54-52.1 Uniform Group Insurance Program - North Dakota Statutes

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CHAPTER 54-52.1UNIFORM GROUP INSURANCE PROGRAM54-52.1-01. Definitions. As used in this chapter, unless the context otherwise requires:1."Board" means the public employees retirement board.2."Carrier" means:a.For the hospital benefits coverage, an insurance company authorized to do
business in the state, or a nonprofit hospital service association, or a prepaid
group practice hospital care plan authorized to do business in the state, or the
state if a self-insurance plan is used for providing hospital benefits coverage.b.For the medical benefits coverage, an insurance company authorized to do
business in the state, or a nonprofit medical service association, or a prepaid
group practice medical care plan authorized to do business in the state, or the
state if a self-insurance plan is used for providing medical benefits coverage.c.For the life insurance benefits coverage, an insurance company authorized to
do business in the state.3."Department, board, or agency" means the departments, boards, agencies, or
associations of this state, and includes the state's charitable, penal, and higher
educational institutions; the Bank of North Dakota; the state mill and elevator
association; and counties, cities, district health units, and school districts.4."Eligible employee" means every permanent employee who is employed by a
governmental unit, as that term is defined in section 54-52-01. "Eligible employee"
includes members of the legislative assembly, judges of the supreme court, paid
members of state or political subdivision boards, commissions, or associations,
full-time employees of political subdivisions, elective state officers as defined by
subsection 2 of section 54-06-01, and disabled permanent employees who are
receiving compensation from the North Dakota workforce safety and insurance fund.
As used in this subsection, "permanent employee" means one whose services are
not limited in duration, who is filling an approved and regularly funded position in a
governmental unit, and who is employed at least seventeen and one-half hours per
week and at least five months each year or for those first employed after August 1,
2003, is employed at least twenty hours per week and at least twenty weeks each
year of employment.For purposes of sections 54-52.1-04.1, 54-52.1-04.7,54-52.1-04.8, and 54-52.1-11, "eligible employee" includes retired and terminated
employees who remain eligible to participate in the uniform group insurance
program pursuant to applicable state or federal law.5."Health maintenance organization" means an organization certified to establish and
operate a health maintenance organization in compliance with chapter 26.1-18.1.6."Hospital benefits coverage" means a plan which either provides coverage for, or
pays, or reimburses expenses for hospital services incurred in accordance with the
uniform contract.7."Life insurance benefits coverage" means a plan which provides both term life
insurance and accidental death and dismemberment insurance in amounts
determined by the board, with a minimum of one thousand dollars provided for the
term life insurance portion of the coverage.Page No. 18."Medical benefits coverage" means a plan which either provides coverage for, or
pays, or reimburses expenses for medical services in accordance with the uniform
contract.9."Member contribution" means the payment by the member into the retiree health
benefits fund pursuant to sections 54-52-02.9 and 54-52-17.4.10."Member's account balance" means the member's contributions plus interest at the
rate set by the board.11."Temporary employee" means a governmental unit employee who is not filling an
approved and regularly funded position in an eligible governmental unit and whose
services may or may not be limited in duration.54-52.1-02. Uniform group insurance program created - Formation into subgroups.In order to promote the economy and efficiency of employment in the state's service, reduce
personnel turnover, and offer an incentive to high-grade men and women to enter and remain in
the service of state employment, there is hereby created a uniform group insurance program.
The uniform group must be composed of eligible and retired employees and be formed to
provide hospital benefits coverage, medical benefits coverage, and life insurance benefits
coverage in the manner set forth in this chapter. The uniform group may be divided into the
following subgroups at the discretion of the board:1.Medical and hospital benefits coverage group consisting of active eligible employees
and retired employees not eligible for medicare.In determining premiums forcoverage under this subsection for retired employees not eligible for medicare, the
rate for a non-medicare retiree single plan is one hundred fifty percent of the active
member single plan rate, the rate for a non-medicare retiree family plan of two
people is twice the non-medicare retiree single plan rate, and the rate for a
non-medicare retiree family plan of three or more persons is two and one-half times
the non-medicare retiree single plan rate.2.Retired medicare-eligible employee group medical and hospital benefits coverage.3.Active eligible employee life insurance benefits coverage.4.Retired employee life insurance benefits coverage.5.Terminated employee continuation group medical and hospital benefits coverage.6.Terminated employee conversion group medical and hospital benefits coverage.7.Dental benefits coverage.8.Vision benefits coverage.9.Long-term care benefits coverage.10.Employee assistance benefits coverage.11.Retired medicare-eligible employee group prescription drug coverage.54-52.1-03.Employee participation in plan - Employee to furnish information -Benefits to continue upon retirement or termination.1.Any eligible employee may be enrolled in the uniform group insurance program
created by this chapter by requesting enrollment with the employing department. If
an eligible employee does not enroll in the uniform group insurance program at thePage No. 2time of beginning employment, the eligible employee must meet minimum
requirements established by the board to enroll thereafter.2.Within five days after the expiration of the payroll period during which enrollment
was requested, the employing department shall enroll the employee with the board.
