost forecasts and collect 15 data necessary to determine if the board could construct and 16 sponsor a health care benefit program that would reduce long- 17 term costs or the rate of growth of long-term costs in the 18 aggregate for public school entities while maintaining a 19 comprehensive package of quality health care benefits for school 20 employees. The board shall conduct the study as provided under 21 this section. 22 (b) Data elements.--No later than 60 days after the board is 23 constituted, the board shall determine the information necessary 24 to evaluate the existing health care arrangements covering 25 school employees in this Commonwealth and begin to collect the 26 data, including, but not limited to: 27 (1) The total cost of providing medical/hospital and 28 prescription drug coverage. 29 (2) The types and levels of coverage currently made 30 available to school employees. 20070H1841B2593 - 15 -
1 (3) The nature of health care purchasing arrangements. 2 (4) An explanation and estimate of any financial 3 obligation of or funds owed to a public school entity related 4 to the termination of coverage under a school district- 5 sponsored health benefits plan. 6 (5) An estimate of the amount of and basis for claims 7 which may be outstanding during the transition for public 8 school entities which self-fund their coverage and the status 9 of any reserves established for such outstanding claims. 10 (6) The term and effect of collective bargaining 11 agreements governing health benefits. 12 (7) The amount and basis of any school employee cost- 13 sharing, both individual and in aggregate. 14 (8) The total amount of employer-paid costs in 15 aggregate. 16 (9) An assessment of any postretirement health care 17 benefit liabilities and claims experience data. 18 (c) Data sources.--All entities providing health benefit 19 coverage for eligible individuals or administering coverage for 20 health benefits under this chapter shall provide information on 21 coverage, benefits, plan design, claims data, premiums, cost- 22 sharing and financial arrangements as the board shall specify to 23 meet the requirements of subsection (b). Notwithstanding any law 24 to the contrary, any agency, authority, board, commission, 25 council, department or office under the jurisdiction of the 26 Governor shall cooperate with the board in its collection of 27 health insurance or health care coverage data as specified by 28 the board to effectuate this section in accordance with this 29 section. 30 (d) Public school entities.--The Secretary of Education 20070H1841B2593 - 16 -
1 shall assist the board in obtaining the necessary data for the 2 study from public school entities and consortia. In the event it 3 is necessary to facilitate the collection of data from a 4 noncooperating public school entity or consortium, the Secretary 5 of Education may request the State Treasurer to cause the 6 suspension of any payment of moneys due to the noncooperating 7 public school entity or public school entities that are 8 participants in a noncooperating consortium on account of any 9 appropriation for schools or other purposes until the necessary 10 information is properly provided. A public school entity shall 11 be notified before any payments are suspended and may appeal to 12 the secretary and request an extension of time if there have 13 been extenuating circumstances preventing the timely submission 14 of all necessary information. In considering an appeal, the 15 secretary may grant an extension of time for the public school 16 entity or consortium to provide the necessary information before 17 the suspension is instituted. The board is authorized and shall 18 authorize school entities and consortia to enter into agreements 19 with entities providing or administering coverage for health 20 care benefits under this chapter for the purpose of carrying out 21 the provisions of this section. 22 (e) Health benefit entities.-- 23 (1) An entity providing or administering health 24 insurance or health care coverage for public school 25 employees, with the exception of public school entities or 26 consortia as provided for in subsection (d), shall, upon the 27 written request of the board, public school entities, 28 consortium or insured, provide claims and loss information 29 within 60 days of the request or sooner, if so determined by 30 the board. 20070H1841B2593 - 17 -
1 (2) The Insurance Commissioner, the Department of Health 2 and any other agency, authority, board, commission, council, 3 department or office under the jurisdiction of the Governor 4 having regulatory authority over any entity charged under 5 paragraph (1), hereafter known as "regulating authority," 6 shall cooperate with the board, if necessary, to obtain 7 information from any insurance company, third-party 8 administrator or other administrator or provider of health 9 insurance benefits for school employees, other than a public 10 school entity or consortium. Following notice and hearing, 11 the board may impose an order assessing a penalty of up to 12 $1,000 per day upon any entity, other than a public school 13 entity or consortium, that willfully fails to comply with the 14 obligations imposed by this section. If the entity does not 15 comply with the obligations imposed by this section within 15 16 days of an order being imposed, the board shall notify the 17 regulating authority of the failure of an entity under its 18 jurisdiction to provide data as set forth in this section. 19 Upon notification, the regulating authority shall suspend or 20 revoke the license of the entity or otherwise suspend or 21 revoke the entity's ability to operate until such time as the 22 board notifies the regulating authority that the entity is in 23 compliance. The board shall have standing to petition the 24 Commonwealth Court to seek enforcement of the order. 25 (3) This subsection shall apply to every entity 26 providing or administering group health coverage in 27 connection with providing health care benefits to school 28 employees within this Commonwealth, including plans, 29 policies, contracts or certificates issued by: 30 (i) A stock insurance company incorporated for any 20070H1841B2593 - 18 -
1 of the purposes set forth in section 202(c) of the act of 2 May 17, 1921 (P.L.682, No.284), known as The Insurance 3 Company Law of 1921. 4 (ii) A mutual insurance company incorporated for any 5 of the purposes set forth in section 202(d) of The 6 Insurance Company Law of 1921. 7 (iii) A professional health services plan 8 corporation as defined in 40 Pa.C.S. Ch. 63 (relating to 9 professional health services plan corporations). 10 (iv) A health maintenance organization as defined in 11 the act of December 29, 1972 (P.L.1701, No.364), known as 12 the Health Maintenance Organization Act. 13 (v) A fraternal benefit society as defined in 14 section 2403 of The Insurance Company Law of 1921. 15 (vi) A hospital plan corporation as defined in 40 16 Pa.C.S. Ch. 61 (relating to hospital plan corporations). 17 (vii) Health care plans subject to the Employee 18 Retirement Income Security Act of 1974 (Public Law 93- 19 406, 88 Stat. 829), to the maximum extent permitted by 20 Federal law. 21 (viii) An administrator as defined in section 1002 22 of the act of May 17, 1921 (P.L.789, No.285), known as 23 The Insurance Department Act of 1921. 24 (ix) A person licensed pursuant to Article VI-A of 25 The Insurance Department Act of 1921. 26 (x) Any other person providing or administering 27 group health care coverage on behalf of a public school 28 entity, or accepting charges or premiums from a public 29 school entity, in connection with providing health care 30 coverage for school employees, including, but not limited 20070H1841B2593 - 19 -
1 to, multiple employer welfare arrangements, self-insured 2 public school entities and third-party administrators. 3 (f) Confidentiality.--Any data requested by or provided to 4 the board pursuant to this section shall comply with the 5 standards for privacy established pursuant to the Health 6 Insurance Portability and Accountability Act of 1996 (Public Law 7 104-191, 110 Stat. 1936). 8 (g) Prepared materials.--Any documents, materials or 9 information solely prepared or created for the purpose of 10 implementation of subsection (b) are confidential and shall not 11 be discoverable or admissible as evidence in any civil or 12 administrative action or proceeding. Any documents, materials, 13 records or information that would otherwise be available from 14 original sources shall not be construed as immune from discovery 15 or use in any civil or administrative action or proceeding 16 merely because they were presented to the board. Nothing in this 17 subsection shall be construed to prevent publication or 18 dissemination of the aggregate study findings. 19 (h) Received materials.--Any documents, materials or 20 information received by the board or by a department under the 21 jurisdiction of the Governor on the board's behalf for the 22 purpose of implementation of subsection (b) shall not be 23 discoverable from the board, any department or the submitting 24 entity, nor shall they be admissible as evidence in any civil or 25 administrative action or proceeding. Any documents, materials, 26 records or information that would otherwise be available from 27 original sources shall not be construed as immune from discovery 28 or use in any civil or administrative action or proceeding 29 merely because they were received by the board or any 30 department. 20070H1841B2593 - 20 -
