Title 42. Public Officers and Employees
Chapter 12. Group Insurance
Part III. Health and Accident Insurance
42:851 Authority for employee benefit programs; payroll deduction for payment of premiums
A. The state of Louisiana, through the Office of Group Benefits and each of its governmental and administrative subdivisions, departments, or agencies of the executive, legislative, or judicial branches, and the governing boards and authorities of each state university, college, or public elementary and secondary school system in this state are authorized to:
(1) Procure private contracts of insurance covering their respective employees, officials, and department heads, or any class or classes thereof, and the dependents of such employees, officials, or department heads under a policy or policies of group health, accident, accidental death and dismemberment, and hospital, surgical, or medical expense benefits.
(2) Adopt, administer, or operate or contract for all or a portion of the administration, operation, or both of a self-funded program for that purpose.
B. Each such private contract or self-funded program, the premiums of which are paid in whole or in part with state funds, shall be approved by the Office of Group Benefits, except that any city or parish school board may enter into such private contract or self-funded program without approval. The employee or retiree eligibility provided in such private contract or self-funded program must be identical to the eligibility provided in the Office of Group Benefits programs.
C. (1) Except as provided in Paragraphs (D)(1) and (2) and Subsection E of this Section, and except for those retirees who are not covered by Medicare and who are qualified for coverage in accordance with the rules and regulations of the Office of Group Benefits, the contribution of the state shall not be less than fifty percent of the total premium paid out of funds contributed by the state.
(2) However, except for those retirees who are not covered by Medicare, the contribution by the state shall not be in excess of the dollar amount paid on behalf of members in the rating classification for employees of state departments and agencies.
(3) The employee portion of the premium rate for retirees without Medicare coverage shall not exceed the active employee portion of the premium rates for the same classification of coverage.
D. (1) For those retirees who are covered by Medicare, the minimum contribution of the state shall be seventy-five percent.
(2) For those active employees covered by the provisions of Paragraph (C)(1) of this Section whose state contribution was not less than fifty percent of the total premium paid out of funds of the state on June 30, 2001, the minimum contribution of the state shall be as follows:
(a) Beginning July 1, 2001, the minimum contribution by the state shall be fifty-eight percent of the total premium.
(b) Beginning July 1, 2002, the minimum contribution by the state shall be sixty-five percent of the total premium.
(c) Beginning July 1, 2003, and each year thereafter, the minimum contribution by the state shall be seventy-five percent of the total premium.
(3) Nothing herein shall be construed to prohibit the state from providing contributions at a higher level for participants as provided in Paragraph (2) of this Subsection.
(4) Notwithstanding any provision of law to the contrary, any lapse in participation for employees furloughed or terminated as the result of Hurricanes Katrina and Rita and subsequently rehired between August 30, 2005, and December 31, 2006, shall not reduce the state minimum contribution.
E. (1) Notwithstanding any other provision of this Part to the contrary, for any person who is an active employee as defined by R.S. 42:808 and who does not participate in the Office of Group Benefits program provided by this Part before January 1, 2002, but subsequently enrolls in the program, or for any person who is hired on or after January 1, 2002, who meets the definition of employee as provided by R.S. 42:808 the state contribution of the total premium shall, upon retirement, be:
(a) Nineteen percent for those persons with less than ten years of participation in the Office of Group Benefits program before retirement.
(b) Thirty-eight percent for those persons with ten years of participation but less than fifteen years of participation in the Office of Group Benefits program before retirement.
(c) Fifty-six percent for those persons with fifteen years of participation but less than twenty years of participation in the Office of Group Benefits program before retirement.
(d) Seventy-five percent for those persons with twenty or more years of participation in the Office of Group Benefits program before retirement.
(2) The Office of Group Benefits shall promulgate all rules necessary to carry out the provisions of Subsections A through E, P, and U of this Section.
(3) Nothing herein shall be construed to prohibit the state from providing contributions at a higher level for participants as provided in this Subsection.
