2014 North Dakota Century Code Title 54 State Government Chapter 54-52.1 Uniform Group Insurance Program
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CHAPTER 54-52.1
UNIFORM GROUP INSURANCE PROGRAM
54-52.1-01. Definitions.
As used in this chapter, unless the context otherwise requires:
1. "Board" means the public employees retirement board.
2. "Carrier" means:
a. For the hospital benefits coverage, an insurance company authorized to do
business in the state, or a nonprofit hospital service association, or a prepaid
group practice hospital care plan authorized to do business in the state, or the
state if a self-insurance plan is used for providing hospital benefits coverage.
b. For the medical benefits coverage, an insurance company authorized to do
business in the state, or a nonprofit medical service association, or a prepaid
group practice medical care plan authorized to do business in the state, or the
state if a self-insurance plan is used for providing medical benefits coverage.
c. For the life insurance benefits coverage, an insurance company authorized to do
business in the state.
3. "Department, board, or agency" means the departments, boards, agencies, or
associations of this state, and includes the state's charitable, penal, and higher
educational institutions; the Bank of North Dakota; the state mill and elevator
association; and counties, cities, district health units, and school districts.
4. "Eligible employee" means every permanent employee who is employed by a
governmental unit, as that term is defined in section 54-52-01. "Eligible employee"
includes members of the legislative assembly, judges of the supreme court, paid
members of state or political subdivision boards, commissions, or associations,
full-time employees of political subdivisions, elective state officers as defined by
subsection 2 of section 54-06-01, and disabled permanent employees who are
receiving compensation from the North Dakota workforce safety and insurance fund.
As used in this subsection, "permanent employee" means one whose services are not
limited in duration, who is filling an approved and regularly funded position in a
governmental unit, and who is employed at least seventeen and one-half hours per
week and at least five months each year or for those first employed after August 1,
2003, is employed at least twenty hours per week and at least twenty weeks each year
of employment. For purposes of sections 54-52.1-04.1, 54-52.1-04.7, 54-52.1-04.8,
and 54-52.1-11, "eligible employee" includes retired and terminated employees who
remain eligible to participate in the uniform group insurance program pursuant to
applicable state or federal law.
5. "Health maintenance organization" means an organization certified to establish and
operate a health maintenance organization in compliance with chapter 26.1-18.1.
6. "Hospital benefits coverage" means a plan which either provides coverage for, or pays,
or reimburses expenses for hospital services incurred in accordance with the uniform
contract.
7. "Life insurance benefits coverage" means a plan which provides both term life
insurance and accidental death and dismemberment insurance in amounts determined
by the board, with a minimum of one thousand dollars provided for the term life
insurance portion of the coverage.
8. "Medical benefits coverage" means a plan which either provides coverage for, or pays,
or reimburses expenses for medical services in accordance with the uniform contract.
9. "Member contribution" means the payment by the member into the retiree health
benefits fund pursuant to sections 54-52-02.9 and 54-52-17.4.
10. "Member's account balance" means the member's contributions plus interest at the
rate set by the board.
11. "Temporary employee" means a governmental unit employee who is not filling an
approved and regularly funded position in an eligible governmental unit and whose
services may or may not be limited in duration.
Page No. 1
54-52.1-02. (Contingent expiration date) Uniform group insurance program created Formation into subgroups.
In order to promote the economy and efficiency of employment in the state's service, reduce
personnel turnover, and offer an incentive to high-grade individuals to enter and remain in the
service of state employment, there is created a uniform group insurance program. The uniform
group must be composed of eligible and retired employees and be formed to provide hospital
benefits coverage, medical benefits coverage, and life insurance benefits coverage in the
manner set forth in this chapter. The uniform group may be divided into the following subgroups
at the discretion of the board:
1. Medical and hospital benefits coverage group consisting of active eligible employees
and retired employees not eligible for medicare. In determining premiums for coverage
under this subsection for retired employees not eligible for medicare, the rate for a
non-medicare retiree single plan is one hundred fifty percent of the active member
single plan rate, the rate for a non-medicare retiree family plan of two people is twice
the non-medicare retiree single plan rate, and the rate for a non-medicare retiree
family plan of three or more persons is two and one-half times the non-medicare
retiree single plan rate.
2. In addition to the coverage provided in subsection 1, another coverage option may be
provided for retired employees not eligible for medicare, provided the option does not
increase the implicit subsidy as determined by the governmental accounting standards
board's other postemployment benefit reporting procedure. In offering this additional
option, the board may have an open enrollment but thereafter enrollment for this
option must be as specified in section 54-52.1-03.
3. Retired medicare-eligible employee group medical and hospital benefits coverage.
4. Active eligible employee life insurance benefits coverage.
5. Retired employee life insurance benefits coverage.
6. Terminated employee continuation group medical and hospital benefits coverage.
7. Terminated employee conversion group medical and hospital benefits coverage.
8. Dental benefits coverage.
9. Vision benefits coverage.
10. Long-term care benefits coverage.
11. Employee assistance benefits coverage.
12. Prescription drug coverage.
(Contingent effective date) Uniform group insurance program created - Formation
into subgroups. In order to promote the economy and efficiency of employment in the state's
service, reduce personnel turnover, and offer an incentive to high-grade individuals to enter and
remain in the service of state employment, there is created a uniform group insurance program.
The uniform group must be composed of eligible and retired employees and be formed to
provide hospital benefits coverage, medical benefits coverage, and life insurance benefits
coverage in the manner set forth in this chapter. The uniform group may be divided into the
following subgroups at the discretion of the board:
1. Medical and hospital benefits coverage group consisting of active eligible employees
and retired employees not eligible for medicare, except for employees who first retire
after the effective date of this section and are not eligible for medicare on their
retirement. In determining premiums for coverage under this subsection for retired
employees not eligible for medicare, the rate for a non-medicare retiree single plan is
one hundred fifty percent of the active member single plan rate, the rate for a
non-medicare retiree family plan of two people is twice the non-medicare retiree single
plan rate, and the rate for a non-medicare retiree family plan of three or more persons
is two and one-half times the non-medicare retiree single plan rate.
