(1) (a) The board shall design a group health care program for retirees, members, DPS members, DPS retirees, and their dependents, with or without full medicare coverage provided by the federal "Health Insurance for the Aged Act", 42 U.S.C. sec. 1395, as amended. This program shall provide health care benefits and a level of reimbursement for health care expenses which are consistent with prevailing community practices and other governmental health care systems, protection from catastrophic financial loss, and current and long-term fiscal soundness of the trust fund as determined by the board.
(b) Any group health care plan offered by the board that provides pharmacy benefits through the services of a pharmacy benefits manager shall require such manager to allow participation by any nonmail order retail pharmacy provider licensed in the state of Colorado if such pharmacy provider agrees to accept the fee schedule, terms, and conditions of participation established by the plan's pharmacy benefits manager.
(1.5) Any employer, as defined by section 24-51-101 (20), may elect to provide health care coverage through the health care program for its employees who are members. Participation in the health care program by an employer shall be voluntary and in the employer's sole discretion and shall not be mandatory for the employer.
The board shall establish procedures for enrollment and determine the methods ofclaims administration for the health care program.
(a) The board shall ensure that the premium amount for the health care program is paid by those individuals enrolled in said program.
The premium amount for a benefit recipient shall be deducted from monthly benefits.If the premium amount exceeds the monthly benefits, the excess amount shall be collected from the benefit recipient directly. The premium amount for a member shall be collected directly from the member's employer.
Surviving spouses and divorced spouses enrolled in the health care program pursuantto the provisions of section 24-51-1204 (1)(b) and (1)(c) shall directly pay the premium amount.
If an individual who is directly paying for enrollment in the health care program failsto pay the premium amount within a reasonable period of time, as determined by the board, the association shall notify the individual that enrollment may be cancelled within thirty days if payment is not received.
The board may change the design and costs of the health care program at any time.Individuals enrolled in the health care program shall be notified thirty days prior to any change.
DPS retirees may enroll in the association's health care program subject to the provisions of this part 12.
Source: L. 87: Entire article, R&RE, p. 1075, § 1, effective July 1. L. 99: (1) and (3)(b) amended and (1.5) added, p. 342, § 7, effective January 1, 2001. L. 2009: (1)(a) amended and (5) added, (SB 09-282), ch. 288, p. 1348, § 46, effective January 1, 2010.
Editor's note: This section is similar to former §§ 24-51-1403, 24-51-1404, and 24-511408 as they existed prior to 1987. For a detailed comparison, see the comparative tables located in the back of the index.
Authority to contract and to self-insure. The board shall have the authority to contract, self-insure, and make disbursements necessary to carry out the purposes of the health care program. Said authority shall include, but is not limited to, contracting with insurance carriers, health maintenance organizations, preferred provider organizations, and any other company or association as deemed necessary and proper by the board.
Source: L. 87: Entire article R&RE, p. 1075, § 1, effective July 1.
Editor's note: This section is similar to former § 24-51-1403 as it existed prior to 1987.
Health care program - eligibility. (1) The following persons are eligible to enroll in the health care program:
All benefit recipients, including those from the Denver public schools division, andtheir dependents, including any dependent as defined in section 10-16-102 (17), C.R.S.; any unmarried children who are not natural or adopted children of the benefit recipient but who reside full time with the benefit recipient, are dependents of the benefit recipient for federal income tax purposes, and meet the age requirements of section 10-16-102 (17), C.R.S.; and any qualified children as defined in the rules adopted by the board;
A surviving spouse of a retiree who elected option 1 or a DPS retiree who elected asingle life annuity pursuant to part 17 of this article, if such spouse was covered by the health care program at the time of the death of the retiree;
A divorced spouse of a retiree or of a DPS retiree if such spouse was enrolled in thehealth care program at the time of the divorce from the retiree;
The guardian of a child receiving survivor benefits while the child is enrolled in thehealth care program;
A member or a DPS member while receiving short-term disability program paymentspursuant to part 7 of this article; and
A member or a DPS member whose employer has elected to provide coverage through the health care program and such member's dependents.
(2) If a supplemental needs trust is receiving benefit payments pursuant to this article, the supplemental needs trust is not eligible to enroll in the health care program; however, the beneficiary of such trust is eligible to enroll in the health care program in the same manner that the beneficiary would be allowed to enroll if the beneficiary was the direct benefit recipient.
Source: L. 87: Entire article R&RE, p. 1075, § 1, effective July 1. L. 97: (1)(e) added, p. 778, § 15, effective July 1. L. 98: (1)(a) amended, p. 128, § 2, effective March 27. L. 99: (1)(d) and (1)(e) amended and (1)(f) added, p. 342, § 8, effective January 1, 2001. L. 2009: Entire section amended, (SB 09-282), ch. 288, p. 1348, § 47, effective January 1, 2010. L. 2013: (1)(a) amended, (HB 13-1266), ch. 217, p. 991, § 59, effective May 13. L. 2015: (2) added, (SB 15097), ch. 111, p. 327, § 7, effective April 16.
Editor's note: This section is similar to former §§ 24-51-1402 and 24-51-1405 as they existed prior to 1987. For a detailed comparison, see the comparative tables located in the back of the index.
Cross references: For the legislative declaration in SB 15-097, see section 1 of chapter 111, Session Laws of Colorado 2015.