1 (i) Document review.--No current or former member or 2 employee of the board or any department shall be allowed to 3 testify as to any matters by reason of the member's or 4 employee's review of documents, materials, records or 5 information submitted to the board by the entity providing 6 health insurance or health care coverage pursuant to subsection 7 (b). The enjoinment of testimony does not apply to findings or 8 actions by the board or any department that are public records. 9 (j) Original source document.--In the event an original 10 source document as set forth in subsection (g) is determined by 11 a court of competent jurisdiction to be unavailable from the 12 entity providing health insurance or health care coverage in a 13 civil action or proceeding, then, in that circumstance alone, 14 the board may be required pursuant to a court order to release 15 that original source document to the party identified in the 16 court order. 17 (k) Right-to-know requests.--Any documents, materials or 18 information made confidential by subsection (f) shall not be 19 subject to requests under the act of June 21, 1957 (P.L.390, 20 No.212), referred to as the Right-to-Know Law, or any successor 21 statute. 22 (l) Liability.--Notwithstanding any other provision of law, 23 no person or entity providing any documents, materials or 24 information to the board, any department or other entity on the 25 board's behalf shall be held by reason of having provided the 26 documents, materials or information to have violated any 27 criminal law, or to be civilly liable under any law, unless the 28 information is false and the person providing the information 29 knew or had reason to believe that the information was false and 30 was motivated by malice toward any person directly affected by 20070H1841B2593 - 21 -
1 the action. 2 § 9322. Board review and election. 3 (a) Options assessment.--Upon collection of the necessary 4 information, the board shall evaluate existing public school 5 entity health care arrangements, examine options that would 6 aggregate, either Statewide or regionally, health care coverage 7 for public school employees, assess possible cost-management 8 improvements and solicit input from public school entities and 9 consortia identified with best practice standards. The board 10 shall investigate the creation of a Statewide health benefits 11 program as provided for in section 9331 (relating to health 12 benefits program) with the goal of improving the overall 13 affordability of providing health care coverage for public 14 school employees. The cost projections shall be predicated on a 15 plan that provides quality health care benefits at a level 16 consistent with those now provided to most school employees 17 through existing collective bargaining contracts and offers 18 coverage to school employees and other eligible individuals. 19 (b) Election to proceed with program.--No later than ten 20 months after the board is constituted, unless a request by the 21 board for an extension is granted by the Governor, the board 22 shall decide whether to implement a Statewide health benefits 23 program, as provided for in section 9331, or to implement an 24 alternative measures program, as provided for in section 9351 25 (relating to alternative measures program), to reduce health 26 coverage costs for public school entities. The board's election 27 to implement a Statewide health benefits program shall require 28 approval by a qualified majority vote. Upon election to proceed 29 with a Statewide health benefits program, the board shall 30 develop a plan for adoption, pursuant to section 9323 (relating 20070H1841B2593 - 22 -
1 to plan adoption). 2 (c) Alternative election.--If the board decides that a 3 Statewide health benefits program cannot be created in 4 accordance with subsection (a), or the board fails to achieve 5 agreement and approve a plan for implementing a Statewide health 6 benefits program, the board will proceed with consideration of 7 an alternative measures program that will reduce long-term costs 8 or the rate of growth of such costs in the aggregate for public 9 school entities in accordance with Subchapter E (relating to 10 alternative measures for cost reduction). 11 § 9323. Plan adoption. 12 (a) Statewide health benefits program adoption.--Within 13 three months of electing to proceed with the Statewide health 14 benefits program, pursuant to section 9322(b) (relating to board 15 review and election), the board shall verify that implementation 16 of a Statewide health care program will result in reduction in 17 the Statewide aggregate cost of the purchase of benefits or the 18 rate of growth of such costs and adopt a proposed plan for the 19 implementation of the program. The proposed plan shall be in 20 writing and shall include a detailed description of the program 21 and the transition procedures necessary to phase in and 22 implement the program. The board's adoption of a proposed plan 23 shall require approval by a qualified majority vote. 24 (b) Parameters of program.--The description of the Statewide 25 health benefits program shall at minimum include: 26 (1) The eligibility requirements for a school employee 27 and the employee's health care dependents to qualify for 28 participation in the program. 29 (2) The identification of the benefits to be included as 30 part of the standard benefit package. 20070H1841B2593 - 23 -
1 (3) Disclosure of any member cost-sharing contributions, 2 whether expressed as a target percentage of overall program 3 costs or individually determined as a flat fee or a 4 percentage of salary and whether the cost-sharing is uniform 5 on a Statewide basis or varies by health care region. 6 (4) The designation of health care regions. 7 (5) The design of the Statewide pool or regional pools 8 that would be established to aggregate public school entities 9 for the purpose of purchasing services and managing health 10 insurance risks. 11 (6) The requirements for electronic eligibility 12 transmission between the board and other participating 13 entities, including public school entities, consortia and the 14 retirement system. 15 (7) Financial and accounting plans, including the 16 establishment of any necessary reserves or escrow accounts 17 with carriers. 18 (c) Transition procedures.--The description of the steps to 19 phase in and implement the Statewide health benefits program 20 shall at minimum include: 21 (1) A determination of when the standard benefit package 22 shall become the mandatory program offering for eligible 23 individuals in a public school entity as health care benefits 24 for school employees are normalized on a Statewide basis. 25 (2) A determination, based on the size and structure of 26 any risk pool established within a health care region, as to 27 when the program would be phased in within that region. 28 (3) The interim steps to aggregate public school 29 entities into a Statewide pool or regional pools, including 30 any best practice standards and benchmarks to be applied to 20070H1841B2593 - 24 -
1 new or existing consortia, or public school entities, or in 2 any selection process to build a Statewide or regional pool. 3 (4) Transition rules on member cost-sharing 4 responsibility until any member cost-sharing is required for 5 all members Statewide, or within any region. 6 (5) Transition rules to limit any negative financial 7 impact on a public school entity required to purchase health 8 care coverage through a Statewide or regional pool and to 9 normalize contribution rates for all participating public 10 school entities within the same health care region. 11 (d) Alternative measures program adoption.--Within three 12 months of proceeding with consideration of an alternative 13 measures program pursuant to section 9322(c) (relating to board 14 review and election), the board shall adopt a proposed plan for 15 the implementation of an alternative measures program, pursuant 16 to Subchapter E (relating to alternative measures for cost 17 reduction), that will result in reduction in the Statewide 18 aggregate cost of the purchase of benefits or the rate of growth 19 of such costs. The proposed plan shall be in writing and shall 20 include a detailed description and the transition procedures 21 necessary to phase in and implement the alternative measures 22 program. 23 (e) Legislative and public review.-- 24 (1) The board shall publish the provisions of any 25 proposed plan adopted pursuant to this section in the 26 Pennsylvania Bulletin and make it available on the board's 27 Internet website. Following publication, the board shall 28 schedule at least three public hearings to be conducted in 29 geographically diverse areas of this Commonwealth to solicit 30 public input on the plan. 20070H1841B2593 - 25 -
1 (2) The board shall submit the provisions of any 2 proposed plan adopted pursuant to this section to the 3 chairman and minority chairman of the Education Committee of 4 the Senate and the chairman and minority chairman of the 5 Education Committee of the House of Representatives. The 6 committees shall have 45 days to review the proposed plan and 7 submit comments to the board. 8 (f) Final plan adoption.--Upon completion of the public 9 hearings pursuant to subsection (e)(1) and expiration of the 10 committee review pursuant to subsection (e)(2), the board shall 11 review all the testimony and comments received regarding the 12 proposed plan. The board may, subject to a qualified majority 13 vote, make changes and adjustments to the plan to effectuate 14 this chapter. Within 90 days of publishing the proposed plan, 15 pursuant to subsection (e)(1), the board shall publish the final 16 plan, as adopted by the board, in the Pennsylvania Bulletin. 17 (g) Failure to reach consensus.--If the board fails to 18 achieve agreement and approve a plan for implementing a 19 Statewide health benefits program by a qualified majority vote 20 or if the board fails to achieve agreement and approve a plan 21 for implementing an alternative measures program, the board 22 shall report as to its findings and reasons preventing agreement 23 on a plan to the Governor, the President pro tempore of the 24 Senate and the Speaker of the House of Representatives. 25 SUBCHAPTER D 26 STATEWIDE HEALTH BENEFITS PROGRAM 27 Sec. 28 9331. Health benefits program. 29 9332. Mandatory participation and optional membership. 30 9333. Continuation of coverage and transfer employees. 20070H1841B2593 - 26 -