(4) The provisions of this Subsection shall not affect the contributions paid by the state for any retiree covered under this Part on June 29, 2001, or the contributions paid by the state for any participant who retires before January 1, 2002.
F. The contributions of employees, officials, or department heads to the premiums for such benefits may be deducted by the employer from the salaries of the employees, officials, or department heads when authorized in writing by the respective persons. However, the amount paid toward the premium by the state or any of its governmental and administrative subdivisions, departments, or agencies and the governing boards and authorities of each state university, college, or public elementary and secondary school system of the state shall be subject to the approval of the office.
G. No reductions of state contributions shall be made on contracts heretofore written and continued in force, and, in addition, the premiums shall be paid out of funds appropriated for the purpose and included in the respective budgets of the state or other entity.
H. (1) Nothing herein shall be construed as limiting the authority of the office to adopt, administer, or operate or to contract for all or a portion of the administration, operation, or both of a primary self-funded program or additional programs with premium rate structures and state contribution rates which are different from the primary program.
(2) Under any such self-funded program the office, for purposes of establishing rates and premiums, may group risks into multiple classifications. There may be one classification for employees of state departments and agencies; there may be one classification for employees of eligible school boards; there may be one classification for employees of eligible political subdivisions and other public entities of the state; and there may be one or more classifications for retirees.
(3) For the purposes of this Subsection, the classification of state departments and agencies shall mean that group of eligible participants in the executive, legislative, or judicial branch of state government whose contributions for premiums are paid in whole or in part through appropriations by the legislature. The classification of school boards shall mean that group of eligible participants of city or parish school systems which receive funding through the Minimum Foundation Program. The classification of political subdivisions and other public entities shall mean participants of all other entities eligible for the program under the provisions of this Section not included in the classification of state departments and agencies or the classification of school boards.
(4) The rates and premiums adopted for each classification shall take into consideration the loss experience in the classification as well as other relevant factors.
(5) If a state department or agency, school board, or political subdivision or other public entity elects to participate in the state group health and accident insurance program after participation in another group health and accident program, the premium rate applicable to such employees and former employees intended to be covered by the program shall be the greater of the premium rate based on the loss experience of the group under the prior plan or the premium rate based on the loss experience of the classification into which the group is entering.
(6) The rates so fixed shall not be excessive, inadequate, or unfairly discriminatory and shall be uniform within each classification.
I. Notwithstanding any provision of law to the contrary, nothing herein shall be construed to exclude city and parish school board members from eligibility for participation as provided in R.S. 17:1223.
J. Notwithstanding any provision of law to the contrary, any eligible entity which elects to participate in the life insurance coverage as provided in Part II of Chapter 12 of Title 42 of the Louisiana Revised Statutes of 1950 shall also participate in the group health and accident insurance coverage as provided in this Part.
K. Notwithstanding any provision of law to the contrary, the employee portion of the premium rate for active employees or retirees shall not be increased to fund any deficit related to the provision of coverage. If a deficit is identified, the minimum contribution by the state may be increased to fully fund such deficit.
L. (1) School boards may pay from local funds any portion of the cost of the group policy.
(2) Nothing in this Section shall be construed to require any school board to use local funds to pay all or any portion of the cost of the group policy for participating former employees now retired.
M. (1) Notwithstanding any provision of law or any rule or regulation to the contrary, the state of Louisiana shall continue to contribute its portion of the premium or charges due under this Section for which an employee is granted leave of absence without pay due to a service-related injury for a period not to exceed twelve months. The state may contribute its portion of the premium and charges due under this Section for which an employee is granted leave of absence without pay due to active military duty or is granted leave without pay under the provisions of the federal Family and Medical Leave Act.1
(2) If the employee should suffer a job-related injury that meets the definition of a total and permanent disability under the workers’ compensation laws of Louisiana, the state of Louisiana shall continue to contribute its portion of the premiums or charges due under this Section until the employee becomes gainfully employed or is placed on state disability retirement.
