S218 - State Health Plan Administrative Changes

• Expands grounds for coverage cessation to include false statements regarding eligibility or enrollment information, in addition to false claims for reimbursement.

• Clarifies premium payment obligations for retirees with 10-20 years of service hired after October 1, 2006, defining total premium as the sum of employer contribution rate plus employee contribution.

• Simplifies newborn coverage procedures by automatically covering children born to covered employees without requiring coverage type changes or waiting periods for preexisting conditions, effective October 1, 2017.

• Establishes a four-tier allocation system for surplus health benefit funds: incurred but unpresented claims reserve, reduction of unfunded retiree health liability (up to 50%), premium reduction, and plan improvements at State Treasurer discretion with Board approval.

• Grants Board of Trustees members immunity from civil liability except for actions outside official duties, bad faith, gross negligence, improper personal financial benefit, or motor vehicle operations; creates new fraud detection and audit authority with access to records of employers and medical service providers.