1 9334. Partnership for stable benefits funding. 2 9335. Powers and duties of board. 3 9336. Public School Employees' Benefit Trust Fund. 4 9337. Misrepresentation, refusal to cooperate and fraud. 5 9338. Miscellaneous provisions. 6 § 9331. Health benefits program. 7 (a) Creation.--Upon adoption of a Statewide health plan 8 under section 9323(f) (relating to plan adoption), the board 9 shall proceed to initiate and sponsor an employee benefits 10 program for eligible individuals. 11 (b) Program design.--The board shall design a program which 12 follows the parameters of the plan and transition procedures as 13 established in section 9323. The board may develop and 14 administer the program itself or operate through any legal 15 entity authorized by law to do so, including consortia, and the 16 program may be developed and administered differently within 17 each health care region as long as a standard benefit package 18 that is substantially equivalent in coverage, as determined by 19 the board, is available to eligible individuals. The program may 20 also be administered in whole or in part on a fully insured or 21 self-funded basis at the board's sole discretion. 22 (c) Implementation.--The board may: 23 (1) Establish pools for selected areas of coverage, such 24 as pharmacy services, transplants, stop-loss insurance, 25 health care management or other possible areas that in the 26 board's judgment can be offered Statewide or regionally on a 27 more stable and cost-effective basis. The board may offer 28 separate plans to public school entities and consortia prior 29 to the phase-in of the standard benefit package. 30 (2) Make the program available in some health care 20070H1841B2593 - 27 -
1 regions before it is made available within all regions. 2 (d) Eligibility requirements.--The board shall have full 3 authority to determine eligibility requirements for benefits and 4 to adopt rules and regulations setting forth the same which will 5 be binding on all eligible individuals. No coverage shall be 6 provided for eligible individuals without payment being made, 7 except under circumstances as may be established by the board 8 under reasonable guidelines. 9 (e) Coverage and plan selection.--The board shall have full 10 authority to select and contract with insurance carriers, health 11 maintenance organizations, pharmacy benefit managers, third- 12 party administrators, reinsurers and any other entities 13 necessary to provide a range of benefit packages to eligible 14 individuals through the program. The board shall have full 15 authority to determine the nature, amount and duration and 16 discontinuation of coverage to be provided. 17 (f) Standard and optional benefits.-- 18 (1) A standard benefit package shall be established by 19 the board that shall include coverage for medical and 20 hospital services, prescription drugs and other benefits in 21 amounts to be determined by the board. 22 (2) Within each health care region, the board shall 23 approve and make available to each eligible individual 24 affiliated with a public school entity which is participating 25 in the program the following: 26 (i) A health care plan that includes coverage the 27 board determines to be the equivalent of the standard 28 benefit package established in paragraph (1). 29 (ii) One or more alternate health care plans or plan 30 designs which in the board's judgment contain benefits 20070H1841B2593 - 28 -
1 equivalent to the standard benefit package in paragraph 2 (1). The deductibles and copayments for each alternate 3 health care plan shall be set and annually adjusted so 4 that the cost of providing the coverage for the 5 Commonwealth and a public school entity is no greater 6 than the cost incurred for the health plan in 7 subparagraph (i). 8 (iii) One or more optional benefit plans, as 9 approved by the board, which allow an eligible individual 10 to purchase coverage that is not included in the standard 11 benefit package, provided that any cost over and above 12 the cost of the health care plan in subparagraph (i) is 13 to be paid by the member. 14 (3) The detailed basis on which payment of benefits is 15 to be made shall be specified in writing. The benefits 16 provided in this chapter are subject to change or 17 modification by the board from time to time as the board, in 18 its discretion, may determine. All changes or modifications 19 shall be specified in writing and communicated to members 20 within a reasonable period of time. 21 § 9332. Mandatory participation and optional membership. 22 (a) Mandatory participation.--The board shall have the 23 authority to require public school entities to participate in 24 the program on a Statewide basis or may phase in and require 25 participation on a regional basis. Except as provided under 26 subsections (c), (d), (e) and (f), public school entities in any 27 health care region designated by the board shall be required to 28 participate in the program. 29 (b) Transition plan.--When the board determines pursuant to 30 subsection (a) that a public school entity shall be required to 20070H1841B2593 - 29 -
1 participate in the program, the public school entity or 2 consortium in which the public school entity is a participant 3 shall, within a reasonable period of time as determined by the 4 board, present to the board a transition plan with a schedule 5 for the eventual migration of school employees into the program. 6 The board shall review the transition plan with the public 7 school entity or consortium and make any necessary modifications 8 before granting approval of the plan. A public school entity or 9 consortium shall be subject to adherence to the transition plan 10 approved by the board. 11 (c) Extensions of time.--The board shall give due 12 consideration to a transition plan submitted pursuant to 13 subsection (b) that includes a request for an extension of time. 14 Requests may be submitted by, but shall not be limited to, any 15 of the following: 16 (1) A public school entity that participates in a 17 consortium where an extension of time is necessary for the 18 rundown and proper termination of the consortium's health 19 care program. 20 (2) A public school entity that participates in a 21 consortium where the withdrawal of the public school entity 22 may undermine the financial stability of the consortium. 23 (3) A public school entity or a consortium which will 24 incur a significant financial penalty under terms of a 25 contract with an insurance carrier or other provider of 26 health care coverage for a contract in existence on or before 27 January 1, 2008. 28 (4) A public school entity or consortium which will 29 incur a significant financial cost, including fees, penalties 30 or other contractual financial obligations, related to the 20070H1841B2593 - 30 -
1 termination of coverage under a contract of insurance or, in 2 the case of a public school entity that self-insures, 3 insufficient reserves to pay claims incurred during the 4 previous coverage year, if the obligation relates to a plan 5 of coverage that was in existence on or before January 1, 6 2008, and the public school entity or consortium provides the 7 board with a financial plan for meeting these obligations. 8 (d) Optional membership.--No school district of the first 9 class, as classified pursuant to section 202 of the Public 10 School Code, shall be required to participate in the program, 11 except as may be agreed upon under terms of a collective 12 bargaining agreement covering a majority of employees of a 13 school district of the first class. Upon a school district of 14 the first class entering participation in the program pursuant 15 to a collective bargaining agreement, continued participation in 16 the program shall become mandatory. 17 (e) Prohibited membership.--A public school entity that, on 18 the effective date of this chapter, participates in the 19 Pennsylvania Employees' Benefit Trust Fund shall be prohibited 20 from participating in the program, and employees of the public 21 school entity shall not have the right to elect membership in 22 the program. 23 (f) Transition of employees.--A public school entity that 24 provides some or all of its employees with health benefits 25 through another health care plan by virtue of one or more 26 collective bargaining agreements, entered into prior to the 27 effective date of this chapter, shall not be required to join 28 the program until expiration of the collective bargaining 29 agreements. The public school entity and some or all of its 30 employees or bargaining representatives of its employees may by 20070H1841B2593 - 31 -
1 mutual agreement and approval of the board join the program at 2 an earlier date. Renewal or extension of a collective bargaining 3 agreement shall constitute its expiration for the purpose of 4 this subsection. 5 § 9333. Continuation of coverage and transfer employees. 6 (a) Annuitants.--Upon retirement, an annuitant eligible 7 under paragraph (1) or (2) shall have the option to elect 8 coverage in the program, including coverage for any eligible 9 health care dependent. The annuitant shall be responsible to pay 10 the full cost of the coverage, unless a public school entity has 11 agreed, separate from any requirements of the program, to pay 12 toward the coverage pursuant to an award of health benefits 13 under a written policy or agreement collectively bargained or 14 otherwise entered into by the public school entity. The board 15 shall annually determine the cost of coverage as follows: 16 (1) For an annuitant who is enrolled in the program 17 pursuant to section 513 of the Public School Code or an 18 annuitant who pursuant to any award of health benefits for 19 annuitants under a written policy or agreement collectively 20 bargained or otherwise entered into by the public school 21 entity prior to the effective date of this section, payments 22 shall be based on the total contribution rate established 23 pursuant to section 9334(b) and (c) (relating to partnership 24 for stable benefits funding) for a school employee in the 25 same health care region, plus a 2% administrative fee. 26 (2) For an annuitant, other than an annuitant qualified 27 for coverage under paragraph (1), payments shall be made on 28 the same basis as an annuitant qualified for coverage under 29 paragraph (1), except as determined as follows: 30 (i) The board shall periodically have the actuary 20070H1841B2593 - 32 -