2. In addition to the coverage provided in subsection 1, another coverage option may be
provided for retired employees not eligible for medicare, except for employees who
first retire after the effective date of this section and are not eligible for medicare on
their retirement, provided the option does not increase the implicit subsidy as
determined by the governmental accounting standards board's other postemployment
benefit reporting procedure. In offering this additional option, the board may have an
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5.
6.
7.
8.
9.
10.
11.
12.
open enrollment but thereafter enrollment for this option must be as specified in
section 54-52.1-03.
Retired medicare-eligible employee group medical and hospital benefits coverage.
Active eligible employee life insurance benefits coverage.
Retired employee life insurance benefits coverage.
Terminated employee continuation group medical and hospital benefits coverage.
Terminated employee conversion group medical and hospital benefits coverage.
Dental benefits coverage.
Vision benefits coverage.
Long-term care benefits coverage.
Employee assistance benefits coverage.
Prescription drug coverage.
54-52.1-03. Employee participation in plan - Employee to furnish information Benefits to continue upon retirement or termination.
1. Any eligible employee may be enrolled in the uniform group insurance program
created by this chapter by requesting enrollment with the employing department. If an
eligible employee does not enroll in the uniform group insurance program at the time
of beginning employment, the eligible employee must meet minimum requirements
established by the board to enroll thereafter.
2. Within five days after the expiration of the payroll period during which enrollment was
requested, the employing department shall enroll the employee with the board. The
employee's insurance coverage becomes effective on the date of enrollment.
3. A retiree who has accepted a periodic distribution from the defined contribution
retirement plan pursuant to section 54-52.6-13 who the board determines is eligible for
participation in the uniform group insurance program or has accepted a retirement
allowance from the public employees retirement system, the highway patrolmen's
retirement system, the teachers' insurance and annuity association of America college retirement equities fund for service credit earned while employed by North
Dakota institutions of higher education, the retirement system established by job
service North Dakota under section 52-11-01, the judges' retirement system
established under chapter 27-17, or the teachers' fund for retirement may elect to
participate in the uniform group under this chapter without meeting minimum
requirements at age sixty-five, when the member's spouse reaches age sixty-five,
upon the receipt of a benefit, or when the spouse terminates employment. If a retiree
or surviving spouse does not elect to participate at the times specified in this
subsection, the retiree or surviving spouse must meet the minimum requirements
established by the board. Subject to sections 54-52.1-03.2 and 54-52.1-03.3, each
retiree or surviving spouse shall pay directly to the board the premiums in effect for the
coverage then being provided. A retiree or surviving spouse who has met the initial
eligibility requirements of this subsection to begin participation in the uniform group
insurance program remains eligible as long as the retiree maintains the retiree's
participation in the program by paying the required premium pursuant to rules adopted
by the board.
4. Upon the termination of employment when the employee is not eligible to participate
under subsection 3 or 5 or applicable federal law, that employee cannot continue as a
member of the uniform group.
5. A member or former member of the legislative assembly or that person's surviving
spouse may elect to continue membership in the uniform group within the applicable
time limitations after either termination of eligible employment as a member of the
legislative assembly or termination of other eligible employment or, for a surviving
spouse, upon the death of the member or former member of the legislative assembly.
The member or former member of the legislative assembly or that person's surviving
spouse shall pay the premiums in effect for the coverage provided directly to the
board.
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7.
Each eligible employee requesting enrollment shall furnish the appropriate person in
the employing department, board, or agency with such information and in such form as
prescribed by the board to enable the enrollment of the employee, or employee and
dependents, in the uniform group insurance program created by this chapter.
If the participating employee is a faculty member in a state charitable, penal, or
educational institution who receives a salary or wages on less than a twelve-month
basis and has signed a contract to teach for the next ensuing school year, the agency
shall make arrangements to include that employee in the insurance program on a
twelve-month basis and make the contribution authorized by this section for each
month of the twelve-month period.
54-52.1-03.1. Certain political subdivisions authorized to join uniform group
insurance program - Employer contribution.
A political subdivision may extend the benefits of the uniform group insurance program
under this chapter to its permanent employees, subject to minimum requirements established by
the board and a minimum period of participation of sixty months. If the political subdivision
withdraws from participation in the uniform group insurance program, before completing sixty
months of participation, unless federal or state laws or rules are modified or interpreted in a way
that makes participation by the political subdivision in the uniform group insurance program no
longer allowable or appropriate, the political subdivision shall make payment to the board in an
amount equal to any expenses incurred in the uniform group insurance program that exceed
income received on behalf of the political subdivision's employees as determined under rules
adopted by the board. The Garrison Diversion Conservancy District, and district health units
required to participate in the public employees retirement system under section 54-52-02, shall
participate in the uniform group insurance program under the same terms and conditions as
state agencies. A retiree who has accepted a retirement allowance from a participating political
subdivision's retirement plan may elect to participate in the uniform group under this chapter
without meeting minimum requirements at age sixty-five, when the employee's spouse reaches
age sixty-five, upon the receipt of a benefit, when the political subdivision joins the uniform
group insurance plan if the retiree was a member of the former plan, or when the spouse
terminates employment. If a retiree or surviving spouse does not elect to participate at the times
specified in this section, the retiree or surviving spouse must meet the minimum requirements
established by the board. Each retiree or surviving spouse shall pay directly to the board the
premiums in effect for the coverage then being provided. The board may require documentation
that the retiree has accepted a retirement allowance from an eligible retirement plan other than
the public employees retirement system.
54-52.1-03.2. (Contingent expiration date) Retiree health benefits fund Appropriation.
