TITLE I
THE STATE AND ITS GOVERNMENT

CHAPTER 21-I
DEPARTMENT OF ADMINISTRATIVE SERVICES

State Employees Group Insurance

Section 21-I:30

    21-I:30 Medical and Surgical Benefits. –
I. The state shall pay a premium for each state employee and permanent temporary or permanent seasonal employee as defined in RSA 98-A:3 including spouse and minor, fully dependent children, if any, toward group hospitalization, hospital medical care, surgical care and other medical benefits plan or a self-funded alternative, within the limits of the funds appropriated at each legislative session.
I-a. Nothing in this section shall prohibit the state or state employees from making contributions to post-retirement medical savings plans for such employees, if authorized by a collective bargaining agreement, but only for the term of such agreement.
II. The state shall pay a premium or partial premium for each Medicare-eligible retired employee, as defined in paragraphs VI and VII of this section, and his or her spouse for their lifetimes, toward group hospitalization, hospital medical care, surgical care and other medical benefits plan or a self-funded alternative within the limits of the funds appropriated at each legislative session and providing any change in plan is approved by the fiscal committee of the general court, after a duly noticed public hearing on any proposed changes to the plan is held before the fiscal committee, prior to its adoption. Retired employees who are eligible for Medicare may voluntarily cease participation in plan benefits at any time and may reenroll without restriction.
II-a. Retired employees who are eligible for Medicare Part A without premium due to age or disability shall provide proof of enrollment in Medicare Parts A and B within 30 days of becoming eligible for Medicare or they shall no longer be eligible to participate in the state retiree benefit plan for as long as they are not participating in Medicare Parts A and B.
III. The state shall pay a partial premium for each retired employee, as defined in paragraphs VI and VII, who is not eligible for Medicare and for his or her spouse for their lifetimes, toward group health care coverage within the limits of the funds appropriated at each legislative session and providing any change in plan is approved by the fiscal committee of the general court prior to its adoption. Pursuant to paragraph XIII, a portion of the premium shall be paid by each retiree and his or her spouse. Retired employees who are not eligible for Medicare may voluntarily cease participation in plan benefits at any time and, not less than one year from the date of withdrawal, may reenroll without restriction.
IV. Fully dependent minor children, children between the ages of 19 through 25 if full-time students, and any certifiably dependent child with a disability who is institutionalized or living in the household and being cared for by the qualified retired member, the member's spouse, or the qualified surviving spouse, and whose certificate is on file, shall be eligible for this plan on payment of a premium as long as they are eligible for the plan benefit per the foregoing requirements. The amount of the premium shall be the full cost of the plan benefits as determined by the department of administrative services. Participants may voluntarily cease participation in plan benefits at any time.
V. (a) Retirees shall be responsible for verification of eligibility by standard acceptable documentation determined by the department of administrative services. Verification documentation shall be produced during a period of 60 days prior to retirement to 60 days after retirement. Failure to file subsequent changes in eligibility within 60 days of occurrence may result in the permanent cessation of plan benefits.
(b) If an unmarried retiree marries after retirement, the benefit plan shall be extended to the new spouse. Notwithstanding paragraph II, if a married retiree divorces after retirement, the divorced spouse shall no longer be eligible to participate in the benefit plan but shall be offered a federal COBRA benefit option.
(c) No retired employee or active employee may be enrolled in the retiree benefit plan under this section if otherwise enrolled in an active state employee benefit plan sponsored by the state.
VI. For the purposes of this section, "retired employee" means each group I state employee who:
(a)(1) Has at least 10 years of creditable service for the state if the employee's service began prior to July 1, 2003 or 20 years of creditable service if the employee's service began on or after July 1, 2003 and prior to July 1, 2011, and who also is at least 60 years of age at the time of retirement; or
(2) Has at least 20 years of creditable service if the employee's service began on or after July 1, 2011, and who also is at least 60 years of age at the time of retirement, provided the employee shall not be eligible to receive benefits under this section until attaining 65 years of age; or