1 review and determine the separate cost of providing 2 continuation of coverage to annuitants under this 3 paragraph, along with an assessment of its impact on the 4 cost of providing coverage to members who are school 5 employees and annuitants qualified for coverage under 6 paragraph (1). The review and assessment shall first 7 occur as part of the school employee health benefits 8 study and evaluation conducted pursuant to section 9321 9 (relating to school employee health benefits study and 10 evaluation) and its results shall be considered in the 11 development of parameters under section 9323(b) (relating 12 to plan adoption). 13 (ii) The board shall consider the findings of the 14 actuary in subparagraph (i) to determine if there is a 15 substantial impact on the cost of providing coverage to 16 members who are school employees and annuitants qualified 17 for coverage under paragraph (1). If there is a 18 substantial cost impact, the board shall require payments 19 for an annuitant qualified to elect coverage in the 20 program under this paragraph to be separately determined 21 and the contribution rate to be based on the 22 disaggregated cost of providing the coverage, plus a 2% 23 administrative fee. 24 (b) Separation from service.--The board shall determine the 25 eligibility of members, other than annuitants covered by 26 subsection (a), to elect continuation of coverage in the program 27 upon separation from service as a school employee. The member 28 shall be responsible to pay the full cost of the coverage in the 29 member's health care region, plus an administrative fee to be 30 set by the board. The board shall, at minimum, provide 20070H1841B2593 - 33 -
1 continuation of coverage eligibility that meets the requirements 2 of Title X of the Employee Retirement Income Security Act of 3 1974 (Public Law 99-272, 29 U.S.C. § 1161 et seq.) and provide 4 the continuation of coverage options required pursuant to 51 5 Pa.C.S. § 7309 (relating to employment discrimination for 6 military membership or duty) for members on military leave. 7 (c) Transfer employees.--The board may, in its discretion, 8 approve the participation of transfer employees in the program, 9 provided that any position for which a transfer employee who is 10 provided health benefits in a health care plan sponsored by a 11 public school entity through an agreement that was in existence 12 on or before January 1, 2008, with the transfer employee's 13 employer shall be allowed to participate in the program. The 14 board shall set the terms and conditions necessary for 15 participation in the program, including the cost of coverage to 16 be paid by the third-party entity which shall be based on the 17 full cost of coverage in the health care region as determined by 18 the board, plus an administrative fee. The sponsoring public 19 school entity shall be responsible to the board for the 20 collection of the payments for transfer employees from the 21 third-party entity. 22 § 9334. Partnership for stable benefits funding. 23 (a) Basis of partnership.--In recognition that the long-term 24 viability and stability of the program will require public 25 school entity employers, members and the Commonwealth to be 26 partners both in sustaining the health benefits program as well 27 as managing the costs of a reasonable and appropriate standard 28 benefit package, the board shall determine for each plan year 29 and in each region the payments due from public school entities, 30 from members and from the Commonwealth. 20070H1841B2593 - 34 -
1 (b) Determination of contribution rate.--The board shall 2 determine for each plan year the total amount of the 3 contributions by the Commonwealth, public school entities and 4 school employees required to provide projected benefits for that 5 plan year under the standard benefit package on behalf of each 6 school employee member and the employee's eligible health care 7 dependents. The contribution rate shall consist of the amount 8 required to provide the standard benefit package, including 9 appropriate reserves and administrative expenses, and shall be 10 adjusted for each health care region to reflect the cost of 11 benefits in that region. The contribution rates may 12 differentiate between single coverage for members only and types 13 of family coverage, as determined by the board. 14 (c) Certification of rate.--The board shall certify the 15 contribution rate for each health care region to the 16 Commonwealth and public school entities, including the payments 17 that shall be due from public school entities, from members and 18 from the Commonwealth. The certifications shall be regarded as 19 final and not subject to modification by the Secretary of the 20 Budget. 21 (d) Commonwealth cost share.--The Commonwealth shall make a 22 contribution to offset a portion of the cost increase consistent 23 with subsections (e) and (f). For any plan year in which the 24 board determines that the aggregate cost of providing the 25 standard benefit package on behalf of members who are school 26 employees and their eligible health care dependents exceeds the 27 sum of: 28 (1) the projected carry-over balance for the plan year 29 in the employer contribution account after all required 30 transfers have been made to the employee benefits account for 20070H1841B2593 - 35 -
1 the prior year; and 2 (2) any employee cost-sharing for the plan year. 3 (e) Budget submission and appropriation.--If the board 4 determines that the requirements of subsection (d) have been 5 met, all of the following shall occur: 6 (1) The board shall submit to the Secretary of the 7 Budget an itemized budget specifying the amount necessary to 8 be appropriated by the Commonwealth consistent with 9 subsection (f). The budget submission shall be on a form and 10 in a manner determined by the Secretary of the Budget and 11 shall occur no later than November 1 of the fiscal year 12 preceding the plan year for which funds are requested. 13 (2) Upon appropriation by the General Assembly to 14 provide for the obligations of the Commonwealth, the amount 15 shall be paid by the State Treasurer through the Department 16 of Revenue into the employer contribution account within 30 17 days of receipt of the requisition presented each month by 18 the board. 19 (f) Limitation on Commonwealth contribution.-- 20 (1) The Commonwealth shall not be obligated to pay any 21 amount beyond that which is appropriated by the General 22 Assembly. The amount requested by the board pursuant to 23 subsection (e)(1) shall not exceed the sum of any amount paid 24 by the Commonwealth for the fiscal year preceding the plan 25 year for which funds are requested and the lesser of: 26 (i) 50% of the amount that the board determines is 27 necessary to meet the increase in the contribution rate 28 on behalf of members who are school employees determined 29 pursuant to subsection (b); and 30 (ii) the product of the total revenue transferred in 20070H1841B2593 - 36 -
1 the prior plan year from the employer contribution 2 account to the employee benefits account and the most 3 recent annual percent change in the per enrollee private 4 health insurance premium for all benefits, as defined in 5 the National Health Expenditure Data published by the 6 Centers for Medicare and Medicaid Services, Department of 7 Health and Human Services. 8 (2) If any excess revenue in the employer contribution 9 account is to be applied to payments for the plan year, then 10 the excess revenue shall be used to reduce the calculation 11 under this subsection in proportion to the Commonwealth's 12 share of the total increase in the contribution rate on 13 behalf of active members for the plan year. 14 (g) Additional optional contribution.--Notwithstanding the 15 limitation in subsection (f), the General Assembly may 16 appropriate additional revenue to the employer contribution 17 account in any fiscal year. 18 (h) Allocation of Commonwealth contribution.--Any 19 contribution made by the Commonwealth under this section shall 20 be used to offset an increase in the contribution rate paid in a 21 health care region by public school entities on behalf of 22 members who are school employees and their eligible health care 23 dependents and to maintain any offset that was paid in a prior 24 year. The Commonwealth contribution shall be allocated to offset 25 a portion of each participating public school entity's cost of 26 coverage on a per-member basis, for members who are school 27 employees and their eligible health care dependents, based on 28 the public school entity's market value/income aid ratio using 29 the most recent data provided by the Department of Education. 30 For any public school entity that is not assigned a market 20070H1841B2593 - 37 -
1 value/income aid ratio by the Department of Education, the 2 Commonwealth contribution shall not be adjusted based on a 3 market value/income aid ratio. For the purpose of this 4 subsection, "market value/income aid ratio" shall have the same 5 meaning given to it in the Public School Code. 6 (i) Contributions on behalf of school employees.--Consistent 7 with any transition procedure pursuant to section 9323(c)(5) 8 (relating to plan adoption), each public school entity shall be 9 required to make payments to the trust fund on behalf of members 10 who are school employees and their eligible health care 11 dependents based on the contribution rate certified by the board 12 in subsection (c). The increase in payments made from one year 13 to the next by public school entities on behalf of school 14 employees shall be equal to or greater than the increase in 15 payment from one year to the next made pursuant to subsection 16 (d), excluding any additional optional contribution made by the 17 Commonwealth pursuant to subsection (g). 18 (j) Deduction from appropriations.--In the event a public 19 school entity does not make the required payment in the time 20 allotted, as determined by the board, the Secretary of Education 21 and the State Treasurer shall cause to be deducted and paid into 22 the trust fund from the amount of any moneys due to any public 23 school entity on account of any appropriation for schools or 24 other purposes the amount due to the trust fund as certified by 25 the board and as remains unpaid on the date such appropriations 26 would otherwise be paid to the public school entity by the 27 Department of Education, and the amount shall be credited to the 28 public school entity's account in the trust fund. 29 (k) Transition.--Until any transition pursuant to section 30 9323(c)(5) has been completed, the payments made by each public 20070H1841B2593 - 38 -