(3) However, such contribution shall not be made for any period during which an employee is under a suspension from his employment without pay unless reinstated.
(4) An employee who is granted leave of absence without pay for any reason other than those enumerated above may continue participation in the Office of Group Benefits program for a period not to exceed twelve months upon the employee’s payment of the full premium or charges due.
N. The Department of Insurance shall make an examination, at least once every five years, of the health indemnity plan of the Office of Group Benefits following the same guidelines applied to other health insurers, and report its findings to the Joint Legislative Committee on the Budget along with any recommendations for assuring plan solvency and quality.
O. Notwithstanding any provision of law to the contrary, any person who is an active employee, as defined in R.S. 42:808(A)(1), of the state Department of Education, special school district or the Department of Public Safety and Corrections, office of youth services who was employed by such state agency on or after January 1, 2002, but no later than March 29, 2004, who has participated in the Office of Group Benefits continuously during his state employment who, prior to such employment, was a professional and fully qualified employee of a city, parish, or other local public school system in a position that required certification by the state Department of Education and who participated in the group health insurance program made available by the school system for not less than twenty years shall, upon retirement, be eligible to maintain enrollment in the Office of Group Benefits program with a state contribution of seventy-five percent of his premium.
P. (1) Any person who is eligible for and receives disability retirement benefits from a retirement system created under the laws of this state shall receive the same retiree health care premium subsidy as an individual who has participated for twenty or more years in the Office of Group Benefits health care program. In order to be eligible for the retiree health care premium subsidy, the person shall have participated in health care programs sponsored by the Office of Group Benefits for the number of years sufficient to earn disability retirement benefits.
(2)(a) Notwithstanding any provision of law to the contrary, a spouse who is eligible for and receives survivor benefits from the State Police Retirement System pursuant to R.S. 11:1316 or 1345.8 shall be eligible to participate in the Office of Group Benefits health care program and receive the same health care premium subsidy as a retiree who has participated for twenty or more years in the Office of Group Benefits health care program. For the spouse to be eligible for the retiree health care premium subsidy, the member shall have participated in health care programs sponsored by the Office of Group Benefits for the number of years sufficient to earn survivor retirement benefits. A spouse who did not meet the qualifications for health care premium subsidy coverage pursuant to this Paragraph due to the date of death of the member occurring prior to June 30, 2021, shall have the option to select coverage no later than December 31, 2021.
(b) Notwithstanding any provision of law to the contrary, a child who has not attained the age of twenty-six years or a child who has a disability or is mentally incapacitated regardless of age who is eligible for and receives, or who was eligible for and received, survivor benefits from the State Police Retirement System pursuant to R.S. 11:1316 or 1345.8 shall be eligible to participate in the Office of Group Benefits health care program and receive the same health care premium subsidy as a retiree who has participated for twenty or more years in the Office of Group Benefits health care program. For the child to be eligible for the retiree health care premium subsidy, the member shall have participated in health care programs sponsored by the Office of Group Benefits for the number of years sufficient to earn survivor retirement benefits. A child who did not meet the qualifications for health care premium subsidy coverage pursuant to this Paragraph due to the date of death of the member occurring prior to June 30, 2021, shall have the option to select coverage no later than December 31, 2021.
Q. Notwithstanding any provision of law to the contrary, any person who is an active employee of the Jefferson Parish School System, or is employed as a probation and parole officer with the Department of Public Safety and Corrections on or before August 15, 1986, and participates in the Office of Group Benefits program, who elects to take retirement within the Louisiana State Employees’ Retirement System2 pursuant to Act No. 194 of the 2004 Regular Session of the Legislature, and who has participated in the Office of Group Benefits program provided by this Part for at least ten years, shall, upon retirement, be eligible to maintain enrollment in the Office of Group Benefits program with a state contribution of seventy-five percent of his premium.