(b) Has at least 30 years of creditable service for the state at the time of retirement if the employee's service began prior to July 1, 2011, regardless of the employee's age; or
(c) Is but for the provisions of 1989, 376:10, otherwise eligible to receive medical and surgical benefits under this section notwithstanding subparagraphs (a) and (b), and paragraph IV, on June 30, 1989, and who retires between July 1, 1989, and June 30, 1994; or
(d) Dies or retires and is eligible for accidental death or accidental disability retirement benefits, regardless of the state employee's age or number of years of creditable service; or
(e) Retires and is eligible for ordinary disability retirement benefits, regardless of the state employee's age; or
(f) Dies and is eligible for ordinary death retirement benefits, if the state employee was eligible for service retirement at the time of his or her death, if the state employee had at least 10 years of creditable service for the state if the employee's service began prior to July 1, 2003 or 20 years of creditable service if the employee's service began on or after July 1, 2003.
VII. For the purposes of this section, "retired employee" also means each group II state employee who:
(a) Retires if the employee's state service began prior to July 1, 2010 or who retires with at least 20 years of creditable service for the state if the employee's state service began on or after July 1, 2010; or
(b) Dies or retires and is eligible for accidental death or accidental disability retirement benefits, regardless of the state employee's age or number of years of creditable service; or
(c) Retires and is eligible for ordinary disability retirement benefits, regardless of the state employee's age; or
(d) Dies and is eligible for ordinary death retirement benefits, if the state employee was eligible for service retirement at the time of his or her death, if the state employee had at least 20 years of creditable service for the state if the employee's state service began on or after July 1, 2010.
VIII. Any vested deferred state retiree may receive medical and surgical benefits under this section if the vested deferred state retiree is eligible. To be eligible, a group I vested deferred state retiree shall have at least 10 years of creditable service with the state if the employee's service began prior to July 1, 2003 or 20 years of creditable service with the state if the employee's service began on or after July 1, 2003 and a group II vested deferred state retiree shall have at least 20 years of creditable service with the state if the employee's service with the state began on or after July 1, 2010. In addition, if the vested deferred state retiree is a member of group I, such retiree shall be at least 60 years of age to be eligible. If the vested deferred state retiree is a member of group II who is in vested status before January 1, 2012, such retiree shall not be eligible until 20 years from the date of becoming a member of group II and shall be at least 45 years of age, and any group II member who commenced service on or after July 1, 2011 shall not be eligible until 25 years from the date of becoming a member of group II and shall be at least 52.5 years of age, and group II members who have not attained vested status prior to January 1, 2012 shall be as provided in the transition provisions in RSA 100-A:5, II(d).
IX. Each state employee who has at least 10 years of creditable service for the state if the employee's service began prior to July 1, 2003 or 20 years of creditable service if the employee's service began on or after July 1, 2003 and prior to July 1, 2011, and who elects to take a reduced service retirement allowance shall be defined as a "retired employee" for the purposes of being eligible to receive medical and surgical benefits under this section when the state employee reaches age 60.
X. No state employee who terminates his or her state service before he or she becomes eligible for retirement benefits as a "retired employee" as defined under paragraphs VI-IX shall be eligible for medical and surgical benefits under this section.
XI. A state employee who commences service on or after July 1, 2011 and who is eligible for benefits under this section shall not receive such benefit until attaining age 52.5 if the state employee retired from group II service with the state or attaining age 65 if the state employee retired from group I service with the state.
