FILE: EGAC
HEALTH AND GROUP HOSPITALIZATION INSURANCE
The Superintendent shall be authorized and directed to execute contracts with insurance companies for group insurance covering the lives of its full-time employees (those who work 30 or more hours per week unless the work is such that less than 30 hours per week is required for the full-time position), and for group medical, surgical, and hospital benefits for its full-time employees and qualified retired employees. The Lafourche Parish School Board shall pay all or a portion of the necessary premiums.
The Board shall fund a proportionate share of the premium for coverage (under a separate policy) for part-time employees employed prior to the 1983-84 school session and who are still employed as part-time employees by the Board. After this date, no new part-time employees shall be included in the group hospitalization plan.
INSURANCE CONTRACT
The contract shall include provisions for the following:
1. Coverage for Active Employees, Superintendent, and Board Members (Category A). The Board shall pay a portion of the premiums (excluding optional supplemental life premiums) for all active employees, Superintendent and Board Members, which shall include coverage for life, accidental death, and dismemberment insurance, as well as medical, surgical, hospital, and major medical benefits. The portion of the premiums paid shall be determined by a recommendation of the Insurance Committee with the approval of the Board.
New employees electing to participate in the board’s group health insurance program must enroll within thirty days of the initial date of employment. If a new employee does not enroll during the initial thirty-day period, then he/she cannot enroll until an open enrollment period or a qualifying event*.
*Qualifying events include:
a. Change in family status (marriage, divorce, birth, legal separation,
adoption, death)
b. Termination of or eligibility for other health insurance coverage due to a
change in job status of employee or dependent
c. An involuntary loss of other health insurance coverage
d. Substantial change in benefits or premium of employer’s health insurance
plan or spouse/dependent’s health insurance plan.
2. Dependent Coverage. Dependent life and hospitalization premiums, if desired, shall be paid by the employee.
3. Retired Personnel (Category B) - Eligibility. The Board will follow the Office of Group Benefit eligibility requirements. A Retiree is an Employee immediately prior to the date of retirement and who, upon retirement, satisfied one of the following categories:
a. Immediately received retirement benefits from an approved state or
governmental agency defined benefit plan;
b. Was not eligible for participation in such plan or legally opted not to
participate in such plan; and either:
i. Began employment prior to September 15, 1979, has 10 years of
continuous state service, and has reached the age of 65; or
ii. Began employment after September 16, 1979, has 10 years of continuous
state service, and has reached the age of 70; or
iii. Was employed after July 8, 1992, has 10 years of continuous state service,
has a credit for a minimum of 40 quarters in the Social Security system at
the time of employment, and has reached the age of 65; or
iv. Maintained continuous coverage with the Program as an eligible
Dependent until he/she became eligible as a former state employee to
receive a retirement benefit from an approved state governmental
agency defined benefit plan.
c. Immediately received retirement benefits from a state-approved or state governmental agency-approved defined contribution plan and has accumulated the total number of years of creditable service which would have entitled him/her to receive a retirement allowance from the defined benefit plan of the retirement system for which the employee would have otherwise been eligible. The appropriate state governmental agency or retirement system responsible for administration of the defined contribution plan is responsible for certification of eligibility to the Office of Group Benefits.
d. Retiree also means an individual who was a covered Employee and
continued the coverage through the provisions of COBRA immediately prior
to the date of retirement and who, upon retirement, qualified for any of
items 1, 2, or 3 above.
4. Rates and Employer/Employee Contributions. Rates and Employer/Employee contributions shall be established by the recommendation of the Insurance Committee subject to final approval of the Board. The Board shall consider years of service in the Parish and continuous years of participation in the Board’s health insurance plan in determining and setting Employer/Employee contributions. Said rates shall be determined annually.
