HOUSE BILL 540
50th legislature - STATE OF NEW MEXICO - first session, 2011
INTRODUCED BY
Danice Picraux
AN ACT
RELATING TO PUBLIC EMPLOYEES; REQUIRING THE RISK MANAGEMENT DIVISION OF THE GENERAL SERVICES DEPARTMENT TO ESTABLISH A PROGRAM THAT PROVIDES RESULTS-BASED WELLNESS INCENTIVES TIED TO EMPLOYEE HEALTH INSURANCE PREMIUMS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. A new section of the Group Benefits Act is enacted to read:
"[NEW MATERIAL] RESULTS-BASED WELLNESS INCENTIVE PROGRAM.--
A. The risk management division of the general services department shall establish a results-based "wellness incentive program" that ties the cost of a public employee's premium for the group benefits self-insurance plan health care coverage pursuant to Section 10-7B-6 NMSA 1978 to the health status of the public employee and the public employee's covered dependents, if applicable, based on health risk evaluations. The program shall be designed to provide monetary incentives in the form of increases or decreases in premium costs for participating in the program and for improving one's health status. The goal of the program is to promote the health and wellness of participants and lower health care expenses subsidized by taxpayers.
B. Health risk evaluations shall include:
(1) body mass index;
(2) tobacco use;
(3) blood pressure;
(4) blood cholesterol; and
(5) blood glucose.
C. The committee shall advise the risk management division on the requirements of the program, including:
(1) adopted health status goals;
(2) cost to the employee for not participating in the program;
(3) incentives, in the form of decreases or increases in employee contributions relative to the employee's and the employee's covered dependents' health status;
(4) limitations on incentives;
(5) how often health status reassessments will occur, which must be at least once a year;
(6) reasonable alternatives for persons with medical issues that make a typical healthy lifestyle goal unreasonable; and
(7) an appeal process.
D. The program shall be operational by July 1, 2012."
SECTION 2. Section 10-7-4 NMSA 1978 (being Laws 1941, Chapter 188, Section 1, as amended) is amended to read:
"10-7-4. GROUP INSURANCE--CAFETERIA PLAN--CONTRIBUTIONS FROM PUBLIC FUNDS.--
A. All state departments and institutions and all political subdivisions of the state, excluding municipalities, counties and political subdivisions of the state with twenty-five employees or fewer, shall cooperate in providing group term life, medical or disability income insurance for the benefit of eligible employees or salaried officers of the respective departments, institutions and subdivisions.
B. The group insurance contributions of the state or any of its departments or institutions, including institutions of higher education and the public schools, shall be made as follows:
(1) at least seventy-five percent of the cost of the insurance of an employee whose annual salary is less than fifteen thousand dollars ($15,000);
(2) at least seventy percent of the cost of the insurance of an employee whose annual salary is fifteen thousand dollars ($15,000) or more but less than twenty thousand dollars ($20,000);
(3) at least sixty-five percent of the cost of the insurance of an employee whose annual salary is twenty thousand dollars ($20,000) or more but less than twenty-five thousand dollars ($25,000); [or] and
(4) at least sixty percent of the cost of the insurance of an employee whose annual salary is twenty-five thousand dollars ($25,000) or more.
C. Effective July 1, 2004, the group insurance contributions of the state or any of its executive, judicial or legislative departments, including agencies, boards or commissions, shall be made as follows; provided that the contribution percentage shall be the same for all affected public employees in a given salary bracket:
(1) up to eighty percent of the cost of the insurance of an employee whose annual salary is less than thirty thousand dollars ($30,000);
(2) up to seventy percent of the cost of the insurance of an employee whose annual salary is thirty thousand dollars ($30,000) or more but less than forty thousand dollars ($40,000); and
(3) up to sixty percent of the cost of the insurance of an employee whose annual salary is forty thousand dollars ($40,000) or more.
D. Effective July 1, 2005, the group insurance contributions of the state or any of its executive, judicial or legislative departments, including agencies, boards or commissions, shall be made as follows; provided that the contribution percentage shall be the same for all affected public employees in a given salary bracket, except as provided in the wellness incentive program:
(1) up to eighty percent of the cost of the insurance of an employee whose annual salary is less than fifty thousand dollars ($50,000);
(2) up to seventy percent of the cost of the insurance of an employee whose annual salary is fifty thousand dollars ($50,000) or more but less than sixty thousand dollars ($60,000); and
(3) up to sixty percent of the cost of the insurance of an employee whose annual salary is sixty thousand dollars ($60,000) or more.
E. The state shall not make any group insurance contributions for legislators. A legislator shall be eligible for group benefits only if the legislator contributes one hundred percent of the cost of the insurance.
F. As used in this section, "cost of the insurance" means the premium required to be paid to provide coverages, taking into account any decreases in premiums but not increases in premiums pursuant to the wellness incentive program. Any contributions of the political subdivisions of the state, except the public schools and political subdivisions of the state with twenty-five employees or fewer, shall not exceed sixty percent of the cost of the insurance.
