2021 Delaware Code
Title 29 - State Government
Chapter 52. Health Care Insurance
§ 5202. Payment of premium or subscription charge.
(a) The State shall pay premium or subscription charges for a regular officer or employee and eligible spouse and child dependents not eligible for federal Medicare as follows:
(1) Ninety-six percent of the total cost of the basic individual, individual and spouse, individual and child, or family health care insurance plan as set forth in § 5203 of this title;
(2) Ninety-five percent of the total cost of a consumer-directed health plan for individual, individual and spouse, individual and child, or family;
(3) Ninety-three and one-half percent of the total cost of an HMO plan for individual, individual and spouse, individual and child, or family;
(4) Eighty-six and three-quarter percent of the total cost of a comprehensive PPO plan for individual, individual and spouse, individual and child, or family; or
(5) Beginning January 1, 2006, employees identified under Title 14 who are receiving a short-term disability benefit for a period greater than 90 days pursuant to § 5253(b) of this title and have exhausted all of their paid leave, an amount equivalent to that provided under paragraph (a)(1), (2), (3) or (4) of this section.
(b) (1) For eligible pensioners not eligible for federal Medicare and their eligible dependents who were first employed by the State on or before June 30, 1991, or who are receiving a disability pension or primary survivors receiving a survivor's pension under § 8372(a) of Title 11, due to death in the line of duty of the employee, the State shall pay premium or subscription charges for the following, whichever is applicable:
a. Ninety-six percent of the total cost of the basic individual, individual and spouse, individual and child, or family health-care insurance plan as set forth in § 5203 of this title;
b. Ninety-five percent of the total cost of a consumer-directed health plan for individual, individual and spouse, individual and child, or family;
c. Ninety-three and one-half percent of the total cost of an HMO plan for individual, individual and spouse, individual and child, or family; or
d. Eighty-six and three-quarter percent of the total cost of a comprehensive PPO plan for individual, individual and spouse, individual and child, or family.
(2) For eligible pensioners who are eligible for federal Medicare and their eligible dependents:
a. Who retire before July 1, 2012, or who are receiving a disability pension or primary survivors receiving a survivor's pension under § 8372(a) of Title 11, due to death in the line of duty of the employee, the State shall pay 100% of the premium or subscription charges for the coverage provided, unless they are subject to the schedule based on years of service, as set forth in paragraph (b)(3) of this section.
b. Who retire after July 1, 2012, the State shall pay 95% of the premium or subscription charges for the coverage provided, unless they are subject to the schedules based on years of service, as set forth in paragraph (b)(3) or (b)(4) of this section.
(3) For eligible pensioners who were first employed by the State on or after July 1, 1991, and before January 1, 2007, except those receiving a disability pension or primary survivors receiving a survivor's pension under § 8372(a) of Title 11, due to death in the line of duty of the employee, the State shall pay premium and subscription charges as follows:
a. For eligible pensioners employed by the State for at least 10 but less than 15 years at the time of retirement, 50 percent of premium or subscription charges as set forth in paragraphs (b)(1) and (b)(2) of this section; or
b. For eligible pensioners employed by the State for at least 15 but less than 20 years at the time of retirement, 75 percent of the premium or subscription charges as set forth in paragraphs (b)(1) and (b)(2) of this section; or
c. For eligible pensioners employed by the State for 20 or more years at the time of retirement, 100 percent of the premium or subscription charges as set forth in paragraphs (b)(1) and (b)(2) of this section.
(4) For eligible pensioners who were first employed by the State on or after January 1, 2007, the State shall pay premium and subscription charges as follows:
a. For eligible pensioners employed by the State for at least 15 but less than 17.5 years at the time of retirement, 50 percent of premium or subscription charges paid for by the State as set forth in paragraphs (b)(1) and (b)(3) of this section;
b. For eligible pensioners employed by the State for at least 17.5 but less than 20 years at the time of retirement, 75 percent of the premium or subscription charges as set forth in paragraphs (b)(1) and (b)(3) of this section; or
c. For eligible pensioners employed by the State for 20 or more years at the time of retirement, 100 percent of the premium or subscription charges as set forth in paragraphs (b)(1) and (b)(3) of this section.
(c) If the employee or pensioner is covered in any way by a group insurance program issued by the same insurer, duplicate coverage shall not be procured by the State; however, it shall be at the employee's or pensioner's option as to whether to be covered by the state group insurance plan or by a program of the spouse. If covered by a program of the spouse, the employee or pensioner shall obtain no monetary credit or rebate from the State.
(d) For the purposes of this chapter, eligible employees who were each first employed as a regular officer or employee by the State on or before December 31, 2011, a husband and wife legally married on or before December 31, 2011, may each qualify as a regular officer, employee or eligible pensioner of the State. In the case where 2 members of a family qualify, the following options are set forth:
(1) The 2 employees, or each eligible pensioner, and all eligible dependents may elect to enroll under 1 family contract.
(2) Each employee, or each eligible pensioner, may elect to enroll under a separate contract. Eligible dependents may be enrolled under either contract, but no dependent shall be enrolled more than once under the state health insurance program.
