Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 8.00 - MUNICIPAL HEALTH COVERAGE › Section 8.02 - Health Coverage Payments

Current through Register 1525, July 5, 2024
(1) The
			 Commission shall determine the full cost rates for Health Coverage, to be
			 shared by the Municipal Employer and Municipal Insureds. The full cost rates
			 shall consist of a premium cost and an administrative fee determined by the
			 Commission. The administrative fee shall not exceed 1% of the premium
			 cost.
(2) The Municipal Employer
			 shall arrange for all Municipal Insureds' premium contributions to be deducted
			 from their paychecks or retirement allowance one month in advance of
			 coverage.
(3) No later than March
			 1st, the Municipal Employer shall notify the
			 Commission of any change to Municipal Insureds' premium contribution ratios.
			 Changes to contribution ratios shall be effective July
			 1st.
(4)
			 The Municipal Employer shall transmit monthly to the Commission the full cost
			 of Municipal Insureds' Health Coverage, including the applicable administrative
			 fee. Payment of Municipal Insureds' Health Coverage is due on a date determined
			 by the Commission. The Commission shall invoice the Municipal Employer on a
			 monthly billing cycle for the full cost health insurance premium liability and
			 administrative fee. Monthly invoices are available through the Commission's
			 eligibility system, MAGIC, and invoices must be reconciled to the payment
			 submitted to the Commission. If the Municipality does not pay the invoice in
			 full, the Commission will bill the Municipality for outstanding balances until
			 full payment is made or discrepancies are reported and reconciled. Failure to
			 remit full payment may result in cancellation of coverage for that
			 Municipality's enrollees. Adjustments will be separately noted on the following
			 month's invoice on the eligibility system.
(a)
			 In the event that a Municipal Employer fails to pay the cost of its Insureds'
			 Health Coverage within 30 days of the premium due date, the Commission shall
			 send an overdue notice to the Municipal Employer. Payments not received after
			 30 days' delinquency will be subject to interest charges and further
			 action.
(b) The Commission shall
			 notify the Public Employee Committee, the Municipal Employer, and the Executive
			 Office for Administration and Finance of the delinquency and the Commission's
			 intention to cancel coverage if the Municipal Employer fails to pay the full
			 amount in arrears for more than 60 days from the invoice due date.
(c) As to remaining arrearages, the
			 Commission may inform the state treasurer who shall issue a warrant in the
			 manner provided by M.G.L. c. 59, § 20 requiring the Municipal Employer to
			 pay into the treasury, as prescribed by the Commission, the amount of the
			 premium and administrative expenses attributable to the political subdivision,
see
M.G.L. c. 58, § 20A.
(d) If any amount remains in arrears at the
			 end of a 90-day period, the Commission may begin termination proceedings of the
			 Municipal Employer's health coverage, and the Municipal Employer may be
			 responsible for all claims incurred during the period in which the full premium
			 was not paid.