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H.B. 250 Enrolled






Chief Sponsor: John Dougall

Senate Sponsor: Curtis S. Bramble

             8      LONG TITLE
             9      General Description:
             10          This bill modifies the Public Employees' Benefit and Insurance Program Act by
             11      amending provisions related to the determination of state employee insurance benefits.
             12      Highlighted Provisions:
             13          This bill:
             14          .    requires the Public Employees' Benefit and Insurance Program (PEHP) to provide
             15      the Legislature with its recommended benefit adjustments for state employees; and
             16          .    requires that PEHP determine benefits and rates based on the total estimated costs
             17      and the employee premium shares established by the Legislature.
             18      Monies Appropriated in this Bill:
             19          None
             20      Other Special Clauses:
             21          None
             22      Utah Code Sections Affected:
             23      AMENDS:
             24          49-20-401, as last amended by Laws of Utah 2006, Chapter 139
             26      Be it enacted by the Legislature of the state of Utah:
             27          Section 1. Section 49-20-401 is amended to read:
             28           49-20-401. Program -- Powers and duties.
             29          (1) The program shall:

             30          (a) act as a self-insurer of employee benefit plans and administer those plans;
             31          (b) enter into contracts with private insurers or carriers to underwrite employee benefit
             32      plans as considered appropriate by the program;
             33          (c) indemnify employee benefit plans or purchase commercial reinsurance as considered
             34      appropriate by the program;
             35          (d) provide descriptions of all employee benefit plans under this chapter in cooperation
             36      with covered employers;
             37          (e) process claims for all employee benefit plans under this chapter or enter into
             38      contracts, after competitive bids are taken, with other benefit administrators to provide for the
             39      administration of the claims process;
             40          (f) obtain an annual actuarial review of all health and dental benefit plans and a periodic
             41      review of all other employee benefit plans;
             42          (g) consult with the covered employers to evaluate employee benefit plans and develop
             43      recommendations for benefit changes;
             44          (h) annually submit a budget and audited financial statements to the governor and
             45      Legislature which includes total projected benefit costs and administrative costs;
             46          (i) maintain reserves sufficient to liquidate the unrevealed claims liability and other
             47      liabilities of the employee benefit plans as certified by the program's consulting actuary;
             48          (j) submit, in advance, its recommended benefit adjustments for state employees to:
             49          (i) the Legislature; and
             50          (ii) the executive director of the state Department of Human Resource Management;
             51          (k) determine benefits and rates, upon approval of the board, for multiemployer risk
             52      pools, retiree coverage, and conversion coverage;
             53          (l) determine benefits and rates based on the total estimated costs and the employee
             54      premium share established by the Legislature, upon approval of the board [and the Legislature],
             55      for state employees;
             56          (m) administer benefits and rates, upon ratification of the board, for single employer
             57      risk pools;

             58          (n) request proposals for provider networks or health and dental benefit plans
             59      administered by third party carriers at least once every three years for the purposes of:
             60          (i) stimulating competition for the benefit of covered individuals;
             61          (ii) establishing better geographical distribution of medical care services; and
             62          (iii) providing coverage for both active and retired covered individuals;
             63          (o) offer proposals which meet the criteria specified in a request for proposals and
             64      accepted by the program to active and retired state covered individuals and which may be
             65      offered to active and retired covered individuals of other covered employers at the option of the
             66      covered employer;
             67          (p) perform the same functions established in Subsections (1)(a), (b), (e), and (h) for the
             68      Department of Health if the program provides program benefits to children enrolled in the Utah
             69      Children's Health Insurance Program created in Title 26, Chapter 40, Utah Children's Health
             70      Insurance Act;
             71          (q) establish rules and procedures governing the admission of political subdivisions or
             72      educational institutions and their employees to the program;
             73          (r) contract directly with medical providers to provide services for covered individuals;
             74      and
             75          (s) take additional actions necessary or appropriate to carry out the purposes of this
             76      chapter.
             77          (2) (a) Funds budgeted and expended shall accrue from rates paid by the covered
             78      employers and covered individuals.
             79          (b) Administrative costs shall be approved by the board and reported to the governor
             80      and the Legislature.
             81          (3) The Department of Human Resource Management shall include the benefit
             82      adjustments described in Subsection (1)(j) in the total compensation plan recommended to the
             83      governor required under Subsection 67-19-12 (6)(a).

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