R. Notwithstanding any other provision of law to the contrary, persons made eligible as part of a special group for participation in programs sponsored by the Office of Group Benefits pursuant to R.S. 42:808(A)(11) may elect to participate in group health insurance programs upon the end of their state service as provided in R.S. 42:808(A)(11) provided they participated in a program of group health insurance sponsored by the Office of Group Benefits for not less than ten consecutive years prior to the end of their service. One hundred percent of the premium cost for coverage of any person in such group electing to participate shall be paid entirely by such person and shall be risk rated by the Office of Group Benefits. The election to continue insurance coverage pursuant to this Subsection must be made by the employee on or before the termination of the employee’s service and the payment of the premiums to be paid pursuant to this Subsection shall begin on the date of termination.
S. Notwithstanding Paragraph (E)(1) of this Section or any provision of law to the contrary, any person who retires within the Louisiana State Employees’ Retirement System and who elects to suspend his retirement benefits pursuant to the laws applicable to that system shall be eligible to maintain enrollment in programs sponsored by the Office of Group Benefits with the same contribution by the state as was applicable to such person upon his retirement. If such person is reemployed subsequent to his retirement, such contributions by the state shall be maintained through the course of such person’s reemployment and his subsequent retirement thereafter.
T. (1) Notwithstanding any provision of law to the contrary, any person who retired on or after May 1, 2013, and on or before May 31, 2013, who participated in health care programs sponsored by the Office of Group Benefits for more than eighteen years, whose doctor certifies that on the date of his retirement he was medically unable to perform his job duties shall, upon retirement, be eligible to maintain enrollment in the Office of Group Benefits Program with a state contribution of seventy-five percent of his premium, if the sum of his accumulated unused leave on his retirement date plus his years of participation in the Office of Group Benefits Program, rounded to the nearest year, is twenty years or more.
(2) Notwithstanding any provision of law to the contrary, any person who is an employee, as defined in R.S. 42:808(A), who was employed by the Office of Community Relations and Rural Development after January 1, 2004, who subsequently becomes a state elected official as defined in R.S. 42:808(11)(b)(ii), and who has participated in the Office of Group Benefits continuously during his state employment, shall, upon retirement, be eligible to maintain enrollment in the Office of Group Benefits program with a state contribution of his premium, as provided in Subsection D of this Section.
U. (1) Notwithstanding any other provision of law or any rule or regulation to the contrary, health insurance coverage shall begin concurrent with employment by a public elementary or secondary school system if all of the following apply on the employee’s first date of employment with that employer:
(a) The school system is in an area that is the subject of a gubernatorially or presidentially declared disaster or emergency.
(b) The declaration of disaster or emergency specifies that the disaster or emergency involves risks to the health or well-being of any individual who engages in certain activities.
(c) Among the activities posing a risk to an individual’s health or well-being are activities integral to services to the school system that the employee is required to perform.
(2) The premium for the first month’s insurance shall be paid immediately. The school system shall pay the employer contribution. The employee contribution may be paid by the school system or the employee. If the school system pays the employee contribution, the school system shall be reimbursed by a deduction from the employee’s wages.
Acts 2001, No. 1178, § 5, eff. June 29, 2001. Amended by Acts 2003, No. 897, § 1; Acts 2005, No. 498, § 1; Acts 2005, 1st Ex.Sess., No. 57, § 1, eff. Dec. 6, 2005; Acts 2006, No. 757, § 1, eff. June 30, 2006; Acts 2007, No. 366, § 1, eff. July 10, 2007; Acts 2014, No. 771, § 1, eff. June 30, 2014; Acts 2020, 2nd Ex.Sess., No. 32, § 2, eff. Oct. 28, 2020; Acts 2021, No. 56, § 1, eff. June 30, 2021.
Footnotes
1 See 5 U.S.C.A. § 6381 et seq., 29 U.S.C.A. § 2601 et seq.
2 R.S. 11:401 et seq.