1 school entity shall be no less than the total amount paid by the 2 public school entity to provide, purchase and administer health 3 care benefits to members who are school employees and their 4 eligible health care dependents in the year before 5 implementation of the program. Any contributions received by the 6 public school entity from school employees in the form of cost- 7 sharing payments for health care coverage shall be excluded from 8 the amount. 9 (l) Applicability.--Any expenditures necessary to fund 10 participation in this program shall qualify as costs incurred 11 under section 333(f)(2)(ix) of the act of June 27, 2006 (1st 12 Sp.Sess., P.L.1873, No.1), known as the Taxpayer Relief Act. 13 § 9335. Powers and duties of board. 14 (a) Powers.--In addition to the powers granted by other 15 provisions of this chapter, the board shall have the powers 16 necessary or convenient to carry out this subchapter, including, 17 but not limited to, the power to: 18 (1) Determine appropriate geographic health care regions 19 for the administration of the program and make changes to the 20 regions as necessary. 21 (2) Formulate and establish the conditions of 22 eligibility, including eligibility for health care dependent 23 coverage for members, to include consideration if a member or 24 health care dependent is covered, or eligible for coverage, 25 under another employer-sponsored group health insurance plan; 26 provisions for payment of benefits; and all other provisions 27 that may be required or necessary to carry out the intent and 28 purpose of the program. 29 (3) Determine and make necessary changes to the standard 30 benefit package and benefit structure of the program. 20070H1841B2593 - 39 -
1 (4) Establish copayments, annual deductibles, 2 coinsurance levels, exclusions, formularies and other 3 coverage limitations and payment responsibilities of members 4 incurred at the time of service. 5 (5) Set and adjust member cost-sharing contributions to 6 be expressed as a target percentage of overall program costs 7 or individually determined as a flat fee or a percentage of 8 salary. The board shall determine whether member cost-sharing 9 shall be uniform on a Statewide basis or shall vary by health 10 care region. 11 (6) Impose and collect necessary fees and charges. 12 (7) Determine enrollment procedures. 13 (8) Establish procedures for coordination of benefits 14 with other plans and third-party payers, including 15 coordinating benefits or contracting directly with Medicare. 16 (9) Establish a plan with the retirement system to 17 coordinate health care coverage for annuitants between the 18 program established by this chapter and the group health 19 insurance program sponsored by the retirement system under 20 the provisions of Chapter 89 (relating to group health 21 insurance program) and to coordinate the sharing of 22 information pertaining to premium assistance payment 23 transfers. 24 (10) Set and adjust contribution rates sufficient to 25 maintain the adequacy of any reserves established by this 26 chapter and to fully fund the benefits offered by and to pay 27 for the administrative expenses related to the program. 28 (11) Set and adjust costs for members electing to 29 continue coverage upon retirement or separation from 30 employment. The board may establish different cost rates to 20070H1841B2593 - 40 -
1 be charged for different categories of members electing to 2 continue coverage. 3 (12) Purchase insurance or employ self-insurance, alone 4 or in combination, to provide benefits as shall be determined 5 by the board. 6 (13) Establish appropriate reserves based on generally 7 accepted standards as applied by Federal and State regulators 8 to similar types of plans. 9 (14) Issue self-liquidating debt or borrow against 10 contributions, payments or other accounts receivable for the 11 purposes of prepaying any health benefits, establishing 12 reserves or otherwise lowering the cost of coverage. 13 (15) Establish procedures to verify the accuracy of 14 statements and information submitted by eligible individuals 15 on enrollment forms, claim forms or other forms. 16 (16) Receive and collect all contributions due and 17 payable to the accounts or delegate to a public school entity 18 or claims processor the right to receive contributions, 19 payments or perform ministerial functions required to assert 20 the board's rights. In so doing, the board shall have the 21 right to: 22 (i) maintain any and all actions and legal 23 proceedings necessary for the collection of 24 contributions; and 25 (ii) prosecute, defend, compound, compromise, 26 settle, abandon or adjust any actions, suits, 27 proceedings, disputes, claims, details and things related 28 to the accounts and program. 29 (17) Establish procedures to hear and determine any 30 claims and controversies under this chapter. 20070H1841B2593 - 41 -
1 (18) Promulgate rules and regulations regarding the 2 administration of the program, including the establishment of 3 the plan year. 4 (19) Ensure that a public school entity provides 5 detailed information about the program to eligible employees 6 at least 90 days before program coverage begins to be offered 7 to school employees. 8 (20) Seek and take all necessary steps to retain 9 eligibility for the members, public school entities and the 10 Commonwealth to receive tax-preferred or tax-free treatment 11 under the IRC for contributions to and earnings of the trust 12 fund. 13 (21) Enter into agreements with entities providing or 14 administering coverage for health benefits under this chapter 15 for the electronic exchange of data between the parties at a 16 frequency as determined by the board. 17 (22) Perform and do any and all such actions and things 18 that may be properly incidental to the exercising of powers, 19 rights, duties and responsibilities of the board. 20 (23) Determine best practice standards and benchmarks 21 for consortia in any selection process to build a Statewide 22 pool or regional pools, including the power to require a 23 consortium to merge with another consortium. The board shall 24 have the power to require consortia, as a condition of 25 continued participation in the program, to accept any public 26 school entity applying to join and participate in a 27 consortium. 28 (24) Enter into agreements with any public school entity 29 or consortium to implement the program developed pursuant to 30 this chapter and delegate powers necessary to administer 20070H1841B2593 - 42 -
1 coverage for health benefits. 2 (b) Administrative duties of board.--In addition to other 3 duties of the board provided in this chapter, the following 4 duties shall be afforded to the board for the implementation of 5 this section. 6 (c) Regulations and procedures.--The board shall, with the 7 advice of the Office of General Counsel and the actuary, adopt 8 and promulgate rules and regulations for the uniform 9 administration of the program. The actuary shall approve in 10 writing all computational procedures used in the calculation of 11 contributions and the cost of benefits, and the board shall by 12 resolution adopt the computational procedures prior to their 13 application by the board. The rules, regulations and 14 computational procedures as so adopted from time to time and as 15 in force and effect at any time, together with tables that are 16 adopted as necessary for the calculation of contributions and 17 the cost of benefits, shall be effective as if fully set forth 18 in this chapter. 19 (d) Data.--The board shall keep in electronic format records 20 of claims, eligibility and other data as are stipulated by the 21 actuary in order that an annual contribution rate determination 22 for each health care region and various program options can be 23 completed within six months of the close of each plan year. The 24 board shall have final authority over the means by which data is 25 collected, maintained and stored and in so doing shall protect 26 the rights of its membership as to privacy and confidentiality. 27 (e) Annual financial statement.--The board shall prepare and 28 have published within six months following the end of each plan 29 year a financial statement showing the condition of the trust 30 fund as of the end of the previous plan year. The board shall 20070H1841B2593 - 43 -
1 submit said financial statement to the Governor and shall make 2 copies available to public school entities for the use of the 3 school employees and the public. 4 (f) Independent audit.--The board shall provide for an 5 annual audit of the trust fund by an independent certified 6 public accounting firm. 7 (g) Manual of regulations.--The board shall, with the advice 8 of the Office of General Counsel and the actuary, prepare within 9 six months of the commencement of a program adopted under this 10 chapter a manual incorporating rules and regulations consistent 11 with the provisions of this chapter for each participating 12 public school entity that shall make information contained in 13 the manual available to school employees. The board shall 14 thereafter advise public school entities within 90 days of any 15 changes in rules and regulations due to changes in the law or 16 due to changes in administrative policies. 17 (h) Annual budget.--The board shall establish an annual 18 budget for the program and make disbursements from the trust 19 fund that are consistent with the budget. 20 (i) Program assistance.--The board may solicit and accept 21 grants, loans and other aid from any person, corporation or 22 other legal entity or from the Federal, State or local 23 government and participate in any Federal, State or local 24 government program if necessary for prudent management of the 25 program. 26 (j) Functions.--The board shall perform other functions as 27 are required for the execution of this chapter and shall have 28 the right to inspect employment records of public school 29 entities. 30 (k) Qualified majority voting provision.--A qualified 20070H1841B2593 - 44 -
1 majority vote shall be required on any matter voted upon by the 2 board affecting the development of or any change in: 3 (1) The plan to implement the program adopted pursuant 4 to section 9323(f) (relating to plan adoption). 5 (2) The standard benefit package, benefit options or 6 plan design offered by the program to covered employees. 7 (3) Membership eligibility criteria. 8 (4) The addition, deletion or significant change in 9 status of an insurance carrier, benefits administrator or 10 other major contractor in the administration of benefits, or 11 the addition, deletion or significant change in status of a 12 health care provider network. 13 (5) Any determination on the use of excess fund 14 payments. 15 (6) The overall per-employee cost of the standard 16 benefit package to the trust fund and any public school 17 entity funding and member cost-sharing responsibilities. 18 (7) Cost containment measures such as managed care, 19 wellness centers and large case management. 20 (8) Contracts valued at more than $25,000,000. 21 (9) Changes in trust document, bylaws or any major 22 internal operating policies or procedures, such as claims 23 appeal procedures, not to include routine ministerial 24 functions. 25 (l) Duties conferred upon secretary.--The secretary of the 26 board shall supervise a staff of administrative, technical and 27 clerical employees engaged in recordkeeping and clerical 28 processing activities in maintaining files of members, 29 accounting for contributions, processing payments, preparing 30 required reports and counseling. 20070H1841B2593 - 45 -
