SB195INTRODUCED
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SB195
W1Z2YE5-1
By Senator Orr
RFD: Finance and Taxation Education
First Read: 25-Feb-25
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5 W1Z2YE5-1 02/24/2025 KMS (L)cr 2025-864
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First Read: 25-Feb-25
SYNOPSIS:
Under existing law, the Public Education
Employees' Health Insurance (PEEHIP) Board is required
to renegotiate contracts for health benefit plans every
three years.
This bill would require the renegotiation of
contracts for Medicare retiree health benefit plans
every five years.
A BILL
TO BE ENTITLED
AN ACT
Relating to the Public Education Employees' Health
Insurance (PEEHIP) Board; to amend Section 16-25A-7, Code of
Alabama 1975; to require the renegotiation of contracts for
Medicare retiree health benefit plans every five years.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Section 16-25A-7 of the Code of Alabama
1975, is amended to read as follows:
"ยง16-25A-7
(a) The board is hereby authorized to may execute a
contract or contracts to provide for the benefits or the
administration of the plan determined in accordance with the
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administration of the plan determined in accordance with the
provisions of this article. Such The contract or contracts may
be executed with one or more agencies or corporations licensed
to transact or administer group health insurance business in
this state. All of the benefits to be provided under this
article may be included in one or more similar contracts
issued by the same or different companies. The board is
further authorized to develop a plan whereby it the board may
become self-insured upon its finding that such the arrangement
would be financially advantageous to the state and plan
participants.
(b)(1) Before entering into any contract or contracts
authorized by subsection (a), the board shall invite
competitive bids from all qualified entities who may wish to
administer or offer plans for the health insurance coverage or
the administrative services desired. The board shall award
such the contract or contracts on a competitive basis as
determined by the benefits afforded, administrative costs, the
costs to be incurred by employee, retiree, and employer, the
experience of the offering company or agency in the group
health insurance field , and its facilities for the handling of
claims. In evaluating these factors the board may employ the
services of impartial professional insurance analysts or
actuaries.
(2) The board shall reevaluate the contract or
contracts yearly, and renegotiate all contracts, except for
contracts for Medicare retiree health care, on a competitive
basis at least every three years. Contracts for Medicare
retiree health care shall be renegotiated on a competitive
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retiree health care shall be renegotiated on a competitive
basis at least every five years.
(c) The board may authorize the carrier with whom the
primary contracts are executed to reinsure portions of such
the contract with other such carriers which elect to be a
reinsurer and who are legally qualified to enter into
reinsurance agreement under the laws of this state.
(d) Each employee or retired employee who is covered by
the plan provided pursuant to this article shall receive
evidence of such the coverage. In addition, each employee or
retired employee shall receive , upon request, information
setting forth the benefits to which the employee or retired
employee and his or her dependents are entitled, to whom such
the benefits shall be payable, to whom claims shall be
submitted, and a summary of the provisions of the plan as they
affect the employee and his or her dependents.
(e) The plan shall require adequate notice in writing
to any participant whose claim for benefits under the plan has
been denied, setting forth the specific reasons for such the
denial and shall afford a reasonable opportunity to any
participant whose claim for benefits has been denied for a
full and fair review by the claims administrator upon the
written request of the participant, within 60 days of after
the date of denial, setting forth the specific reasons for
review. The claims administrator shall provide in writing,
within 60 days of after the request for review, a final
determination of the claim provided that an extension of 60
days may be obtained upon written notification to the
participant. Review of a final decision by the claims
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participant. Review of a final decision by the claims
administrator shall be by the Circuit Court of Montgomery
County as provided for the review of contested cases under the
Alabama Administrative Procedure Act, Section 41-22-20.
(f) The board may, at the end of any contract period ,
may discontinue any contract or contracts it the board has
executed with any carrier and replace same with a contract or
contracts with any other carrier or carriers meeting the
requirements of this article.
(g) The Public Education Employees' Health Insurance
Board may enter into contracts of the State Employees'
Insurance Board that were awarded through a competitive bid
process, upon the mutual consent of the State Employees'
Insurance Board and the contractor."
Section 2. This act shall become effective immediately.
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