The employee's insurance coverage becomes effective on the date of enrollment.3.A retiree who has accepted a periodic distribution from the defined contribution
retirement plan pursuant to section 54-52.6-13 who the board determines is eligible
for participation in the uniform group insurance program or has accepted a
retirement allowance from the public employees retirement system, the highway
patrolmen's retirement system, the teachers' insurance and annuity association of
America - college retirement equities fund for service credit earned while employed
by North Dakota institutions of higher education, the retirement system established
by job service North Dakota under section 52-11-01, the judges' retirement system
established under chapter 27-17, or the teachers' fund for retirement may elect to
participate in the uniform group under this chapter without meeting minimum
requirements at age sixty-five, when the member's spouse reaches age sixty-five,
upon the receipt of a benefit, or when the spouse terminates employment.If aretiree or surviving spouse does not elect to participate at the times specified in this
subsection, the retiree or surviving spouse must meet the minimum requirements
established by the board. Subject to sections 54-52.1-03.2 and 54-52.1-03.3, each
retiree or surviving spouse shall pay directly to the board the premiums in effect for
the coverage then being provided.A retiree who has met the initial eligibilityrequirements of this subsection to begin participation in the uniform group insurance
program remains eligible as long as the retiree maintains the retiree's participation in
the program by paying the required premium pursuant to rules adopted by the
board.4.Upon the termination of employment when the employee is not eligible to participate
under subsection 3 or 5 or applicable federal law, that employee cannot continue as
a member of the uniform group.5.A member or former member of the legislative assembly or that person's surviving
spouse may elect to continue membership in the uniform group within the applicable
time limitations after either termination of eligible employment as a member of the
legislative assembly or termination of other eligible employment or, for a surviving
spouse, upon the death of the member or former member of the legislative
assembly.The member or former member of the legislative assembly or thatperson's surviving spouse shall pay the premiums in effect for the coverage provided
directly to the board.6.Each eligible employee requesting enrollment shall furnish the appropriate person in
the employing department, board, or agency with such information and in such form
as prescribed by the board to enable the enrollment of the employee, or employee
and dependents, in the uniform group insurance program created by this chapter.7.If the participating employee is a faculty member in a state charitable, penal, or
educational institution who receives a salary or wages on less than a twelve-month
basis and has signed a contract to teach for the next ensuing school year, the
agency shall make arrangements to include that employee in the insurance program
on a twelve-month basis and make the contribution authorized by this section for
each month of the twelve-month period.54-52.1-03.1.Certain political subdivisions authorized to join uniform groupinsurance program - Employer contribution. A political subdivision may extend the benefits of
the uniform group insurance program under this chapter to its permanent employees, subject to
minimum requirements established by the board and a minimum period of participation of sixty
months. If the political subdivision withdraws from participation in the uniform group insurancePage No. 3program, before completing sixty months of participation, the political subdivision shall make
payment to the board in an amount equal to any expenses incurred in the uniform group
insurance program that exceed income received on behalf of the political subdivision's
employees as determined under rules adopted by the board.The Garrison DiversionConservancy District, and district health units required to participate in the public employees
retirement system under section 54-52-02, shall participate in the uniform group insurance
program under the same terms and conditions as state agencies. A retiree who has accepted a
retirement allowance from a participating political subdivision's retirement plan may elect to
participate in the uniform group under this chapter without meeting minimum requirements at
age sixty-five, when the employee's spouse reaches age sixty-five, upon the receipt of a benefit,
when the political subdivision joins the uniform group insurance plan if the retiree was a member
of the former plan, or when the spouse terminates employment. If a retiree or surviving spouse
does not elect to participate at the times specified in this section, the retiree or surviving spouse
must meet the minimum requirements established by the board.Each retiree or survivingspouse shall pay directly to the board the premiums in effect for the coverage then being
provided.The board may require documentation that the retiree has accepted a retirementallowance from an eligible retirement plan other than the public employees retirement system.54-52.1-03.2. Retiree health benefits fund - Appropriation.1.The board shall establish a retiree health benefits fund account with the Bank of
North Dakota for the purpose of prefunding and providing hospital benefits coverage
and medical benefits coverage under the uniform group insurance program for
retired eligible employees or surviving spouses of retired eligible employees and
their dependents as provided in this chapter. The state shall contribute monthly to
the retiree health benefits fund an amount equal to one and fourteen hundredths