1 § 9336. Public School Employees' Benefit Trust Fund. 2 (a) Establishment of trust fund.--The Public School 3 Employees' Benefit Trust Fund is established in the State 4 Treasury. The moneys of the trust fund are appropriated on a 5 continuing basis and shall be used exclusively for the purposes 6 set forth in this chapter. All of the assets of the trust fund 7 shall be maintained and accounted for, separate from all other 8 funds and moneys of the Commonwealth. The Treasury Department 9 shall credit to the trust fund all moneys received from the 10 Department of Revenue arising from the contributions required 11 under this chapter and all earnings from investments or moneys 12 of the trust fund. There shall be established and maintained by 13 the board the several ledger accounts, including: 14 (1) The employee benefits account shall be the ledger 15 account to which shall be credited the payments from section 16 9333(a),(b) and (c) (relating to continuation of coverage and 17 transfer employees), payments from members for cost sharing 18 and any additional member-paid cost associated with optional 19 benefit packages elected by members and transfers from the 20 employer contribution account as provided in paragraph (3). 21 All earnings derived from investment of the assets of the 22 employee benefits account shall be credited to this account. 23 The board is authorized to separately invest the amounts in 24 the employee benefits account in a prudent manner intended to 25 maximize the safety of the capital contained in the employee 26 benefits account. Payments for member health care benefits 27 and the direct administrative expenses of the board related 28 to the administration of the employee benefits program, as 29 provided in section 9312(d) (relating to administrative 30 duties of board), shall be charged to this account. 20070H1841B2593 - 46 -
1 (2) Reserve account. 2 (i) A restricted reserve account, or more than one 3 account if the board determines it necessary to have 4 segregated accounts, is established within the trust fund 5 for the purpose of establishing and maintaining a reserve 6 or separate reserves sufficient: 7 (A) to pay the expected claims experience of the 8 program in the event the board elects to self-fund 9 all or a portion of the program for any plan years; 10 (B) to prefund the accrued liability for any 11 postretirement health care benefits earned by 12 employees enrolled in the program pursuant to section 13 9333(a)(1) (relating to continuation of coverage and 14 transfer employees) as the benefit is earned by the 15 employees; and 16 (C) to amortize the unfunded actuarial accrued 17 liability for postretirement health care benefits 18 already earned by employees and annuitants pursuant 19 to section 9333(a)(1) in the event the board elects 20 to assume all or a portion of the liability. The 21 board shall use an amortization period that does not 22 exceed 30 years for this purpose. 23 (ii) The board shall annually establish through an 24 actuary retained by the board the amount necessary, if 25 any, to establish and maintain a reserve or separate 26 reserves sufficient for the purposes of this paragraph. 27 Any moneys needed to maintain the reserve or separate 28 reserves established under this paragraph shall be 29 collected through the adjustment of the contribution rate 30 established pursuant to section 9334(b) and (c) (relating 20070H1841B2593 - 47 -
1 to partnership for stable benefits funding) or through 2 other available sources. 3 (iii) The moneys in any reserve account may be 4 invested by the board separate from other moneys of the 5 trust fund. All earnings derived from investment of the 6 assets of any reserve account shall be credited to the 7 reserve account. 8 (3) The employer contribution account shall be the 9 ledger account to which shall be credited all contributions 10 made by the Commonwealth as determined in accordance with 11 section 9334(e) and payments from public school entities as 12 determined in accordance with section 9334(i), as well as all 13 earnings derived from the investment of the assets of the 14 employer contribution account. The total amount of the 15 Commonwealth and public school entity contributions required 16 to provide the standard benefit package on behalf of all 17 members who are school employees and their eligible health 18 care dependents shall be transferred on a monthly basis to 19 the employee benefits account. 20 (b) Composition.--The trust fund shall consist of: 21 (1) All payments made by members or received from the 22 Commonwealth and public school entities and all interest, 23 earnings and additions thereto. 24 (2) Any other money, public or private, appropriated or 25 made available to the board for the trust fund or any reserve 26 account from any source and all interest, earnings and 27 additions thereto. 28 (c) Administration of trust and associated funds.--The 29 assets of the trust fund shall be preserved, invested and 30 expended solely pursuant to and for the purposes set forth in 20070H1841B2593 - 48 -
1 this chapter. 2 (d) Control and management of trust fund.-- 3 (1) The board shall have exclusive control and 4 management of the trust fund and full power to invest and 5 manage the assets of each account of the trust fund as a 6 prudent investor would, by considering the purposes, terms 7 and other circumstances of each account and by pursuing an 8 overall investment strategy reasonably suited to the trust 9 fund. 10 (2) The board may invest in every kind of property and 11 type of investment, including, but not limited to, mutual 12 funds and similar investments, consistent with this 13 subsection. 14 (3) In making investment and management decisions, the 15 board shall consider, among other things, to the extent 16 relevant to the decision or action: 17 (i) the size and nature of the account; 18 (ii) the liquidity and payment requirements of the 19 account; 20 (iii) the role that each investment or course of 21 action plays in the overall investment strategy; 22 (iv) to the extent reasonably known to the board, 23 the needs for present and future payments; and 24 (v) the reasonable diversification of assets, taking 25 into account the purposes, terms and other circumstances 26 of the trust fund and the requirements of this section. 27 (e) Custodian of trust fund.--The State Treasurer shall be 28 the custodian of the trust fund. 29 (f) Name for transacting business.--By the name of "The 30 Public School Employees' Benefit Trust Fund," all of the 20070H1841B2593 - 49 -
1 business of the trust fund shall be transacted, its fund 2 invested, all requisitions for money drawn and payments made and 3 all of its cash and securities and other property shall be held, 4 except that, any other law to the contrary notwithstanding, the 5 board may establish a nominee registration procedure for the 6 purpose of registering securities in order to facilitate the 7 purchase, sale or other disposition of securities. 8 (g) Payment from trust fund.--All payments from the trust 9 fund shall be made by the State Treasurer in accordance with 10 requisitions signed by the secretary of the board or the 11 secretary's designee. The board shall reimburse the State 12 Treasurer for the cost of making disbursements from the trust 13 fund. 14 (h) Fiduciary status of board.--Board members, employees of 15 the board and agents thereof shall stand in a fiduciary 16 relationship to the members regarding the investments and 17 disbursements of any of the moneys of the trust fund and shall 18 not profit either directly or indirectly with respect thereto. 19 (i) Transfers.--The board may transfer moneys among the 20 various accounts of the trust fund, including any reserve 21 accounts established under subsection (a)(2), as may be 22 necessary to satisfy the provisions of this chapter. Transfers 23 from funds retained in the reserve account pursuant to 24 subsection (a)(2)(i)(A) may be made only for the payment of 25 claims or expected claims as determined by the actuary retained 26 by the board. Transfers from funds retained in the reserve 27 account pursuant to subsection (a)(2)(i)(B) or (C) may be made 28 only for paying toward the cost of providing health care 29 benefits to annuitants enrolled in the program pursuant to 30 section 9333(a)(1). 20070H1841B2593 - 50 -
1 (j) Additional powers of board.--The board may: 2 (1) Adopt, from time to time, appropriate investment 3 policy guidelines and convey the same to those fiduciaries 4 who have the responsibility for the investment of funds. 5 (2) Retain such portion of the moneys of the accounts in 6 cash or cash balances as the board may deem desirable, 7 without any liability or interest thereon. 8 (3) Settle, compromise or submit to arbitration all 9 claims or damages due from or to the accounts, commence or 10 defend any legal, equitable or administrative proceedings 11 brought in connection with the program and represent the 12 trust fund in all proceedings under this paragraph. 13 (k) Additional duties of secretary.--The secretary of the 14 board shall serve as liaison to the Treasury Department, the 15 Department of the Auditor General and between the board and the 16 investment counsel and the mortgage supervisor in arranging for 17 investments to secure maximum returns to the trust fund. 18 § 9337. Misrepresentation, refusal to cooperate and fraud. 19 (a) Misrepresentation.--If the eligible individual or anyone 20 acting on behalf of an eligible individual makes a false 21 statement or withholds information on the application for 22 enrollment with intent to deceive or affect the acceptance of 23 the enrollment application or the risks assumed by the program 24 or otherwise misleads the board, the board shall be entitled to 25 recover its damages, including legal fees, from the eligible 26 individual or from any other person responsible for misleading 27 the board and from the person for whom the benefits were 28 provided. Any material misrepresentation on the part of the 29 eligible individual in making application for coverage or any 30 application for reclassification thereof or for service 20070H1841B2593 - 51 -