1. The board shall establish a retiree health benefits fund account with the Bank of North
Dakota for the purpose of prefunding and providing hospital benefits coverage and
medical benefits coverage under the uniform group insurance program for retired
eligible employees or surviving spouses of retired eligible employees and their
dependents as provided in this chapter. The state shall contribute monthly to the
retiree health benefits fund an amount equal to one and fourteen hundredths percent
of the monthly salaries and wages of all participating members of the highway
patrolmen's retirement system under chapter 39-03.1, and one and fourteen
hundredths percent of the monthly salaries of all supreme or district court judges who
are participating members of the public employees retirement system under chapter
54-52. Each governmental unit that contributes to the public employees retirement
system fund under section 54-52-06 or the retirement plan under chapter 54-52.6 shall
contribute monthly to the retiree health benefits fund an amount equal to one and
fourteen hundredths percent of the monthly salaries or wages of all participating
members of the public employees retirement system under chapter 54-52 or chapter
54-52.6, except for nonteaching employees of the superintendent of public instruction
who elect to participate in the public employees retirement system pursuant to section
Page No. 4
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54-52-02.13 and employees of the state board for career and technical education who
elect to participate in the public employees retirement system pursuant to section
54-52-02.14. For nonteaching employees of the superintendent of public instruction
who elect to participate in the public employees retirement system pursuant to section
54-52-02.13, the superintendent of public instruction shall contribute monthly to the
retiree health benefits fund an amount equal to three and twenty-four hundredths
percent of the monthly salaries or wages of those nonteaching employee members,
beginning on the first of the month following the transfer under section 54-52-02.13
and continuing thereafter for a period of eight years, after which time the
superintendent of public instruction shall contribute one and fourteen hundredths
percent of the monthly salary or wages of those nonteaching employee members. For
employees of the state board for career and technical education who elect to
participate in the public employees retirement system pursuant to section 54-52-02.14,
the state board for career and technical education shall contribute monthly to the
retiree health benefits fund an amount equal to two and ninety-nine hundredths
percent of the monthly salary or wages of those employee members, beginning on the
first of the month following the transfer under section 54-52-02.14 and continuing
thereafter for a period of eight years, after which time the state board for career and
technical education shall contribute one and fourteen hundredths percent of the
monthly salary or wages of those employee members. The employer of a national
guard security officer or firefighter shall contribute monthly to the retiree health benefits
fund an amount equal to one and fourteen hundredths percent of the monthly salaries
or wages of all national guard security officers or firefighters participating in the public
employees retirement system under chapter 54-52. Job service North Dakota shall
reimburse monthly the retiree health benefits fund for credit received under section
54-52.1-03.3 by members of the retirement program established by job service North
Dakota under section 52-11-01. The board, as trustee of the fund and in exclusive
control of its administration, shall:
a. Provide for the investment and disbursement of moneys of the retiree health
benefits fund and administrative expenditures in the same manner as moneys of
the public employees retirement system are invested, disbursed, or expended.
b. Adopt rules necessary for the proper administration of the retiree health benefits
fund, including enrollment procedures.
All moneys deposited in the fund established under subsection 1, not otherwise
appropriated, are hereby appropriated to the board for the purpose of making
investments for the fund and to make contributions toward hospital and medical
benefits coverage for eligible retired employees or surviving spouses of eligible retired
employees and their dependents under the uniform group insurance program.
If a member terminates employment because of death, permanent and total disability,
or any voluntary or involuntary reason prior to retirement, the member or the member's
designated beneficiary is entitled to the member's account balance at termination. If a
member's account balance is withdrawn, the member relinquishes all rights to benefits
under the retiree health benefits fund.
(Contingent effective date) Retiree health benefits fund - Appropriation.
1. The board shall establish a retiree health benefits fund account with the Bank of North
Dakota for the purpose of prefunding and providing hospital benefits coverage and
medical benefits coverage and prescription drug coverage under any health insurance
program and dental, vision, and long-term care benefits coverage under the uniform
group insurance program for retired eligible employees or surviving spouses of retired
eligible employees and their dependents as provided in this chapter. The state shall
contribute monthly to the retiree health benefits fund an amount equal to one and
fourteen hundredths percent of the monthly salaries and wages of all participating
members of the highway patrolmen's retirement system under chapter 39-03.1, and
one and fourteen hundredths percent of the monthly salaries of all supreme or district
court judges who are participating members of the public employees retirement
Page No. 5
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system under chapter 54-52. Each governmental unit that contributes to the public
employees retirement system fund under section 54-52-06 or the retirement plan
under chapter 54-52.6 shall contribute monthly to the retiree health benefits fund an
amount equal to one and fourteen hundredths percent of the monthly salaries or
wages of all participating members of the public employees retirement system under
chapter 54-52 or chapter 54-52.6, except for nonteaching employees of the
superintendent of public instruction who elect to participate in the public employees
retirement system pursuant to section 54-52-02.13 and employees of the state board
for career and technical education who elect to participate in the public employees
retirement system pursuant to section 54-52-02.14. For nonteaching employees of the
superintendent of public instruction who elect to participate in the public employees
retirement system pursuant to section 54-52-02.13, the superintendent of public
instruction shall contribute monthly to the retiree health benefits fund an amount equal
to three and twenty-four hundredths percent of the monthly salaries or wages of those
nonteaching employee members, beginning on the first of the month following the
transfer under section 54-52-02.13 and continuing thereafter for a period of eight
years, after which time the superintendent of public instruction shall contribute one and
fourteen hundredths percent of the monthly salary or wages of those nonteaching
employee members. For employees of the state board for career and technical
education who elect to participate in the public employees retirement system pursuant
to section 54-52-02.14, the state board for career and technical education shall
contribute monthly to the retiree health benefits fund an amount equal to two and
ninety-nine hundredths percent of the monthly salary or wages of those employee
members, beginning on the first of the month following the transfer under section
54-52-02.14 and continuing thereafter for a period of eight years, after which time the
state board for career and technical education shall contribute one and fourteen
hundredths percent of the monthly salary or wages of those employee members. The
employer of a national guard security officer or firefighter shall contribute monthly to
the retiree health benefits fund an amount equal to one and fourteen hundredths
percent of the monthly salaries or wages of all national guard security officers or
firefighters participating in the public employees retirement system under chapter
54-52. Job service North Dakota shall reimburse monthly the retiree health benefits
fund for credit received under section 54-52.1-03.3 by members of the retirement
program established by job service North Dakota under section 52-11-01. The board,
as trustee of the fund and in exclusive control of its administration, shall:
a. Provide for the investment and disbursement of moneys of the retiree health
benefits fund and administrative expenditures in the same manner as moneys of
the public employees retirement system are invested, disbursed, or expended.
b. Adopt rules necessary for the proper administration of the retiree health benefits
fund, including enrollment procedures.