(3) The provisions of this paragraph shall continue to apply to a surviving spouse for employee only or employee and children contracts after the death of 1 of the spouses covered pursuant to this paragraph has occurred, as long as the surviving spouse is entitled to a survivor's pension pursuant to § 5528 of this title.
(4) Effective July 1, 2012, to December 31, 2017, if the 2 employees enroll under an employee and spouse or family contract, there shall be a $25 per month charge to the employee who enrolls for the coverage. If the employees choose to enroll in separate plans, employee only and employee and children contracts, either the employee cost share premium or a $25 per month charge shall apply to both contracts, whichever is less. If employee and spouse are eligible pensioners where 1 or both retire on or after July 1, 2012, and before July 1, 2017, only 1 $25 per month charge shall apply when separate contracts are required for a Medicare Supplement plan.
(5) Effective January 1, 2018, if the 2 employees or non-Medicare pensioners enroll under an employee and spouse or family contract, the employee or non-Medicare pensioner who enrolls for the coverage shall be charged 50 percent of the employee or non-Medicare pensioner cost share premium per month, or $25 per month, whichever is greater. If the employees or non-Medicare pensioners choose to enroll in separate plans, employee only and employee and children contracts, each employee or non-Medicare pensioner shall be charged 50 percent of the employee or non-Medicare cost share premium per month, or $25 per month, whichever is greater for the plans chosen.
If both spouses are eligible pensioners and 1 is not yet Medicare eligible, the non-Medicare pensioner will enroll under a pensioner only or pensioner and children contract and the Medicare pensioner will enroll in the Medicare Supplement plan. The non-Medicare pensioner shall be charged 50 percent of the cost share premium, or $25 per month, whichever is greater.
If 1 spouse is a regular officer or employee and 1 spouse is a Medicare eligible pensioner, the regular officer or employee who enrolls for employee and spouse or family coverage shall be charged 50 percent of the employee cost share premium If the employee and Medicare eligible spouse choose to enroll in separate plans, each employee and Medicare eligible pensioner shall be charged 50 percent of the employee and Medicare supplement cost share premium per month, or $25 per month, whichever is greater for the plans chosen.
If both spouses are Medicare eligible and 1 or both retired on or after July 1, 2017, only 1 50 percent pensioner only, or $25 per month premium, whichever is greater, shall apply when separate contracts are required for a Medicare Supplement Plan.
If both spouses are Medicare eligible and both retired after July 1, 2012, and before July 1, 2017, each Medicare eligible pensioner shall be charged $25 per month premium when separate contracts are required for a Medicare Supplement plan.
(6) In no case shall there be a monetary credit or return to the spouse for that spouse's basic credits.
(e) If a regular officer or employee is required to pay any portion of the cost of the health-care insurance for himself/herself, his/her spouse or his/her dependents, the regular officer or employee may enter into a written agreement with the State whereby he/she agrees to reduce his/her salary in an amount equal to the portion of the health-care insurance that the regular officer or employee is required to pay.
(f) Subsection (e) of this section shall not be effective until implementation has been approved by the State Treasurer, Secretary of Finance, Director of the Office of Management and Budget and Controller General.
(g) Salary reductions voluntarily taken pursuant to subsection (e) of this section shall not affect the compensation used in the calculation of pension benefits under any state pension plan and shall be made on a pretax basis, provided that employees who had designated employee deductions on a posttax basis as of July 1, 2000, shall continue to have the right to make those deductions on a posttax basis as long as the employee remains in a benefit program or the employee makes a change to pretax employee benefit deductions.
(h) A survivor who is receiving a deceased pensioner's retirement benefits in accordance with the State Employees' Pension Plan under Chapters 53 and 55 of this title, the State Police Pension Plan under subchapter II and subchapter III of Chapter 83 of Title 11, the Pension Plan for State Judiciary under Chapter 56 of this title shall only be entitled to coverage for the survivor and any "eligible child dependent" as defined in § 5201 of this title.
29 Del. C. 1953, § 5202; 57 Del. Laws, c. 319; 62 Del. Laws, c. 158, §§ 3, 4; 62 Del. Laws, c. 294, § 1; 63 Del. Laws, c. 79, § 1; 63 Del. Laws, c. 155, § 1; 65 Del. Laws, c. 87, § 80; 66 Del. Laws, c. 85, § 93; 67 Del. Laws, c. 324, § 1; 68 Del. Laws, c. 84, §§ 65, 66; 68 Del. Laws, c. 178, §§ 1-3; 69 Del. Laws, c. 291, § 34; 70 Del. Laws, c. 61, § 1; 70 Del. Laws, c. 186, § 1; 72 Del. Laws, c. 94, § 75; 75 Del. Laws, c. 88, §§ 20(6), 21(13), 26(2); 75 Del. Laws, c. 114, §§ 1, 2; 75 Del. Laws, c. 227, § 4; 76 Del. Laws, c. 280, § 22; 78 Del. Laws, c. 14, §§ 1-5; 78 Del. Laws, c. 78, § 25; 78 Del. Laws, c. 254, § 1; 81 Del. Laws, c. 58, § 24; 81 Del. Laws, c. 323, § 3;