1 thereunder shall render the coverage under the program null and 2 void. 3 (b) Refusal to cooperate.--The board may refuse to pay 4 benefits, or cease to pay benefits, on behalf of an eligible 5 individual who fails to sign any document deemed by the board to 6 be relevant to protecting its subrogation rights or certifying 7 eligibility or who fails to provide relevant information when 8 requested. As used in this subsection, the term "information" 9 includes any documents, insurance policies, police reports or 10 any reasonable request by the claims processor to enforce the 11 board's rights. 12 (c) Penalty for fraud.--In any case in which the board finds 13 that an eligible individual is receiving benefits based on false 14 information, the additional amounts received predicated on the 15 false information, together with interest doubled and compounded 16 and legal fees, shall be due from the member. To secure payment 17 of funds, the board shall have the right to garnish or attach 18 all or a portion of any compensation payable to the party by the 19 party's employer, any annuity payable to the party by the 20 retirement system, any accumulated deductions held by the 21 retirement system in the party's account or any process 22 whatsoever. 23 § 9338. Miscellaneous provisions. 24 (a) Construction of chapter.-- 25 (1) Any termination or other modifications of the 26 program, including, but not limited to, a change in rates, 27 benefits options or structure of the provision of health care 28 benefits, shall not give rise to any contractual rights or 29 claims by any eligible individuals or any other person 30 claiming an interest, either directly or indirectly, in the 20070H1841B2593 - 52 -
1 program. No provisions of this chapter, nor any rule or 2 regulation adopted pursuant to this chapter, shall create in 3 any person a contractual right in that provision. 4 (2) The provisions of this chapter are severable and if 5 any of its provisions shall be held to be unconstitutional, 6 the decision of the court shall not affect or impair any of 7 the remaining provisions. It is hereby declared to be the 8 legislative intent that this chapter would have been adopted 9 had the unconstitutional provisions not been included. 10 (b) Hold harmless.--Neither the Commonwealth nor the board, 11 including their respective officers, directors and employees, 12 shall be liable for any claims, demands, actions or liability of 13 any nature, including, but not limited to, attorney fees and 14 court costs, based upon or arising out of the operations of the 15 program, whether incurred directly or indirectly. The eligible 16 individuals who enroll and participate in the program shall be 17 deemed to agree, on behalf of themselves and their heirs, 18 successors and assigns, to hold harmless the Commonwealth and 19 the board, including their respective officers, directors and 20 employees, from any claims, demands, actions or liability of any 21 nature, whether directly or indirectly, including attorney fees 22 and court costs, based upon or arising out of the operation of 23 the program. 24 (c) No recourse.--Under no circumstances shall the assets of 25 the Commonwealth be liable for or its assets be used to pay any 26 claims, demands, actions or liability of any nature, whether 27 directly or indirectly, including, but not limited to, attorney 28 fees and court costs, based upon or arising out of the operation 29 of the program. 30 (d) Reservation of immunities.--Nothing contained in this 20070H1841B2593 - 53 -
1 chapter shall be construed as a waiver of the Commonwealth's or 2 board's immunities, defenses, rights or actions arising out of 3 their sovereign status or from the 11th amendment to the 4 Constitution of the United States. 5 (e) Collective bargaining, mediation and binding 6 arbitration.--Nothing in this chapter or in any other law shall 7 be construed to permit, authorize or require collective 8 bargaining, mediation or binding arbitration to create, alter or 9 modify health benefits set forth in this chapter or administered 10 by the board for school employees and their health care 11 dependents. Further, nothing in this chapter or in any other law 12 shall be construed to permit, authorize or require a public 13 school entity, through collective bargaining, mediation or 14 binding arbitration, or otherwise, to establish, create, alter 15 or modify a health benefits plan or pay health benefits set 16 forth in this chapter or administered by the board that modify 17 or supplement in any way the health benefits set forth in this 18 chapter for school employees and their health care dependents. 19 Notwithstanding the provisions of this subsection, the parties 20 may: 21 (1) Continue to engage in collective bargaining with 22 regard to health benefits until such time as the board- 23 sponsored program, pursuant to this subchapter, is released 24 and the standard benefit package is made available to 25 employees of a public school entity. However, any health 26 benefits provided under a collective bargaining agreement 27 entered into on or after the effective date of this chapter 28 shall contain a provision that school employees covered by 29 the agreement must join the board-sponsored program as 30 required by section 9332 (relating to mandatory participation 20070H1841B2593 - 54 -
1 and optional membership) as a condition of continuing to 2 receive health benefits. The board shall determine the 3 appropriate timing and phase-in of the program in any public 4 school entity taking into consideration the need for the 5 public school entity to properly terminate any existing 6 health benefits arrangements. 7 (2) Negotiate or otherwise agree to provide benefits 8 that have not been included as part of the standard benefit 9 package so long as they do not increase or diminish the level 10 of any benefit provided as part of the standard benefit 11 package or any alternate health care plan or any optional 12 benefit packages. Nothing contained in this section shall 13 restrict a public school entity from negotiating or otherwise 14 agreeing to make payment for postretirement health benefits 15 for members or as may be provided for in Subchapter F 16 (relating to retirement health savings plan). 17 SUBCHAPTER E 18 ALTERNATIVE MEASURES FOR COST REDUCTION 19 Sec. 20 9351. Alternative measures program. 21 § 9351. Alternative measures program. 22 (a) Creation.--Upon completing the study required under 23 section 9321 (relating to school employee health benefits study 24 and evaluation) with either a negative recommendation to proceed 25 with implementation of a Statewide health care program or if the 26 board fails to achieve agreement and approve a plan for 27 implementing a Statewide health benefits program by a qualified 28 majority vote, the board shall proceed to initiate and sponsor 29 an alternative measures program to reduce the costs for public 30 school entities in providing health care coverage to employees 20070H1841B2593 - 55 -
1 and other eligible individuals. 2 (b) Program design.--In designing an alternative measures 3 program, the board may consider all of the following: 4 (1) Establishment of pools for selected areas of 5 coverage, such as pharmacy services, transplants, stop-loss 6 insurance, health care management or other possible areas 7 that in the board's judgment can be offered Statewide or 8 regionally on a more stable and cost-effective basis. 9 (2) Assistance in the formation of consortia to serve 10 public school entities that do not have the option of joining 11 an existing consortium. 12 (3) Development of best practice standards and 13 benchmarks for public school entities and consortia- 14 sponsoring health care plans for school employees. 15 (4) Requirements that public school entities and 16 consortia aggregate into larger regional pools, with opt-out 17 provisions for public school entities or consortia that meet 18 best practice standards and benchmarks. 19 (5) Requirements for public disclosure by public school 20 entities and consortia comparing their health benefits 21 purchasing to established best practice standards in their 22 region. 23 (c) Implementation.--The board shall have full authority to 24 select and contract with insurance carriers, health maintenance 25 organizations, pharmacy benefit managers, third-party 26 administrators, reinsurers and any other entities necessary to 27 provide the selected areas of coverage. The board shall have 28 full authority to determine the nature, amount and duration and 29 discontinuation of coverage to be provided. 30 (d) Mandatory and optional participation.--The board shall 20070H1841B2593 - 56 -
1 have the authority to require public school entities and 2 consortia to participate in the alternative measures program. 3 (e) Transition plan.--If the board determines that a public 4 school entity or consortium shall be required to participate in 5 the alternative measures program, the public school entity or 6 consortium shall, within a reasonable period of time as 7 determined by the board, present to the board a transition plan 8 with a schedule for the public school entity or consortium to 9 join the alternative measures program. The board shall review 10 the transition plan with the public school entity or consortium 11 and make any necessary modifications before granting approval of 12 the plan. A public school entity or consortium shall be subject 13 to adherence to the transition plan approved by the board. 14 (f) Extensions of time.--The board shall give due 15 consideration to a transition plan submitted pursuant to 16 subsection (e) that includes a request for an extension of time. 17 Consideration shall be given to a public school entity or 18 consortium which will incur a significant financial cost or 19 penalty. 20 (g) Prohibited membership.--A public school entity that 21 participates in the Pennsylvania Employees' Benefit Trust Fund 22 shall be prohibited from participating in the alternative 23 measures program. 24 (h) Transition of employees.--A public school entity that 25 provides some or all of its employees with health benefits 26 through another health care plan by virtue of one or more 27 collective bargaining agreements entered into prior to the 28 effective date of this chapter shall not be required to join the 29 alternative measures program until expiration of the collective 30 bargaining agreements. The public school entity and some or all 20070H1841B2593 - 57 -