All moneys deposited in the fund established under subsection 1, not otherwise
appropriated, are hereby appropriated to the board for the purpose of making
investments for the fund and to make contributions toward hospital and medical
benefits coverage and prescription drug coverage under any health insurance program
and dental, vision, and long-term care benefits coverage under the uniform group
insurance program for eligible retired employees or surviving spouses of eligible
retired employees and their dependents as elected.
If a member terminates employment because of death, permanent and total disability,
or any voluntary or involuntary reason prior to retirement, the member or the member's
designated beneficiary is entitled to the member's account balance at termination. If a
member's account balance is withdrawn, the member relinquishes all rights to benefits
under the retiree health benefits fund.
Page No. 6
54-52.1-03.3. (Contingent expiration date) Eligibility for retiree health benefits - Fixed
contribution and reduction factors.
1. The following persons are entitled to receive credit for hospital and medical benefits
coverage under subsection 2:
a. A member or surviving spouse of the highway patrolmen's retirement system is
eligible for the credit beginning on the date retirement benefits are effective
unless the premium is billed to the employer.
b. A member or surviving spouse of the public employees retirement system is
eligible for the credit beginning on the date retirement benefits are effective
unless the premium is billed to the employer.
c. A member or surviving spouse of the retirement program established by job
service North Dakota under section 52-11-01 receiving retirement benefits is
eligible for the credit beginning on the date retirement benefits are effective
unless the premium is billed to the employer.
d. A retired judge or surviving spouse receiving retirement benefits under the
retirement program established under chapter 27-17 is eligible for the credit
beginning on the date retirement benefits are effective unless the premium is
billed to the employer.
e. A former participating member of the defined contribution retirement plan
receiving retirement benefits, or the surviving spouse of a former participating
member of that retirement plan who was eligible to receive or was receiving
benefits, under section 54-52.6-13, is eligible as determined by the board
pursuant to its rules.
2. The board shall calculate the allowable monthly credit toward hospital and medical
benefits coverage for a person eligible under subsection 1 in an amount equal to five
dollars multiplied by the member's or deceased member's number of years of credited
service under the highway patrolmen's retirement system, the public employees
retirement system, the retirement program established by job service North Dakota
under section 52-11-01, or the judges' retirement program established under chapter
27-17. For a member of the public employees retirement system receiving an early
retirement benefit or the surviving spouse of that member, or a former participating
member of the defined contribution retirement plan who is receiving a periodic
distribution and would not meet the normal retirement provisions of the public
employees retirement system, the allowable monthly credit must be reduced by three
percent if the member terminates employment within one year prior to attaining the
age of sixty-five and an additional reduction factor of six percent shall apply for each
year the member terminates employment prior to attaining the age of sixty-four. For a
member of the highway patrolmen's retirement system receiving an early retirement
benefit or the surviving spouse of that member, the allowable monthly credit must be
reduced by three percent if the member terminates employment within one year prior
to attaining the age of fifty-five and an additional reduction factor of six percent shall
apply for each year the member terminates employment prior to attaining the age of
fifty-four. For a member of the retirement program established by job service North
Dakota under section 52-11-01 receiving an early retirement benefit or a discontinued
service annuity under the plan provisions of that retirement program or the surviving
spouse of that member, the allowable monthly credit must be reduced by three percent
if the member terminates employment within one year prior to attaining the age of
sixty-five and an additional reduction factor of six percent applies for each year the
member terminates employment prior to attaining the age of sixty-four.
3. The board shall apply the credit allowable under subsection 2 to the payment of
monthly premiums required of each person eligible under subsection 1 for hospital
benefits coverage and medical benefits coverage under the uniform group insurance
program. The board shall allow spouses who each have credit under subsection 2 to
combine their credits and shall apply the combined credit to the required monthly
premiums under the uniform group insurance program. However, if the allowable credit
under any circumstance exceeds the monthly premium in effect for selected coverage,
Page No. 7
4.
that amount of the credit which exceeds the premium is forfeited and may not be used
for any other purpose.
The board may, as an alternative to the calculation of the allowable monthly credit
under subsection 2, provide actuarially reduced benefit options for the member and
the member's surviving spouse including a one hundred percent joint and survivor
option, a fifty percent joint and survivor option, or a five-year or ten-year certain option.
(Contingent effective date) Eligibility for retiree health benefits - Fixed contribution
and reduction factors.
1. The following persons are entitled to receive credit for hospital and medical benefits
coverage and prescription drug coverage under any health insurance program and
dental, vision, and long-term care benefits coverage under the uniform group
insurance program under subsection 2:
a. A member or surviving spouse of the highway patrolmen's retirement system is
eligible for the credit beginning on the date retirement benefits are effective
unless the premium is billed to the employer.
b. A member or surviving spouse of the public employees retirement system is
eligible for the credit beginning on the date retirement benefits are effective
unless the premium is billed to the employer.
c. A member or surviving spouse of the retirement program established by job
service North Dakota under section 52-11-01 receiving retirement benefits is
eligible for the credit beginning on the date retirement benefits are effective
unless the premium is billed to the employer.
d. A retired judge or surviving spouse receiving retirement benefits under the
retirement program established under chapter 27-17 is eligible for the credit
beginning on the date retirement benefits are effective unless the premium is
billed to the employer.
e. A former participating member of the defined contribution retirement plan
receiving retirement benefits, or the surviving spouse of a former participating
member of that retirement plan who was eligible to receive or was receiving
benefits, under section 54-52.6-13, is eligible as determined by the board
pursuant to its rules.