percent of the monthly salaries and wages of all participating members of the
highway patrolmen's retirement system under chapter 39-03.1, and one and
fourteen hundredths percent of the monthly salaries of all supreme or district court
judges who are participating members of the public employees retirement system
under chapter 54-52.Each governmental unit that contributes to the publicemployees retirement system fund under section 54-52-06 or the retirement plan
under chapter 54-52.6 shall contribute monthly to the retiree health benefits fund an
amount equal to one and fourteen hundredths percent of the monthly salaries or
wages of all participating members of the public employees retirement system under
chapter 54-52 or chapter 54-52.6, except for nonteaching employees of the
superintendent of public instruction who elect to participate in the public employees
retirement system pursuant to section 54-52-02.13 and employees of the state
board for career and technical education who elect to participate in the public
employees retirement system pursuant to section 54-52-02.14.For nonteachingemployees of the superintendent of public instruction who elect to participate in the
public employees retirement system pursuant to section 54-52-02.13, the
superintendent of public instruction shall contribute monthly to the retiree health
benefits fund an amount equal to three and twenty-four hundredths percent of the
monthly salaries or wages of those nonteaching employee members, beginning on
the first of the month following the transfer under section 54-52-02.13 and continuing
thereafter for a period of eight years, after which time the superintendent of public
instruction shall contribute one and fourteen hundredths percent of the monthly
salary or wages of those nonteaching employee members. For employees of the
state board for career and technical education who elect to participate in the public
employees retirement system pursuant to section 54-52-02.14, the state board for
career and technical education shall contribute monthly to the retiree health benefits
fund an amount equal to two and ninety-nine hundredths percent of the monthly
salary or wages of those employee members, beginning on the first of the month
following the transfer under section 54-52-02.14 and continuing thereafter for a
period of eight years, after which time the state board for career and technical
education shall contribute one and fourteen hundredths percent of the monthly
salary or wages of those employee members. The employer of a national guard
security officer or firefighter shall contribute monthly to the retiree health benefitsPage No. 4fund an amount equal to one and fourteen hundredths percent of the monthly
salaries or wages of all national guard security officers or firefighters participating in
the public employees retirement system under chapter 54-52. Job service North
Dakota shall reimburse monthly the retiree health benefits fund for credit received
under section 54-52.1-03.3 by members of the retirement program established by
job service North Dakota under section 52-11-01. The board, as trustee of the fund
and in exclusive control of its administration, shall:a.Provide for the investment and disbursement of moneys of the retiree health
benefits fund and administrative expenditures in the same manner as moneys
of the public employees retirement system are invested, disbursed, or
expended.b.Adopt rules necessary for the proper administration of the retiree health
benefits fund, including enrollment procedures.2.All moneys deposited in the fund established under subsection 1, not otherwise
appropriated, are hereby appropriated to the board for the purpose of making
investments for the fund and to make contributions toward hospital and medical
benefits coverage for eligible retired employees or surviving spouses of eligible
retired employees and their dependents under the uniform group insurance
program.3.If a member terminates employment because of death, permanent and total
disability, or any voluntary or involuntary reason prior to retirement, the member or
the member's designated beneficiary is entitled to the member's account balance at
termination. If a member's account balance is withdrawn, the member relinquishes
all rights to benefits under the retiree health benefits fund.54-52.1-03.3. Eligibility for retiree health benefits - Fixed contribution and reductionfactors.1.The following persons are entitled to receive credit for hospital and medical benefits
coverage under subsection 2:a.A member or surviving spouse of the highway patrolmen's retirement system is
eligible for the credit beginning on the date retirement benefits are effective
unless the premium is billed to the employer.b.A member or surviving spouse of the public employees retirement system is
eligible for the credit beginning on the date retirement benefits are effective
unless the premium is billed to the employer.c.A member or surviving spouse of the retirement program established by job
service North Dakota under section 52-11-01 receiving retirement benefits is
eligible for the credit beginning on the date retirement benefits are effective
unless the premium is billed to the employer.d.A retired judge or surviving spouse receiving retirement benefits under the
retirement program established under chapter 27-17 is eligible for the credit
beginning on the date retirement benefits are effective unless the premium is
billed to the employer.e.A former participating member of the defined contribution retirement plan
receiving retirement benefits, or the surviving spouse of a former participating
member of that retirement plan who was eligible to receive or was receiving
benefits, under section 54-52.6-13, is eligible as determined by the board
pursuant to its rules.Page No. 52.The board shall calculate the allowable monthly credit toward hospital and medical