Retirees who have retired prior to December 7, 2011, shall remain in their respective TIER category below, and this policy is not intended to move or reassign pre-December 7, 2011 retirees, or their dependents, participating in the Plan. The following tiers shall be used by the Board to determine the Employer/Employee contributions for employees retiring after December 7, 2011:
a. TIER 1. Thirty Years of Service and participating in the Board’s Self Funded
Plan for at least 10 Years immediately prior to retirement. The Board shall
pay a portion of the premiums (excluding optional supplemental life
premiums) for those employees who shall have completed thirty (30) or
more years of service within the parish from the initial date of employment
and who have participated in the Board’s Self Funded Plan for at least ten
(10) years immediately prior to retirement. The portion of the premiums paid
shall be determined by a recommendation of the Insurance Committee
with the approval of the Board.
Years of service for such purpose is defined as years credited with the state
retirement system for which an employee receives pay from the said
retirement system. Service within the parish is defined as years of service
while assigned to the parish, as well as any military service purchased and
recognized by the retirement system. Leaves of absence while in service in
the parish and purchased with the appropriate retirement system shall also
be recognized as service within the parish, in addition to any accumulated
days of sick leave credited by the appropriate retirement system.
Notwithstanding, Employees hired prior to July 1, 2009, with 30 years of
service, must be employed with LPSB for at least the last ten (10)
consecutive years prior to retirement, and be enrolled in the group health
plan for at least the last five (5) consecutive years at the time of retirement
to be eligible for this premium tier.
b. TIER 2. Less than Thirty Years of Service but participated in the Board’s Self
Funded Plan for the more than Ten Year immediately prior to retirement.
Those employees who retired with less than thirty (30) years of service within
the parish, but with at least ten (10) consecutive years of service within the
parish immediately preceding retirement and having participated in the
Board’s Self Funded Plan for at least ten (10) consecutive years immediately
prior to retirement, may continue the life and hospitalization benefits.
Notwithstanding, Employees hired prior to July 1, 2009, with less than 30 years of service, must be employed with LPSB for at least the last ten (10) consecutive years prior to retirement, and be enrolled in the group health plan for at least the last five (5) consecutive years at the time of retirement to be eligible for this premium tier.
c. TIER 3. Less than Ten Year of Participation in the Board’s Self Funded Plan
immediately prior to retirement. Employees who upon retiring not eligible to
participate in TIER 1 or TIER 2 immediately preceding retirement, may continue the
life and hospital benefits under this TIER.
d. ADDITIONAL DEPENDENT COVERAGE. Employer/Employee contribution,
and TIER eligibility for both the employee/retiree and any additional
dependent coverage, e.g., spouses, eligible family members, etc., shall be
based upon the spouse and/or eligible family member’s years of
participation in the Board’s Self Funded Plan, who was added last. (For
example, if the last added dependent coverage is added after July 1, 2009,
but the last added dependent’s participation in the Plan is less than 10
consecutive years prior to the date of the employee’s retirement, then the
TIER level for the retiree and all dependents shall be TIER 3. If the last added
dependent coverage is added before July 1, 2009 but the last added
dependent’s participation in the Plan is less than 5 years, then the TIER level
for the retiree and all dependents shall be TIER 3.)
5. Board Members.
Members of the Lafourche Parish School Board (“Board Members”) and their dependents shall be eligible to participate in the District’s group insurance coverages for life accidental death, and dismemberment insurance, as well as medical, surgical, hospital, and major medical benefits. The District shall pay a portion of the premiums (excluding optional supplemental life premiums) for all active Board Members electing to participate.
Any Board Member who has served in such capacity for at least ten (10) consecutive years and has participated in the group health insurance plan for at least five (5) consecutive years immediately prior to the completion of the Board Member’s last term of office shall be eligible to continue participation in the group health insurance program (hereinafter “eligible former Board Member”). Likewise, spouses of an eligible former Board Member must be participating in the District’s group health insurance program a minimum of five consecutive years immediately prior to completion of the Board Member’s last term of office to be eligible to continue participation in the group health insurance program. The District shall pay a portion of the premiums for an eligible former Board Member whose term began prior to December 31, 2006, but in no event shall be greater than the contribution paid on behalf of retirees with similar years of service in the District. Thereafter, Board Members whose term begins January 1, 2007, and who become eligible under this paragraph shall pay one hundred percent (100%) of their premium to continue membership in the plan. Dependent children who meet the eligibility requirements of the Health plan document can also continue coverage.