XII. As of January 2, 2012, the commissioner of administrative services is authorized to utilize managed care and/or cost containment techniques for the state of New Hampshire retiree health care program through the underlying insurer and any additional specialized managed care or cost containment vendors as necessary. The commissioner may offer financial incentives to encourage the use of lower cost facilities, providers, and services, if the financial incentives are proportionately lower than the savings generated. In addition, the commissioner may offer financial incentives to encourage the use of alternative therapies, treatments, services, providers, and facilities that demonstrate better outcomes including, but not limited to lower complication rates, lower readmission rates, lower rejection rates, lower mortality and morbidity rates, or lower infection rates based on widely and generally accepted measures of such performance.
XIII. (a) The commissioner of administrative services shall invoice and collect from retired state employees and/or each applicable spouse who are not Medicare eligible and receiving medical and surgical benefits provided under this section, who do not receive a retirement allowance as defined in RSA 100-A:1, XXII, a premium contribution amount based on a percentage of the total monthly premium attributable to the applicable retiree and/or spouse, as determined by the commissioner of administrative services, with prior approval by the fiscal committee of the general court, provided the percentage is not lower than 20 percent.
(b) The commissioner of administrative services shall invoice and collect from retired state employees and/or spouses who are eligible for Medicare Parts A and B due to age or disability receiving medical and surgical benefits provided under this section, who do not receive a retirement allowance as defined in RSA 100-A:1, XXII, a premium contribution amount based on a percentage of the total monthly premium attributable to the applicable retiree and/or spouse, as determined by the commissioner of administrative services, with prior approval by the fiscal committee of the general court, provided the percentage is not lower than 10 percent. Such premium contribution shall only be collected from eligible state retirees and spouses with a date of birth on or after January 1, 1949.
(c) The commissioner of administrative services is also authorized to invoice and collect from such other participants contribution amounts as specified by law.
(d) Collected amounts shall be deposited in the employee and retiree benefit risk management fund. Failure to remit payment of the contribution amount in full within 30 days of billing shall be grounds for terminating benefits, effective from the beginning of the billing period. Reenrollment shall be dependent upon payment of any outstanding contribution or other amounts within 6 months of the termination date. If a participant fails to remit payment in full for participation within 30 days of billing, on the 30th day the participant shall be notified by certified mail, return receipt requested, that he or she shall remit payment to the department within 10 business days of receiving the letter or his or her benefits shall be terminated effective upon the 10th business day after receipt of the letter and that reenrollment shall be dependent upon payment of any outstanding contribution or other amount within 6 months of the termination date.
XIV. The department of administrative services shall provide a summary of the provisions of this section for inclusion in any pre- or post-retirement counseling, whether verbal or written.
XV. Funds appropriated for the purposes of this section shall not be transferred or used for any other purpose.
XVI. The New Hampshire retiree health care program shall not pay for any medications that are available for purchase without a prescription.
XVII. The cost sharing and plan design for unrepresented active state employees who participate in the health plans offered by the state shall be the same as those for individuals covered by the collective bargaining agreement between the state of New Hampshire and the State Employees' Association of New Hampshire, Inc. Changes to the above plan design cost sharing provisions consistent with RSA 21-I:30, I are permitted with the prior approval of the fiscal committee of the general court. The cost sharing and plan designs for represented active state employees who participate in the health plans offered by the state shall be in accordance with the provisions of the collective bargaining agreements between the state and the employee organizations representing those employees.
XVIII. Agencies may use funds in existing class 60 budgets to pay any penalties imposed under the employer shared responsibility for health coverage under section 4980H of the Internal Revenue Code.

Source. 1985, 399:1. 1990, 209:1. 1991, 355:4. 1993, 276:1, 2; 358:86. 2001, 251:2. 2003, 291:1. 2010, 104:1. 2011, 224:165, 345, eff. July 1, 2011; 242:1, eff. July 1, 2011 at 12:01 a.m. 2012, 175:1, eff. July 1, 2012; 215:2, eff. Aug. 12, 2012. 2015, 276:12-14, 181, eff. July 1, 2015. 2016, 123:1, eff. July 19, 2016. 2017, 77:1, eff. June 2, 2017; 156:6, 7, eff. Jan. 1, 2018; 156:11, eff. July 1, 2017. 2021, 91:9, eff. July 1, 2021.