Colorado § 24-51-1202 - Health care program - design.

§ 24-51-1202. Health care program - design.

(1) (a) The board shall design a group health care program for retirees, members, DPS members, DPS retirees, and their dependents, with or without full medicare coverage provided by the federal "Health Insurance for the Aged Act", 42 U.S.C. sec. 1395, as amended. This program shall provide health-care benefits and a level of reimbursement for health-care expenses which are consistent with prevailing community practices and other governmental health-care systems, protection from catastrophic financial loss, and current and long-term fiscal soundness of the trust fund as determined by the board.

(b) Any group health-care plan offered by the board that provides pharmacy benefits through the services of a pharmacy benefits manager shall require such manager to allow participation by any nonmail order retail pharmacy provider licensed in the state of Colorado if such pharmacy provider agrees to accept the fee schedule, terms, and conditions of participation established by the plan's pharmacy benefits manager.

(1.5) Any employer, as defined by section 24-51-101 (20), may elect to provide health-care coverage through the health care program for its employees who are members. Participation in the health care program by an employer shall be voluntary and in the employer's sole discretion and shall not be mandatory for the employer.

(2) The board shall establish procedures for enrollment and determine the methods of claims administration for the health care program.

(3) (a) The board shall ensure that the premium amount for the health care program is paid by those individuals enrolled in said program.

(b) The premium amount for a benefit recipient shall be deducted from monthly benefits. If the premium amount exceeds the monthly benefits, the excess amount shall be collected from the benefit recipient directly. The premium amount for a member shall be collected directly from the member's employer.

(c) Surviving spouses and divorced spouses enrolled in the health care program pursuant to the provisions of section 24-51-1204 (1)(b) and (1)(c) shall directly pay the premium amount.

(d) If an individual who is directly paying for enrollment in the health care program fails to pay the premium amount within a reasonable period of time, as determined by the board, the association shall notify the individual that enrollment may be canceled within thirty days if payment is not received.

(4) The board may change the design and costs of the health care program at any time. Individuals enrolled in the health care program shall be notified thirty days prior to any change.

(5) DPS retirees may enroll in the association's health care program subject to the provisions of this part 12.

Source: L. 87: Entire article, R&RE, p. 1075, § 1, effective July 1. L. 99: (1) and (3)(b) amended and (1.5) added, p. 342, § 7, effective January 1, 2001. L. 2009: (1)(a) amended and (5) added, (SB 09-282), ch. 288, p. 1348, § 46, effective January 1, 2010.

Editor's note: This section is similar to former §§ 24-51-1403, 24-51-1404, and 24-51-1408 as they existed prior to 1987. For a detailed comparison, see the comparative tables located in the back of the index.

ANNOTATION

Neither the state board of agriculture nor PERA was a self-insurer for the purposes of this section and, accordingly, neither was required to provide notice pursuant to the requirements of this section. Berg v. State Bd. of Agric., 919 P.2d 254 (Colo. 1996).