Bd. of Trust. of State Empl. v. St. Landry

844 So. 2d 90, 2003 WL 367923
CourtLouisiana Court of Appeal
DecidedFebruary 14, 2003
Docket2002 CA 0393
StatusPublished
Cited by12 cases

This text of 844 So. 2d 90 (Bd. of Trust. of State Empl. v. St. Landry) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bd. of Trust. of State Empl. v. St. Landry, 844 So. 2d 90, 2003 WL 367923 (La. Ct. App. 2003).

Opinion

844 So.2d 90 (2003)

BOARD OF TRUSTEES OF STATE EMPLOYEES GROUP BENEFITS PROGRAM
v.
The ST. LANDRY PARISH BOARD, et al.

No. 2002 CA 0393.

Court of Appeal of Louisiana, First Circuit.

February 14, 2003.
Writ Denied May 9, 2003.

*91 H. Alston Johnson, III, Baton Rouge, Counsel for Plaintiff/Appellant The Board *92 of Trustees of the State Employees Group Benefits Program.

Asa A. Skinner, First Assistant District Attorney, Terry W. Lambright, Assistant District Attorney, Leesville, Counsel for Defendant/Appellee Vernon Parish School Board.

A. Gerard Caswell, Eunice, Counsel for Defendant/Appellee St. Landry Parish School Board.

Before: KUHN, DOWNING, and GAIDRY, JJ.

KUHN, J.

The Board of Trustees of the State Employees Group Benefits Program (the "Board of Trustees") filed this suit seeking a declaratory judgment against the St. Landry Parish School Board and the Vernon Parish School Board ("the School Boards"). The Board of Trustees sought a ruling that it was entitled to "risk-rate" the teachers, other school board employees, and persons retired from those positions ("school board participants") upon their entrance into the State Employees Group Benefits Program ("the State Group Program" or "the Program") after participating in another group health and accident program. "Risk-rating" would allow the Board of Trustees to set the premium for these school board participants at "the greater of the premium rate based on the loss experience of the group under the prior plan or the premium rate based on the loss experience of the classification into which the group is entering" as referred to in Acts 1988, No. 902, § 1 (former La. R.S. 42:851 A(5)(b)(iii)). The School Boards reconvened, alleging that the Board of Trustees had improperly "risk-rated" the school board participants for the first year of participation in the program based on the provisions of Acts 1992, No. 601 (former La. R.S. 42:881).[1] This provision imposes "risk-rating" on participants from entities that have 50% or more of its employees participating in a health maintenance organization ("HMO"). The School Boards sought a refund of the additional premiums collected based on the "risk-rating" practice.

In response to each party's motion for summary judgment, the trial court signed a judgment denying the Board of Trustees' motion for summary judgment and granting the School Boards' motions. The trial court ordered the Board of Trustees to refund the additional premiums that the School Boards paid due to the "risk-rating." Finding merit in the arguments advanced by the Board of Trustees on appeal, we reverse and render judgment in its favor.

I. FACTUAL AND PROCEDURAL BACKGROUND

The State Group Program and its Board are authorized to provide health and accident coverage for eligible state employees and retired employees either through securing private contracts of insurance or by operating a self-funded program for that same purpose.[2] La. R.S. 42:851 A(1)(a). Teachers, other school board employees, and persons retired from those positions are considered "state employees" and are entitled to participate in the State Group Program. La. R.S. 42:851 B. City and Parish School Boards may enter into private *93 contracts of insurance without the approval of the Board of Trustees. La. R.S. 42:851 A(1)(b). When these boards opt to participate in the State Group Program after having been covered by another program, they are required to remain as a participant in the State Group Program for a minimum of three years. La. R.S. 42:851 D.

The Louisiana Legislature passed Acts 1988, No.902, effective September 8, 1988, designated La. R.S. 42:851 A(5)(b)(iii), which describes the method of calculating the premiums for an entering school board group, referred to as "risk-rating":

If a school board elects to participate in [the State Group Program] after participation in another group health and accident program, the premium rate applicable to [school board participants] intended to be covered by the program shall be the greater of the premium rate based on the loss experience of the group under the prior plan or the premium rate based on the loss experience of the classification into which the group is entering.

Acts 1988, No. 1009 also amended and reenacted La R.S. 42:851(A)(5)(b) to authorize the Board to group risks into three or more classifications, specifically providing that "there may be one classification for employees of eligible school boards."

In the proceedings below, the parties stipulated to the following uncontested facts:

On September 15, 1988, the Board of Trustees met and adopted a resolution addressing the entry of school boards into the Program. Although the resolution was never promulgated as a formal Rule, it was also never utilized since no school boards sought entry into the Program until October 1, 1993. On April 18, 1991, the Board of Trustees adopted an emergency rule providing, in pertinent part, that "riskrating" of school boards entering the Program would be for a period of no longer than one year. A final rule implementing that provision was promulgated on September 20,1991.

The Monroe City School Board, the Tangipahoa Parish School Board, the St. Tammany Parish School Board and the Madison Parish School Board elected to participate in the Program, with effective dates between July 1991 and October 1992. Each school board was "risk-rated" for one year.

Thereafter, the Louisiana Legislature passed Acts 1992, No. 601, effective July 2, 1992, which became La. R.S. 42:881, providing as follows:

Notwithstanding any other provision of law to the contrary, if fifty percent or more of the employees of an entity which initially becomes a participant employer in the [State Group Program] on or after July 1, 1993, elect to be members of a health maintenance organization licensed to do business in this state, or on any successive July first following the initial enrollment of said entity, if more than fifty percent of the employees of said entity elect to participate in a health maintenance organization, the remaining employees of said entity participating in the health indemnity plan of the [State Group Program] shall be charged a premium rate for that fiscal year based upon their collective claims experience during the previous fiscal year, or that portion of the previous fiscal year during which they were members of the [State Group Program]. This Section shall have no effect upon entities participating in the [State Group Program] prior to July 1, 1993.

Prior to the enactment of Act 601, the Board of Trustees had no authority to "risk-rate" any entity other than school *94 boards, and the Board of Trustees was not "risk-rating" any group other than school boards.

On September 16, 1992, the Management Committee of the Board of Trustees met to discuss changes in the rules concerning school boards' entry into the Program after July 1, 1993. On October 8, 1992, the Board of Trustees adopted a resolution providing that effective July 1, 1993, all new entities that do not have greater than 50% participation in the Program would be "risk-rated" upon entry and would remain "risk-rated" until there was greater than 50% participation in the Program in accordance with Act 601. Although the Board of Trustees published a Notice of Intent regarding this resolution in the November 19, 1992 Louisiana Register, no final rule regarding this resolution was ever adopted or published in the Register.

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844 So. 2d 90, 2003 WL 367923, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bd-of-trust-of-state-empl-v-st-landry-lactapp-2003.