§ 9-3-205 — Administration and management of group insurance program; powers and duties; adoption of rules and regulations; interfund borrowing authority

Wyoming § 9-3-205

• Jurisdiction: Wyoming
• Title 09: Administration of the Government
• Ch. 3: COMPENSATION AND BENEFITS
• Art. 2: INSURANCE PLANS

Text

(a) The department shall administer and manage the state
employees' and officials' group insurance program in accordance
with all provisions of title 26 of the Wyoming statutes
governing group health benefit plans and rules promulgated
thereto. The department, subject to the provisions of this act:
(i) Shall prepare specifications for the health
insurance plan and a supplemental plan, the life insurance plan
and any other group insurance plan contracted for by the
department;
(ii) Shall contract with carriers to underwrite group
or supplemental insurance plans;
(iii) Shall determine the methods of claims
administration, consistent with title 26 of the Wyoming
statutes, under group insurance or supplemental plans, whether
by the state or carrier or both;
(iv) Shall determine the eligibility of employees,
officials and their dependents to participate in group insurance
and supplemental plans;
(v) Shall determine the amount of employee payroll
deductions;
(vi) Shall establish a procedure by which the
department shall hear complaints by insured employees concerning
the allowance and payment of claims, eligibility for coverage
and other matters. The department shall take into consideration
the authority of the department of insurance to investigate
complaints pursuant to title 26 of the Wyoming statutes when
establishing this procedure. Unless otherwise provided in the
group insurance or supplemental plan or plans, any decision of
the department upon complaints is not binding upon either the
employee or carrier and the provisions of the Wyoming
Administrative Procedure Act shall not apply to the proceedings.
The group insurance or supplemental plan or plans may provide
that the decision of the department shall be binding upon both
the employee and the carrier as to certain disputes and in such
event the procedure adopted by the department shall conform to
the provisions of the Wyoming Administrative Procedure Act;
(vii) Shall administer state group insurance reserve
monies;
(viii) Shall continuously study the operation of the
group insurance plan including analysis of:
(A) Gross and net costs, including
administrative costs;
(B) Claims administration;
(C) Comprehensive health claims utilization
information to determine the causes of plan health care cost
increases and strategies to control those costs;
(D) Factors in the plan's design that may
adversely affect participation;
(E) The effect of benefit changes;
(F) Contribution levels and recommendations to
attract a broad mix of participants to the plan;
(G) Demographic information about existing and
eligible participants;
(H) Trends in costs and benefits of the plan
relative to other plans.
(ix) May enter into a contract with a carrier to
underwrite a supplemental plan and negotiate and enter into
amendments to existing health insurance contracts to provide a
supplemental plan and determine an effective date;
(x) May determine that employees, officials and their
dependents who are eligible for medicare or medicaid, or both,
shall be eligible for a supplemental plan and, upon the
effective date of the supplemental plan as to employees,
officials and their dependents presently covered by the health
insurance plan, may transfer them from the health insurance plan
to the supplemental plan;
(xi) May negotiate and enter into amendments to
existing contracts providing group insurance and supplemental
plans to provide appropriate coverage for employees and
officials who may become eligible for coverage after the
effective date of those contracts and to provide for their
enrollment;
(xii) May contract with carriers to underwrite
optional group insurance plans which may be additions to or
supplemental to those plans contracted under this act and which
are paid for entirely by employees and officials, entirely by
the employer, or by both. The contracts shall be designed to
provide the fullest benefits at the lowest cost, and the
department may contract with the same carriers for the optional
group insurance plans as for the other plans contracted for
under this act;
(xiii) May contract with any person for the
furnishing of actuarial services, the preparation of
specifications for group insurance plans and other specialized
services which cannot be performed by the department or by state
employees. Contracts for these services shall be awarded through
responsible competitive bidding at intervals as the department
determines, and shall be reviewed annually by the department;
(xiv) May develop, implement and administer a
flexible benefits plan and may contract with carriers,
third-party administrators or other professionals to develop,
administer and implement a flexible benefits plan;
(xv) Repealed By Laws 2001, Ch. 55, § 3.
(xvi) Have authority to audit payroll records of
voluntary participating employers to ensure compliance with
requirements of this act.
(b) The department shall adopt rules and regulations
consistent with the provisions of this act as necessary to carry
out its statutory duties and responsibilities under this act.
(c) For the purposes of determining financial condition,
ability to fulfill and the manner of fulfillment of its
statutory duties, the nature of its operations and compliance
with law, the insurance commissioner shall examine the affairs,
accounts, records and assets of the Wyoming state employees' and
officials' group insurance plan, as often as he deems advisable
but not less frequently than every three (3) years. The
insurance commissioner may adopt rules consistent with the
provisions of this act and title 26 of the Wyoming statutes to
identify procedures for conducting examinations of the Wyoming
state employees' and officials' group insurance program.
(d) The department shall report the results of the
analysis conducted pursuant to paragraph (a)(viii) of this
section and suggested activities to manage the plan by December
1 of each year to a committee of the legislature designated by
the management council.
(e) Repealed by Laws 2023, ch. 165, § 2.