Bd. of Educ. v. State Health Ben. Com'n

715 A.2d 358, 314 N.J. Super. 486
CourtNew Jersey Superior Court Appellate Division
DecidedAugust 27, 1998
StatusPublished
Cited by6 cases

This text of 715 A.2d 358 (Bd. of Educ. v. State Health Ben. Com'n) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bd. of Educ. v. State Health Ben. Com'n, 715 A.2d 358, 314 N.J. Super. 486 (N.J. Ct. App. 1998).

Opinion

715 A.2d 358 (1998)
314 N.J. Super. 486

BOARD OF EDUCATION OF THE UPPER FREEHOLD REGIONAL SCHOOL DISTRICT, Plaintiff-Appellant,
v.
STATE HEALTH BENEFITS COMMISSION, Defendant-Respondent.

Superior Court of New Jersey, Appellate Division.

Argued March 4, 1998.
Decided August 27, 1998.

Howard M. Newman, Neptune, for plaintiff-appellant (Kalac, Newman, Lavender & Campbell, attorneys; Mr. Newman, on the brief).

Sherrie L. Gibble, Deputy Attorney General, for defendant-respondent (Peter Verniero, Attorney General, attorney; Joseph L. Yannotti, Assistant Attorney General, of counsel; Ms. Gibble, on the brief).

*359 Before Judges KING, KESTIN and CUFF.

The opinion of the court was delivered by KESTIN, J.A.D.

By way of order to show cause and verified complaint, plaintiff, Board of Education of the Upper Freehold Regional School District (Board), sued in the Chancery Division to enjoin the State Health Benefits Commission (Commission) from "attempting to decide the controversy between the parties ... by any administrative procedure pursuant to any adjudicatory authority incorrectly and illegally assumed" by the Commission. The trial court determined that the Commission had properly asserted its authority to adjudicate the controversy administratively as a contested case pursuant to the Administrative Procedure Act, N.J.S.A. 52:14B-9, -10, subject to judicial review in the Appellate Division, R. 2:2-3(a)(2). Accordingly, the complaint was dismissed. The Board appeals. We affirm.

The genesis of the controversy occurred during the 1992-93 school year when the Board negotiated a successor collective agreement with an employee representative. Under the old contract, scheduled to expire on June 30, 1993, the Board had provided health benefits through the State Health Benefits Plan (SHBP or Plan) administered by the Commission pursuant to statute, N.J.S.A. 52:14-17.25 to -17.45. Under the new contract, effective September 1, 1993, the Board would provide health benefits through a private plan. The Board was to withdraw from the SHBP.

By a short certified letter, dated June 15, 1993 and received on June 17, the Board notified the Commission of its withdrawal effective September 1. The letter, in its essential entirety, declared:

The Upper Freehold Regional School District is withdrawing from the New Jersey State Health Benefits Program effective September 1, 1993. We are changing our health insurance carrier to CIGNA.
If you have any questions or need additional information, please let us know.

The Commission responded in a letter dated July 20, which, in its provisions material to this dispute, advised:

Since initial enrollment in the program is accomplished by a resolution adopted by the governing body, likewise, termination of participation must be accomplished in the same manner. I am enclosing the resolution which must be completed in its entirety. You should note the 60 day time element involved before termination will occur[.]
* * * *
As a terminating location, the following regulations deserve your attention:
* * * *
b) Before the final approval of your termination can be processed by the State Health Benefits Commission, all monetary obligations must be paid. Following our audit of your account, you will receive a separate and final billing for any shortages outstanding spanning your period of participation in the State Health Benefits Program. Also, at this time, a refund check will be issued to those locations showing overpayment. ABSOLUTELY NO ADJUSTMENTS SHOULD BE MADE TO YOUR FINAL PAYMENT.
c) Also, before the final approval of your termination can be processed by the State Health Benefits Commission, you must provide adequate documentation of your new program. In accordance with N.J.S.A. 18A:16-21, 52:14-17.27 and 40A:10-25. This documentation must include:

1. A copy of the new insurance or replacement contract.

2. The date the contract becomes effective.

3. The first year's premium under the contract.

4. The second year's projected premium.

5. Premiums for retirees, COBRA and conversion policy paying members.

6. A statement as to whether the premiums include incurred but unreported claims, or whether such claims would be *360 handled through an exit charge or other additional payment upon leaving the plan.

The Commission's letter was received after the Board's July meeting. Thus, the necessary resolution was adopted on August 25, providing for withdrawal effective September 1. It was immediately sent to the Commission.

In a letter dated August 31, the Commission took the position that the Board's withdrawal could be effective no earlier than November 1:

[T]here is a 60 day period after the receipt of the resolution before the termination can be effected. On this basis, we have scheduled your termination from the State Health Benefits Program for November 1, 1993.
* * * *
b) Before the final approval of your termination can be processed by the State Health Benefits Commission, all monetary obligations must be paid. Following our audit of your account, you will receive a separate and final billing for any shortages outstanding spanning your period of participation in the State Health Benefits Program. Also, at this time a refund check will be issued to those locations showing overpayment. ABSOLUTELY NO ADJUSTMENTS SHOULD BE MADE TO YOUR FINAL PAYMENT.

Subsequently, the Commission billed the Board $178,585.40 for anticipated health insurance premiums for September and October. In an exchange of letters, the Board, maintaining its position that its withdrawal was effective September 1, returned the Commission's billing statement.

By all accounts to date, no health benefits claim was paid to any Board employee under the Plan on or after September 1, 1993. Pursuant to the Board's contractual obligations with its employees, premiums have been paid to the private health plan carrier since that date.

In a letter dated February 4, 1994, the Commission modified its position on the amount due from the Board, proposing to resolve the claim for $91,139.52. That total was represented as reflecting amounts actually paid in administrative fees to the Plan's insurance carrier administrators for the Board's coverage during September and October 1993, plus HMO capitation premiums paid for those months, plus the search fees charged by the administrators to determine if any claims from Board employees in those months had been paid. The Board rejected the Commission's proposal in a February 8 letter, which stated:

It is the position of the Board of Education that the notice provided to the State Health Benefits Director on June 15, 1993, should have been sufficient to effect a withdrawal from the State Health Benefits Program. For some unexplained reason, no one at the State Health Benefits Commission ever contacted the Board Secretary to obtain any further information or documentation regarding the Board's withdrawal, until more than one month had transpired.

Thereafter, the Commission declared the controversy to be a contested case and referred it to the Office of Administrative Law for a hearing and initial decision. See N.J.S.A. 52:14B-10(c).

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715 A.2d 358, 314 N.J. Super. 486, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bd-of-educ-v-state-health-ben-comn-njsuperctappdiv-1998.