2. The board shall calculate the allowable monthly credit toward hospital and medical
benefits coverage and prescription drug coverage under any health insurance program
and dental, vision, and long-term care benefits coverage under the uniform group
insurance program for a person eligible under subsection 1 in an amount equal to five
dollars multiplied by the member's or deceased member's number of years of credited
service under the highway patrolmen's retirement system, the public employees
retirement system, the retirement program established by job service North Dakota
under section 52-11-01, or the judges' retirement program established under chapter
27-17. For a member of the public employees retirement system receiving an early
retirement benefit or the surviving spouse of that member, or a former participating
member of the defined contribution retirement plan who is receiving a periodic
distribution and would not meet the normal retirement provisions of the public
employees retirement system, the allowable monthly credit must be reduced by three
percent if the member terminates employment within one year prior to attaining the
age of sixty-five and an additional reduction factor of six percent shall apply for each
year the member terminates employment prior to attaining the age of sixty-four. For a
member of the highway patrolmen's retirement system receiving an early retirement
benefit or the surviving spouse of that member, the allowable monthly credit must be
reduced by three percent if the member terminates employment within one year prior
to attaining the age of fifty-five and an additional reduction factor of six percent shall
apply for each year the member terminates employment prior to attaining the age of
fifty-four. For a member of the retirement program established by job service North
Dakota under section 52-11-01 receiving an early retirement benefit or a discontinued
service annuity under the plan provisions of that retirement program or the surviving
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4.
spouse of that member, the allowable monthly credit must be reduced by three percent
if the member terminates employment within one year prior to attaining the age of
sixty-five and an additional reduction factor of six percent applies for each year the
member terminates employment prior to attaining the age of sixty-four.
The board shall apply the credit allowable under subsection 2 as elected by the eligible
participant to the payment of monthly premiums required of each person eligible under
subsection 1 for hospital benefits coverage and medical benefits coverage and
prescription drug coverage under any health insurance program and dental, vision,
and long-term care benefits coverage under the uniform group insurance program.
The board shall allow spouses who each have credit under subsection 2 to combine
their credits and shall apply the combined credit to the required monthly premiums as
elected pursuant to this subsection. However, if the allowable credit under any
circumstance exceeds the monthly premium in effect for selected coverage, that
amount of the credit which exceeds the premium is forfeited and may not be used for
any other purpose.
The board may, as an alternative to the calculation of the allowable monthly credit
under subsection 2, provide actuarially reduced benefit options for the member and
the member's surviving spouse, including a one hundred percent joint and survivor
option or a fifty percent joint and survivor option.
54-52.1-03.4. Temporary employees and employees on unpaid leave of absence.
A temporary employee employed before August 1, 2007, may elect to participate in the
uniform group insurance program by completing the necessary enrollment forms and qualifying
under the medical underwriting requirements of the program. A temporary employee employed
on or after August 1, 2007, is only eligible to participate in the uniform group insurance program
if the employee is employed at least twenty hours per week and at least twenty weeks each
year of employment. A temporary employee first employed after December 31, 2013, is eligible
to participate in the uniform group insurance program only if the employee meets the definition
of a full-time employee under section 4980H(c)(4) of the Internal Revenue Code [26 U.S.C.
4980H(c)(4)]. The temporary employee or the temporary employee's employer shall pay
monthly to the board the premiums in effect for the coverage being provided. In the case of a
temporary employee who is an applicable taxpayer as defined in section 36B(c)(1)(A) of the
Internal Revenue Code [26 U.S.C. 36B(c)(1)(A)], the temporary employee's required
contribution for medical and hospital benefits self-only coverage may not exceed the maximum
employee required contribution specified under section 36B(c)(2)(C) of the Internal Revenue
Code [26 U.S.C. 36B(c)(2)(C)], and the employer shall pay any difference between the
maximum employee required contribution for medical and hospital benefits self-only coverage
and the cost of the premiums in effect for this coverage. An employer may pay health or life
insurance premiums for a permanent employee on an unpaid leave of absence. A political
subdivision, department, board, or agency may make a contribution for coverage under this
section.
54-52.1-04. Board to contract for insurance.
The board shall receive bids for the providing of hospital benefits coverage, medical
benefits coverage, life insurance benefits coverage for a specified term, and employee
assistance program services; may receive bids separately for prescription drug coverage; and
shall accept one or more bids of and contract with the carriers that in the judgment of the board
best serves the interests of the state and its eligible employees. Solicitations must be made not
later than ninety days before the expiration of an existing uniform group insurance contract. Bids
must be solicited by advertisement in a manner selected by the board that will provide
reasonable notice to prospective bidders. In preparing bid proposals and evaluating bids, the
board may utilize the services of consultants on a contract basis in order that the bids received
may be uniformly compared and properly evaluated. In determining which bid, if any, will best
serve the interests of eligible employees and the state, the board shall give adequate
consideration to the following factors:
1. The economy to be effected.
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2.
3.
4.
5.
The ease of administration.
The adequacy of the coverages.
The financial position of the carrier, with special emphasis as to its solvency.
The reputation of the carrier and any other information that is available tending to
show past experience with the carrier in matters of claim settlement, underwriting, and
services.
The board may reject any or all bids and, in the event it does so, shall again solicit bids as
provided in this section. The board may establish a plan of self-insurance for providing health
insurance benefits coverage only under an administrative services only (ASO) contract or a
third-party administrator (TPA) contract.
