§ 24-51-1202 — Health care program - design

(1) (a) The board shall design a
group health care program for retirees, members, DPS members, DPS retirees, and
their dependents, with or without full medicare coverage provided by the federal
Health Insurance for the Aged Act, 42 U.S.C. sec. 1395, as amended. This program
shall provide health-care benefits and a level of reimbursement for health-care
expenses which are consistent with prevailing community practices and other
governmental health-care systems, protection from catastrophic financial loss, and
current and long-term fiscal soundness of the trust fund as determined by the
board.

(b) Any group health-care plan offered by the board that provides pharmacy
benefits through the services of a pharmacy benefits manager shall require such
manager to allow participation by any nonmail order retail pharmacy provider
licensed in the state of Colorado if such pharmacy provider agrees to accept the
fee schedule, terms, and conditions of participation established by the plan's
pharmacy benefits manager.

(1.5) Any employer, as defined by section 24-51-101 (20), may elect to provide
health-care coverage through the health care program for its employees who are
members. Participation in the health care program by an employer shall be
voluntary and in the employer's sole discretion and shall not be mandatory for the
employer.

(2) The board shall establish procedures for enrollment and determine the
methods of claims administration for the health care program.

(3) (a) The board shall ensure that the premium amount for the health care
program is paid by those individuals enrolled in said program.

(b) The premium amount for a benefit recipient shall be deducted from
monthly benefits. If the premium amount exceeds the monthly benefits, the excess
amount shall be collected from the benefit recipient directly. The premium amount
for a member shall be collected directly from the member's employer.

(c) Surviving spouses and divorced spouses enrolled in the health care
program pursuant to the provisions of section 24-51-1204 (1)(b) and (1)(c) shall
directly pay the premium amount.

(d) If an individual who is directly paying for enrollment in the health care
program fails to pay the premium amount within a reasonable period of time, as
determined by the board, the association shall notify the individual that enrollment
may be canceled within thirty days if payment is not received.

(4) The board may change the design and costs of the health care program
at any time. Individuals enrolled in the health care program shall be notified thirty
days prior to any change.

(5) DPS retirees may enroll in the association's health care program subject
to the provisions of this part 12.

Legislative History

Source: L. 87: Entire article, R&RE, p. 1075, � 1, effective July 1. L. 99: (1) and (3)(b) amended and (1.5) added, p. 342, � 7, effective January 1, 2001. L. 2009: (1)(a) amended and (5) added, (SB 09-282), ch. 288, p. 1348, � 46, effective January 1, 2010.