6. Surviving Dependents/Spouse Coverage.
a. Benefits under the Plan for covered Dependents of a deceased covered
Employee or Retiree will terminate on the last day of the month in which the
Employee’s or Retiree’s death occurred unless the surviving covered
Dependents elect to continue coverage.
i. The surviving legal Spouse of an Employee or Retiree may continue
coverage unless or until the surviving Spouse is or becomes eligible for
coverage in a Group Health Plan other than Medicare;
ii. The surviving, never-married Dependent Child of an Employee or retiree
may continue coverage unless or until such Dependent Child is or
becomes eligible for coverage under a Group Health Plan other than
Medicare or until attainment of the termination age for Children,
whichever occurs first;
b. A surviving Spouse or Dependent cannot add new Dependents to
continued coverage other than a child of the deceased Employee born
after the Employee’s death.
7. Notification Requirements for Participation of Retirees and Eligible Board Members; Exclusions. Retired persons and eligible Board Members who are required to pay all or a portion of the premium and who elect to continue participation in the life and hospitalization plan shall be required to initiate contact with the Board within a time prescribed by the Board. Retirees and eligible former Board Members and their dependents shall not be eligible for coverage if application is made after said time period fixed by the Board. The Board shall accept no responsibility for identifying and contacting retired persons or eligible former Board Members.
The rules governing open enrollment and qualifying event eligibility (as stated on Page 1, under Insurance Contract, No. 1, Coverage for Active Employees) do not apply to retirees or eligible former Board Members.
8. Prohibition from Adding Dependents of Retirees and Eligible Former Board Members. A retiree or eligible former Board Member cannot add spouses to coverage after retirement or after the eligible former Board Member leaves the service of the Board.
9. Prohibition from Reinstatement of Retirees, Board Members and their Dependents. A retiree or eligible former Board Member or the spouse of a retiree or eligible former Board Member cannot be reinstated in medical insurance benefits after the retiree or Board Member cancels his/her or a dependent’s medical benefits or after a cancellation for non-payment of the premiums.
10. Return to Active Status. A retiree that returns to full time employment is considered to have resumed active status and will be subject to active employee premiums.
11. Coordination of Benefits. The contract of insurance shall include a provision for the coordination of benefits for active employees, retired employees, eligible former Board Members, and surviving spouses.
12. Medicare Recipients. Those retirees and/or retired School Board Members sixty-five (65) years of age or older eligible for Medicare Part A (at no cost) must enroll in Medicare Part A and Part B to continue in the Lafourche Parish School Board Retiree medical plan. The premium shall be reduced because of Medicare. A copy of the Medicare Card must be provided to the Insurance Department when a retiree, Board Member, or dependent becomes 65 or eligible for Medicare coverage.
If retirees, dependents, or board members are not eligible, or do not qualify for Medicare Part A (at no cost), the Lafourche Parish School Board Medical Plan will be considered primary. For retirees, dependents, and board members who purchase Medicare Part B, Medicare will be primary for Part B and the Lafourche Parish School Board plan will be secondary.
13. COBRA Coverage. Nothing contained hereinabove shall bar or prohibit a group health participant from exercising extended coverage rights pursuant to the Consolidated Omnibus Budget Reconciliation Act (COBRA).
Generally, events that would qualify employees for COBRA coverage are:
a. Voluntary or involuntary termination of employment for reasons other than “gross misconduct”
b. Reduction in the number of hours of employment
Generally, events that would qualify an employee’s spouse for COBRA coverage are:
a. Voluntary or involuntary termination of the covered employee for reasons other than “gross misconduct”
b. Reduction in the number of hours worked by the covered employee
c. Covered employees becoming entitled to Medicare