54-52.1-04.1. Health maintenance organization contract - Membership option.
Notwithstanding the provisions of section 54-52.1-04, the board may contract with one or
more health maintenance organizations to provide eligible employees the option of membership
in a health maintenance organization. If it makes such a contract, the board may not require that
the health maintenance organization be federally qualified if the health maintenance
organization has a certificate of authority issued by the North Dakota insurance commissioner.
The contract or contracts must be included in the uniform group insurance program.
54-52.1-04.2. Self-insurance plan for hospital and medical benefits coverage.
1. The board may establish a self-insurance plan for providing:
a. Health insurance benefits coverage;
b. Health insurance benefits coverage excluding all or part of prescription drug
coverage; or
c. All or part of prescription drug coverage.
2. Any self-insurance plan under this section must be provided under an administrative
services only (ASO) contract or a third-party administrator (TPA) contract under the
uniform group insurance program, and may be established only if it is determined by
the board that an administrative services only or third-party administrator plan is less
costly than the lowest bid submitted by a carrier for underwriting the plan with
equivalent contract benefits. Upon establishing a self-insurance plan, the board shall
solicit bids for an administrative services only or third-party administrator contract only
every other biennium, and the board is authorized to renegotiate an existing
administrative services only or third-party administrator contract during the interim. In
addition, individual stop-loss coverage insured by a carrier authorized to do business
in this state must be made part of any self-insured plan. All bids under this section are
due no later than January first, and must be awarded no later than March first,
preceding the end of each biennium. All bids under this section must be opened at a
public meeting of the board.
54-52.1-04.3. Contingency reserve fund - Continuing appropriation.
The board shall establish under a self-insurance plan a contingency reserve fund to provide
for adverse fluctuations in future charges, claims, costs, or expenses of the uniform group
insurance program. The board shall determine the amount necessary to provide a balance in
the contingency reserve fund between one and one-half months and three months of claims
paid based on the average monthly claims paid during the twelve-month period immediately
preceding March first of each year. The board also shall determine the amount necessary to
provide an additional balance in the contingency reserve fund between one month and one and
one-half months for claims incurred but not yet reported. The board may arrange for the
services of an actuarial consultant to assist the board in making these determinations. Upon the
initial changeover from a contract for insurance pursuant to section 54-52.1-04 to a
self-insurance plan pursuant to section 54-52.1-04.2, the board must have a plan in place which
is reasonably calculated to meet the funding requirements of this chapter within sixty months. All
moneys in the contingency reserve fund, not otherwise appropriated, are appropriated for the
Page No. 10
payment of claims and other costs of the uniform group insurance program during periods of
adverse claims or cost fluctuations.
54-52.1-04.4. Insurance to cover mammogram examinations.
The board shall provide medical benefits coverage under a contract for insurance pursuant
to section 54-52.1-04 or under a self-insurance plan pursuant to section 54-52.1-04.2 for:
1. One baseline mammogram examination for each woman who is at least thirty-five but
less than forty years of age.
2. One mammogram examination every year, or more frequently if ordered by a
physician, for each woman who is at least forty years of age.
54-52.1-04.5. Insurance to cover involuntary complications of pregnancy.
Medical benefits coverage provided under either a contract for insurance pursuant to
section 54-52.1-04 or under a self-insurance plan pursuant to section 54-52.1-04.2 may not
contain any exclusion, reduction, or other limitation as to coverage, deductible, or coinsurance
provision, as to involuntary complications of pregnancy unless the provisions apply generally to
all benefits paid under the coverage. If a fixed amount is specified for in the coverage for
surgery, the fixed amounts for surgical procedures involving involuntary complications of
pregnancy must be commensurate with other fixed amounts payable for procedures of
comparable difficulty and severity. In a case when a fixed amount is payable for maternity
benefits, involuntary complications of pregnancy are an illness and entitled to benefits otherwise
provided by the coverage. When the coverage contains a maternity deductible, the maternity
deductible applies only to expenses resulting from normal delivery and caesarean section
delivery; however, expenses for caesarean section delivery in excess of the deductible must be
treated as expenses for any other illness under the coverage. For purposes of this section,
"involuntary complications of pregnancy" includes nonelective caesarean section delivery.
54-52.1-04.6. Coverage for treatment of certain disorders.
The board shall provide coverage under either a contract for insurance pursuant to section
54-52.1-04 or under a self-insurance plan pursuant to section 54-52.1-04.2 for coverage for
surgical and nonsurgical treatment of temporomandibular joint disorder and craniomandibular
disorder. Coverage must be the same as that for treatment to any other joint in the body, and
applies if the treatment is administered or prescribed by a physician or a dentist. Benefits for the
coverage may be limited to a lifetime maximum of ten thousand dollars per person for surgery,
and two thousand five hundred dollars for nonsurgical treatment.
54-52.1-04.7. Uniform group insurance program - Vision and dental plans.
The board may establish a dental plan, a vision plan, or both, for eligible employees. The
board shall receive bids for the plan or plans pursuant to section 54-52.1-04. The board may
reject any or all bids and provide a plan of self-insurance. Premiums for this coverage must be
paid by the eligible employee. Any refund, rebate, dividend, experience rating allowance,
discount, or other reduction of premium must be credited as provided by section 54-52.1-06.
54-52.1-04.8. Uniform group insurance program - Long-term care plan.
The board may establish a long-term care plan for eligible employees. The board shall
receive bids for the plan under section 54-52.1-04. The board may reject any or all bids and
provide a plan of self-insurance. Premiums for this plan must be paid by the eligible employee.
Any refund, rebate, dividend, experience rating allowance, discount, or other reduction of
premium must be credited as provided by section 54-52.1-06.
54-52.1-04.9. Uniform group insurance program - Employee assistance program.