1 of its employees, or bargaining representatives of its 2 employees, may, by mutual agreement and approval of the board, 3 join the program at an earlier date. Renewal or extension of a 4 collective bargaining agreement shall constitute its expiration 5 for the purposes of this subsection. 6 (i) Optional membership.--No school district of the first 7 class, as classified pursuant to section 202 of the Public 8 School Code, shall be required to participate in the alternative 9 measures program, except as may be agreed upon under the terms 10 of a collective bargaining agreement covering a majority of 11 employees of the school district. Upon a school district of the 12 first class entering participation in the alternative measures 13 program pursuant to a collective bargaining agreement, continued 14 participation in the alternative measures program shall become 15 mandatory. 16 SUBCHAPTER F 17 RETIREMENT HEALTH SAVINGS PLAN 18 Sec. 19 9361. Retirement health savings plan. 20 § 9361. Retirement health savings plan. 21 (a) Plan created.--The board shall establish a retirement 22 health savings plan through which school employees can save to 23 cover health-related expenses following retirement. For this 24 purpose the board shall make available one or more trusts 25 including a governmental trust or governmental trusts authorized 26 under the IRC as eligible for tax-preferred or tax-free 27 treatment. The board may promulgate regulations regarding the 28 prudent and efficient operation of the retirement health savings 29 plan, including, but not limited to: 30 (1) Establishment of an annual administrative budget and 20070H1841B2593 - 58 -
1 disbursements in accordance with the budget. 2 (2) Determination of the structure of the retirement 3 health savings accounts available to eligible school 4 employees. 5 (3) Determination of enrollment procedures. 6 (b) Contracting authorized.--The board is authorized to 7 administer the retirement health savings plan and to contract 8 with any lawfully authorized entities to provide investment 9 services, recordkeeping, benefit payments and other functions 10 necessary for the administration of the retirement health 11 savings plan. The board may contract with the retirement system 12 to invest funds in an account that shall be maintained and 13 accounted for separately from the funds of the retirement system 14 and invested in a prudent manner intended to maximize the safety 15 of the capital, with all earnings derived from investment of the 16 assets to be credited to the retirement health savings plan. 17 Costs and expenses incurred by the retirement system in 18 administering the investment option shall be paid by the 19 retirement health savings plan. 20 (c) Separate account.--All funds related to the retirement 21 health savings plan shall be maintained and accounted for 22 separately from the health benefits program sponsored by the 23 board. The assets of the retirement health savings plan shall 24 not be liable or utilized for payment of any expenses or claims 25 incurred by the health benefits program other than as may be 26 directed by the participant account holder for reimbursement of 27 an IRC-qualifying health-related expense. 28 (d) Enrollment.--The board shall establish eligibility 29 guidelines consistent with the IRC for school employees to 30 participate in the retirement health savings plan. 20070H1841B2593 - 59 -
1 (e) Contributions.-- 2 (1) The board shall determine what contributions are 3 eligible under the IRC for tax-preferred or tax-free 4 treatment and may be made into a retirement health savings 5 plan by a school employee. The board shall authorize and 6 allow contributions, subject to appropriate limits as may be 7 established by the board, to be paid by a school employee 8 electing participation in the retirement health savings plan 9 subject to the following conditions: 10 (i) A mandatory school employee contribution 11 established as a fixed percentage of compensation may be 12 established through a collective bargaining agreement 13 between a public school entity and a bargaining group 14 representing school employees. The retirement health 15 savings plan contribution rate does not have to be 16 uniform for all groups of school employees. 17 (ii) An optional employee contribution at a fixed 18 percentage of compensation may be elected by a school 19 employee during an annual election window that, once 20 elected, shall continue in effect, except to the extent 21 it may be changed or discontinued at a subsequent annual 22 election window as provided for by the board or 23 supplanted by a mandatory contribution. 24 (iii) An optional school employee contribution of 25 all or any portion of annual leave, vacation pay, 26 personal days or sick leave may be elected by a school 27 employee as so designated by the employee and agreed to 28 by the employee's employer. The board may provide that 29 the election shall be made during an annual election 30 window of no greater than 90 days as determined by the 20070H1841B2593 - 60 -
1 board. Once the election has been made, an employee shall 2 not be allowed to change the amount or discontinue the 3 contributions until the next annual election window. 4 (2) The following contributions shall be made into a 5 retirement health savings plan on behalf of a school 6 employee: 7 (i) For an employee who elects participation in the 8 retirement health savings plan, the employee's employer 9 shall make a contribution to the employee's account equal 10 to the public school entity's savings in Social Security 11 and Medicare taxes resulting from the tax-preferred or 12 tax-free treatment of contributions made by the school 13 employee under this subsection. Additional contributions 14 by a public school entity may be established through a 15 collective bargaining agreement between a public school 16 entity and a bargaining group representing school 17 employees. 18 (ii) Any other payments by the Commonwealth or 19 public school entity, including any set-aside payments to 20 be made to school employee accounts under section 9334 21 (relating to partnership for stable benefits funding) as 22 determined by the board. 23 (3) Contributions to the plan by a school employee or by 24 the Commonwealth or a public school entity on behalf of an 25 employee must be held in trust for reimbursement of employee 26 health-related expenses and the health-related expenses of 27 any health care dependents following retirement of the 28 employee or when otherwise determined to be benefit eligible. 29 The board shall maintain a separate account of the 30 contributions made by or on behalf of each participant and 20070H1841B2593 - 61 -
1 the earnings thereon. The board shall make available a 2 selection of investment options for participants who wish to 3 direct the investment of the accumulations in the 4 participant's account, in addition to a default option for 5 participants to be invested in a prudent manner as determined 6 by the board. 7 (f) Reimbursement for health-related expenses.-- 8 (1) Upon retirement or separation from employment with a 9 public school entity, a participant becomes eligible to seek 10 reimbursements for IRC-qualifying health-related expenses 11 from the participant's retirement health savings plan 12 account, including reimbursements for the health-related 13 expenses of the participant's eligible health care 14 dependents. 15 (2) If a school employee dies prior to exhausting the 16 balance in the employee's retirement health savings plan 17 account, the employee's health care dependents are eligible 18 to seek reimbursement for IRC-qualifying health-related 19 expenses from the account. 20 (3) The board shall pay reimbursements from a retirement 21 health savings plan account until the accumulation in the 22 account has been exhausted. If an account balance remains 23 after the death of all participant account holders, the 24 remainder of the account must be paid to the school 25 employee's beneficiaries or, if none, to the employee's 26 estate. 27 (g) Annual financial statement.--Quarterly and annually the 28 board shall prepare summary retirement health savings plan 29 statements for individual participant account holders listing 30 information on contributions, investment earnings and 20070H1841B2593 - 62 -
1 distributions for the account holders' accounts. 2 (h) Fees.--The board is authorized to charge uniform fees to 3 participants to cover the ongoing costs of operating the plan. 4 Any fees not needed must revert to participant accounts or be 5 used to reduce plan fees the following year. 6 (i) Advisory committee.-- 7 (1) The board shall establish a participant advisory 8 committee for the retirement health savings plan composed of: 9 (i) One representative appointed by each Statewide 10 union that represents bargaining groups of school 11 employees participating in the plan. 12 (ii) One representative of each Statewide 13 organization representing at least 10% of annuitants. 14 (iii) One representative of the Pennsylvania 15 Association of School Business Officials. 16 (iv) One representative of the Pennsylvania School 17 Boards Association. 18 (2) Each participant group shall be responsible for the 19 expenses of its own representative. 20 (3) The advisory committee shall meet at least two times 21 per year and shall be consulted on plan offerings. By October 22 1 of each year, the board shall give the advisory committee a 23 statement of fees collected and the use of the fees. 24 Section 3. Within 18 months after the Statewide health 25 benefits program or the alternative measures program is fully 26 implemented, the Secretary of Administration shall report to the 27 Governor, the President pro tempore of the Senate and the 28 Speaker of the House of Representatives the feasibility of 29 including community college employees in the program. 30 Section 4. This act shall take effect immediately. J2L24BIL/20070H1841B2593 - 63 -