Guam § 4301 - Group Insurance.

§ 4301. Group Insurance.

(a) I Maga’håga/Maga’låhi is authorized to enter contracts and reject proposals, with the written

concurrence of the Speaker of I Liheslaturan Guåhan or the Chief Justice of the Supreme Court of Guam

whose consents may be withheld in their sole discretion, with insurance companies, authorized to do

business in Guam, for group insurance, including, but not limited to, hospitalization, medical care, life, and

accident, for all employees or separate groups of employees, and foster children, of the government of

Guam. If the Legislative or Judicial Branches of government elect to enter into separate contracts for their

employees as authorized in § 4301(c), I Maga’håga/Maga’låhi shall obtain the written concurrence of the

Branch electing to remain with the Executive Branch on or before March 1 of each year. Notwithstanding

any authority granted in each entity’s enabling legislation to procure separate health insurance coverage,

all entities in the Executive Branch, including autonomous and semi-autonomous agencies, public

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corporations and authorities, shall participate in the Government of Guam Group Health Insurance Program.

The government shall not be construed as an agent of any insurance company in negotiating or

administering this group insurance program. Health benefits provided under this authority may be self-

funded and administered by a third party if it is determined to be cost-effective. DOA shall hire an

independent auditing firm to verify the participating contract refunds/no refunds reported by the carriers.

Such verification shall include validating claims reported by insurance carriers.

(b) All participation by employees in such contracts of insurance shall be on a voluntary basis. All

retired employees and survivors of a retired employee who are enrolled in Medicare (Parts A and B), and

who participate by electing either Class I or Class II coverage, shall enroll in the Retiree Supplemental Plan.

Effective in the next contract following the enactment of this subparagraph, the government’s contribution

for health and dental insurance shall be uniform within each class (including separate classes and rates for

retired employees and their survivors) for all competing plans, and shall not be less than fifty percent (50%)

of the lowest premium for a single employee, except that the government shall increase the contributions it

makes on behalf of a retired employee or survivor of a retired employee so that the retired employee or the

survivor of a retired employee contributes no more than an active employee who is otherwise in the same

class. Notwithstanding any other provision of this Section to the contrary, the government of Guam shall

cover the full cost of insurance coverage for foster children, and such coverage shall require no co-payments

nor deductibles for the foster children insured pursuant to this Section.

(c) Contracts of insurance procured under the foregoing may provide for participation by employees

of the Legislative Branch, and the Judicial Branch through the Chief Justice of the Supreme Court of Guam,

at the sole election and discretion of those respective Branches, or such Branches may enter separate

contracts for their employees, subject to the limitations set forth in this Section. The Legislative Branch,

and the Judicial Branch through the Chief Justice of the Supreme Court of Guam, shall have the right to

bring suit in the Superior Court of Guam in order to protect its and its employees’ interests as provided

under this Article for both equitable and legal relief. The government Claims Act shall not apply to such

suits. The right to bring suit shall be retroactively effective for actions arising from Fiscal Year 1997

forward. The government shall not prohibit the sale of insurance products on its premises during working

hours, including during the Open Enrollment periods.

(d) As used in this Section, employees includes officers and retired employees and survivors of retired

employees who are receiving annuity benefits.

(e) [Repealed.]

(f) Any insurance company or health maintenance organization offering group health coverage under

this Section may at its sole option, offer two (2) plans with different premiums and/or benefits, only one of

which plans may offer a rebate, with all members of both plans being in the same risk pool. The plan

offering the rebate or refund shall base the same on the claims made by the plan members under the plan.

(g) [No text]

(1) The negotiating team, as defined in § 4302(c), shall develop an incentive program for all

subscribers and dependents of the government of Guam Group Health Plan that:

(A) promotes wellness;

(B) promotes primary care and preventive care; and

(C) manages and coordinates care for persons with chronic health conditions or acute illness.

(2) The incentive program shall:

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(A) meet the requirements set forth in the federal Health Insurance Portability and

Accountability Act of 1996 (HIPAA) for bona fide wellness programs;

(B) provide financial incentives to covered employees or individuals for participating in the

program; and

(C) provide to covered employees or individuals for whom it is unreasonably difficult to

satisfy the program’s applicable standards reasonable alternative methods for achieving program

participation.

(3) Carriers that propose to charge additional premiums for the Preventive Healthcare, Wellness

and Fitness programs shall specify how the premium charged to the government of Guam will vary

based on the anticipated efficacy of the program in reducing expected utilization or medical claim

costs. The methodology must take into consideration:

(A) the anticipated average percentage of employees or individuals eligible to participate in

the program;

(B) the anticipated efficacy of the financial incentives in producing high levels of program

participation;

(C) the expected success rate for program participants;

(D) the level of program participation achieved in prior coverage periods; and

(E) the realized savings achieved in prior coverage periods.