The board shall establish an employee assistance program available to persons in the
medical and hospital benefits coverage group. The premium for this coverage must be paid as
provided by section 54-52.1-06. The board shall receive bids for this program under section
54-52.1-04. Each department, board, or agency shall obtain employee assistance program
Page No. 11
services through the board for eligible employees and may not enter into any agreement to
obtain employee assistance program services with a third-party provider except that a
department, board, or agency may use its own employee assistance program services to the
extent such services are provided by personnel of that department, board, or agency. As used in
this section, "employee assistance program" means an employer-sponsored service for
employees under which a professional employee assistance program staff assists employees
and their families in finding help for emotional, drug, alcohol, family, health, and other personal
or job-related problems that may be affecting their work performance.
54-52.1-04.10. Insurance to cover dental anesthesia and hospitalization.
The board shall provide medical benefits coverage under a contract for insurance pursuant
to section 54-52.1-04 or under a self-insurance plan pursuant to section 54-52.1-04.2 for dental
anesthesia and hospitalization in the same manner as provided under section 26.1-36-09.9.
54-52.1-04.11. Insurance to cover foods and food products for inherited metabolic
diseases.
The board shall provide medical benefits coverage under a contract for insurance pursuant
to section 54-52.1-04 or under a self-insurance plan pursuant to section 54-52.1-04.2 for foods
and food products for inherited metabolic diseases in the same manner as provided for under
section 26.1-36-09.7.
54-52.1-04.12. Insurance to cover medical services related to intoxication.
The board shall provide medical benefits coverage under a contract for insurance pursuant
to section 54-52.1-04 or under a self-insurance plan pursuant to section 54-52-04.2 for medical
services related to intoxication in the same manner as provided for under subsection 15 of
section 26.1-36-05 and section 26.1-36-09.13.
54-52.1-05. Provisions of contract.
Each uniform group insurance contract entered into by the board must be consistent with
the provisions of this chapter, must be signed for the state of North Dakota by the chairman of
the board, and must include the following:
1. As many optional coverages as deemed feasible and advantageous by the board.
2. A detailed statement of benefits offered, including maximum limitations and exclusions,
and such other provisions as the board may deem necessary or desirable.
54-52.1-06. State contribution.
Each department, board, or agency shall pay to the board each month from its funds
appropriated for payroll and salary amounts a state contribution in the amount as determined by
the primary carrier of the group contract for the full single rate monthly premium for each of its
eligible employees enrolled in the uniform group insurance program and the full rate monthly
premium, in an amount equal to that contributed under the alternate family contract, including
major medical coverage, for hospital and medical benefits coverage for spouses and dependent
children of its eligible employees enrolled in the uniform group insurance program pursuant to
section 54-52.1-07. The board shall then pay the necessary and proper premium amount for the
uniform group insurance program to the proper carrier or carriers on a monthly basis. Any
refund, rebate, dividend, experience rating allowance, discount, or other reduction of premium
amount must be credited at least annually to a separate fund of the uniform group insurance
program to be used by the board to reimburse the administrative expense and benefit fund of
the public employees retirement program for the costs of administration of the uniform group
insurance program. In the event an enrolled eligible employee is not entitled to receive salary,
wages, or other compensation for a particular calendar month, that employee may make direct
payment of the required premium to the board to continue the employee's coverage, and the
employing department, board, or agency shall provide for the giving of a timely notice to the
employee of that person's right to make such payment at the time the right arises.
Page No. 12
54-52.1-06.1. Uniform group insurance program benefits - Continuing appropriation.
The funds necessary to pay the consulting fees and health insurance benefits related to the
uniform group insurance program are hereby appropriated from insurance premiums received
by the board.
54-52.1-07. Optional coverage for employee's family.
Each eligible employee enrolled in the uniform group insurance program may elect to
include that person's spouse and all qualified dependents, as provided for in the plan, within the
hospital benefits coverage and medical benefits coverage, the state to pay the cost of such
coverage as provided in section 54-52.1-06.
54-52.1-08. Administration - Board to promulgate rules and regulations.
It is the responsibility of the board to account for and disburse premium payments, maintain
records, prepare reports, and to perform such other functions as may be necessary to carry out
the provisions of this chapter. The board may promulgate such rules and regulations as may be
necessary to carry out the provisions of this chapter.
54-52.1-08.1. Administrative - Nondiscrimination testing for health and life insurance
programs.
The board shall be responsible for the nondiscrimination testing required under section 89
of the Internal Revenue Code. The board may engage the services of a consultant to assist the
board in its administration of this section. The various state departments, boards, agencies, and
commissions shall provide the board with requested information so the board may carry out its
duties under this section.
54-52.1-08.2. Uniform group insurance program - Compliance with federal
requirements - Group purchasing arrangements.
If the board determines that any section or the phraseology of any section of this chapter
does not comply with applicable federal statutes or rules, the board shall adopt appropriate
terminology with respect to that section to comply with the federal statutes or rules, subject to
the approval of the legislative management's employee benefits programs committee. The
board may assume responsibility for group purchasing arrangements as provided by federal
law. Any plan modifications made by the board under this section are effective until the effective
date of any measure enacted by the legislative assembly providing the necessary amendments
to this chapter to ensure compliance with the federal statutes or rules.
54-52.1-09. Reports.
Each department, board, or agency shall keep such records, make such certifications, and
furnish the board or carriers with such information and reports as may be necessary to enable
the board or carriers to carry out their functions under the provisions of this chapter. Carriers
that have entered into a contract with the board are required to furnish such reasonable reports
as the board determines to be necessary, and to permit the board to examine those records that
relate to the uniform group insurance program.
54-52.1-10. Exemption from state premium tax.
All premiums, consideration for annuities, policy fees, and membership fees collected under
this chapter are exempt from the tax payable pursuant to section 26.1-03-17.
54-52.1-11. Confidentiality of employee records.