G. When a public employee elects to participate in a cafeteria plan as authorized by the Cafeteria Plan Act and enters into a salary reduction agreement with the governmental employer, the provisions of Subsections B through D of this section with respect to the maximum contributions that can be made by the employer are not violated and will still apply. The employer percentage or dollar contributions as provided in Subsections B through D of this section shall be determined by the employee's gross salary prior to any salary reduction agreement.
H. Any group medical insurance plan offered pursuant to this section shall include effective cost-containment measures to control the growth of health care costs. The responsible public body that administers a plan offered pursuant to this section shall report annually by September 1 to appropriate interim legislative committees on the effectiveness of the cost-containment measures required by this subsection.
I. Within available revenue, school districts, charter schools, participating entities pursuant to the Public School Insurance Authority Act and institutions of higher education may contribute up to eighty percent of the cost of the insurance of all employees.
J. Each employee covered by group medical insurance as provided in this section shall participate in the wellness incentive program established pursuant to Section 1 of this 2011 act and meet health risk evaluation targets as required by the program or pay a higher premium. The additional premium cost shall be borne by the employee."
SECTION 3. Section 10-7B-6 NMSA 1978 (being Laws 1989, Chapter 231, Section 6, as amended) is amended to read:
"10-7B-6. STATE EMPLOYEES GROUP BENEFITS SELF-INSURANCE PLAN--AUTHORIZATION--LOCAL PUBLIC BODY PARTICIPATION.--
A. The risk management division of the general services department may, with the prior advice of the committee, establish and administer a group benefits
self-insurance plan, providing life, vision, health, dental and disability coverages, or any combination of such coverages, for employees of the state and of participating local public bodies. Any such group benefits self-insurance plan shall afford coverage for employees' dependents at each employee's option. The health coverage shall include the wellness incentive program established pursuant to Section 1 of this 2011 act. Any such group benefits self-insurance plan may consist of self-insurance or a combination of
self-insurance and insurance; provided that particular coverages or risks may be fully insured, fully self-insured or partially insured and partially self-insured.
B. The director, with the advice of the committee, shall establish by [regulation] rule or letter of administration the types, extent, nature and description of coverages, the eligibility rules for participation, the deductibles, rates and all other matters reasonably necessary to carry on or administer a group benefits self-insurance plan established pursuant to Subsection A of this section.
C. The contribution of each participating state agency to the cost of any such group benefits self-insurance plan shall not exceed that percentage provided for state group benefits insurance plans as provided by law. The contribution of a participating local public body to the cost of any such group benefits self-insurance plan shall not exceed that percentage provided for local public body group benefits insurance plans as provided by law.
D. Except as provided in Subsection E of this section, public employees' contributions to the cost of any group benefits self-insurance plan, including costs associated with the wellness incentive program, may be deducted from their salaries and paid directly to the group self-insurance fund; provided that where risks are insured or reinsured, the director may authorize payment of the costs of such insurance or reinsurance directly to the insurer or reinsurer.
E. A legislator and the legislator's covered dependents and a soil and water conservation district supervisor [or] and the supervisor's covered dependents are eligible to participate in and receive benefits from the group benefits self-insurance plan if the legislator or supervisor pays monthly premiums in amounts that equal one hundred percent of the cost of the insurance. The premiums shall be paid directly to the group self-insurance fund; provided that where risks are insured or reinsured, the director may authorize payment of the premiums directly to the insurer or reinsurer.
F. Local public bodies and state agencies that are not participating in the state group benefits insurance plan or self-insurance plan may elect to participate in any group benefits self-insurance plan established pursuant to Subsection A of this section by giving written notice to the director on a date set by the director, which date shall not be later than ninety days prior to the date participation is to begin. The director shall determine an initial rate for the electing entity in accordance with a letter of administration setting forth written guidelines established by the director with the committee's advice. The initial rate shall be based on the claims experience of the electing entity's group for the three immediately preceding continuous years. If three years of continuous experience [is] are not available, a rate fixed for the entity by the director with the committee's advice shall apply, and the electing entity's group shall be rerated on the first premium anniversary following the date one full year of experience for the group becomes available. Any such election may be terminated effective not earlier than June 30 of the third calendar year succeeding the year in which the election became effective or on any June 30 thereafter. Notice of termination shall be made in writing to the director not later than April 1 immediately preceding the June 30 on which participation will terminate. A reelection to participate in the plan following a termination [may] shall not be made effective for at least three full years following the effective date of termination.
G. As soon as practicable, the director with the committee's advice shall establish an experience rating plan for state agencies and local public bodies participating in any group benefits self-insurance plan created pursuant to Subsection A of this section. Rates applicable to state agencies and participating local public bodies shall be based on such experience rating plan. Any such experience rating plan may provide separate rates for individual state agencies and individual local public bodies or for such other experience centers as the director may determine."
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