Information pertaining to an eligible employee's group medical records for claims, employee
premium payments made, salary reduction amounts taken, history of any available insurance
coverage purchased, and amounts and types of insurance applied for under the supplemental
life insurance coverage under this chapter is confidential and is not a public record. The
information and records may be disclosed, under rules adopted by the board, only to:
Page No. 13
1.
2.
3.
4.
5.
A person to whom the eligible employee has given written authorization to have the
information disclosed.
A person legally representing the eligible employee, upon proper proof of
representation, and unless the eligible employee specifically withholds authorization.
A person authorized by a court order.
A person or entity to which the board is required to disclose information pursuant to
federal or state statutes or regulations.
Any person or entity if the purpose of the disclosure is for treatment, payment, or
health care operations.
54-52.1-12. Ownership and confidentiality of the uniform group health insurance
medical records of employees, retirees, and dependents.
The medical records and related data of the employees, retirees, and dependents, obtained
as the result of enrollment in the uniform group insurance program, are the property of the
public employees retirement system. The records and data are confidential and are not public
records. However, the board may allow administrators of administrative services only contracts
or third-party administrators contracts access to the records and data where it is required in the
performance of the administrator's duties pursuant to the contract. No administrator may be held
liable for furnishing to the board information with respect to any patient, or any physician,
hospital, or other health care provider.
54-52.1-13. Uniform prescription drug cards.
The board shall provide for issuance of uniform prescription drug cards under a contract for
insurance pursuant to section 54-52.1-04 or under a self-insurance plan pursuant to section
54-52.1-04.2 in the same manner as provided under section 26.1-36-43.
54-52.1-14. Wellness program.
The board shall develop an employer-based wellness program. The program must
encourage employers to adopt a board-developed wellness program by either charging extra
health insurance premium to nonparticipating employers or reducing premium for participating
employers.
54-52.1-15. Acceptance and expenditure of third-party payments - Continuing
appropriation.
The board may receive moneys from third parties, including the federal government,
pursuant to one or more federal programs. Any money received from a third party by the board
is appropriated to the board on a continuing basis for the board's use in paying benefits,
premiums, or administrative expenses under the uniform group insurance program.
54-52.1-16. Uniform group insurance program - Collaborative drug therapy program Continuing appropriation.
1. The board may establish a collaborative drug therapy program available to individuals
in the medical and hospital benefits coverage group. The purpose of the collaborative
drug therapy program is to improve the health of individuals in identified health
populations and to manage health care expenditures.
2. Under the program, the board may involve physicians, pharmacists, and other health
professionals to coordinate health care for individuals in identified health populations in
order to improve health outcomes and reduce spending on care for the identified
health problem. Under the program, pharmacists and other health professionals may
be reimbursed for providing face-to-face collaborative drug therapy services to
covered individuals in the identified health population. To encourage enrollment in the
plan, the board may provide incentives to covered individuals in the identified health
population which may include waived or reduced copayment for related treatment
drugs and supplies.
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3.
4.
The board may request the assistance of the North Dakota pharmacists association or
a specified delegate to implement a formalized disease management program with the
approval of the prescriptive practices committee established in section 43-15-31.4,
which must serve to standardize chronic disease care and improve patient outcomes.
This program must facilitate enrollment procedures, provide standards of care, enable
consistent documentation of clinical and economic outcomes, and structure an
outcomes reporting system.
The board may seek and accept private contributions, gifts, and grants-in-aid from the
federal government, private industry, and other sources for a collaborative drug
therapy program for identified health populations. Any funds that may become
available through contributions, gifts, grants-in-aid, or other sources to the board for a
collaborative drug therapy program are appropriated to the board on a continuing
basis.
54-52.1-17. Uniform group insurance program - Collaborative drug therapy program Funding.
1. The board shall establish a collaborative drug therapy program that is to be available
to individuals in the medical and hospital benefits coverage group. The purpose of the
collaborative drug therapy program is to improve the health of individuals with diabetes
and to manage health care expenditures.
2. The board shall involve physicians, pharmacists, and certified diabetes educators to
coordinate health care for covered individuals with diabetes in order to improve health
outcomes and reduce spending on diabetes care. Under the program, pharmacists
and certified diabetes educators may be reimbursed for providing face-to-face
collaborative drug therapy services to covered individuals with diabetes. To encourage
enrollment in the plan, the board shall provide incentives to covered individuals who
have diabetes which may include waived or reduced copayment for diabetes treatment
drugs and supplies.
3. The North Dakota pharmacists association or a specified delegate shall implement a
formalized diabetes management program with the approval of the prescriptive
practices committee established in section 43-15-31.4, which must serve to
standardize diabetes care and improve patient outcomes. This program must facilitate
enrollment procedures, provide standards of diabetes care, enable consistent
documentation of clinical and economic outcomes, and structure an outcomes
reporting system.
4. The board shall fund the program from any available funds in the uniform group
insurance program and if necessary the fund may add up to a two dollar per month
charge on the policy premium for medical and hospital benefits coverage. A state
agency shall pay any additional premium from the agency's existing appropriation.
54-52.1-18. High-deductible health plan alternative with health savings account
option.
The board shall develop and implement a high-deductible health plan as an alternative to
the plan under section 54-52.1-06. The high-deductible health plan alternative with a health
savings account must be made available to state employees by January 1, 2012. The
high-deductible health plan alternative may be offered, at the discretion of the board, to political
subdivisions after June 30, 2013. Health savings account fees for participating state employees
must be paid by the employer. Subject to the limits of section 223(b) of the Internal Revenue
Code [26 U.S.C. 233(b)], the difference between the cost of the single and family premium for
eligible state employees under section 54-52.1-06 and the premium for those employees
electing to participate under the high-deductible health plan under this section must be
deposited in a health savings account for the benefit of each participating employee. Each new
employee of a participating employer under this section must be provided the opportunity to
elect the high-deductible health plan alternative. At least once each biennium, the board shall
have an open enrollment period allowing existing employees of a participating employer under
this section to change their coverage.
Page No. 15
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