benefits coverage for a person eligible under subsection 1 in an amount equal to five
dollars multiplied by the member's or deceased member's number of years of
credited service under the highway patrolmen's retirement system, the public
employees retirement system, the retirement program established by job service
North Dakota under section 52-11-01, or the judges' retirement program established
under chapter 27-17. For a member of the public employees retirement system
receiving an early retirement benefit or the surviving spouse of that member, or a
former participating member of the defined contribution retirement plan who is
receiving a periodic distribution and would not meet the normal retirement provisions
of the public employees retirement system, the allowable monthly credit must be
reduced by three percent if the member terminates employment within one year
prior to attaining the age of sixty-five and an additional reduction factor of six percent
shall apply for each year the member terminates employment prior to attaining the
age of sixty-four.For a member of the highway patrolmen's retirement systemreceiving an early retirement benefit or the surviving spouse of that member, the
allowable monthly credit must be reduced by three percent if the member terminates
employment within one year prior to attaining the age of fifty-five and an additional
reduction factor of six percent shall apply for each year the member terminates
employment prior to attaining the age of fifty-four. For a member of the retirement
program established by job service North Dakota under section 52-11-01 receiving
an early retirement benefit or a discontinued service annuity under the plan
provisions of that retirement program or the surviving spouse of that member, the
allowable monthly credit must be reduced by three percent if the member terminates
employment within one year prior to attaining the age of sixty-five and an additional
reduction factor of six percent applies for each year the member terminates
employment prior to attaining the age of sixty-four.3.The board shall apply the credit allowable under subsection 2 to the payment of
monthly premiums required of each person eligible under subsection 1 for hospital
benefits coverage and medical benefits coverage under the uniform group insurance
program. The board shall allow spouses who each have credit under subsection 2
to combine their credits and shall apply the combined credit to the required monthly
premiums under the uniform group insurance program. However, if the allowable
credit under any circumstance exceeds the monthly premium in effect for selected
coverage, that amount of the credit which exceeds the premium is forfeited and may
not be used for any other purpose.4.The board may, as an alternative to the calculation of the allowable monthly credit
under subsection 2, provide actuarially reduced benefit options for the member and
the member's surviving spouse including a one hundred percent joint and survivor
option, a fifty percent joint and survivor option, or a five-year or ten-year certain
option.54-52.1-03.4. Temporary employees and employees on unpaid leave of absence.A temporary employee employed before August 1, 2007, may elect to participate in the uniform
group insurance program by completing the necessary enrollment forms and qualifying under the
medical underwriting requirements of the program. A temporary employee employed on or after
August 1, 2007, is only eligible to participate in the uniform group insurance program if the
employee is employed at least twenty hours per week and at least twenty weeks each year of
employment. The temporary employee or the temporary employee's employer shall pay monthly
to the board the premiums in effect for the coverage being provided. An employer may pay
health or life insurance premiums for a permanent employee on an unpaid leave of absence. A
political subdivision, department, board, or agency may make a contribution for coverage under
this section.54-52.1-04. Board to contract for insurance. The board shall receive bids for theproviding of hospital benefits coverage, medical benefits coverage, life insurance benefits
coverage for a specified term, and employee assistance program services; may receive bidsPage No. 6separately for retired medicare-eligible employee group prescription drug coverage; and shall
accept the bid of and contract with the carrier that in the judgment of the board best serves the
interests of the state and its eligible employees. Solicitations must be made not later than ninety
days before the expiration of an existing uniform group insurance contract.Bids must besolicited by advertisement in a manner selected by the board that will provide reasonable notice
to prospective bidders. In preparing bid proposals and evaluating bids, the board may utilize the
services of consultants on a contract basis in order that the bids received may be uniformly
compared and properly evaluated. In determining which bid, if any, will best serve the interests
of eligible employees and the state, the board shall give adequate consideration to the following
factors:1.The economy to be effected.2.The ease of administration.3.The adequacy of the coverages.4.The financial position of the carrier, with special emphasis as to its solvency.5.The reputation of the carrier and any other information that is available tending to
show past experience with the carrier in matters of claim settlement, underwriting,
and services.The board may reject any or all bids and, in the event it does so, shall again solicit bids as
provided in this section. The board may establish a plan of self-insurance for providing health
insurance benefits coverage only under an administrative services only (ASO) contract or a
third-party administrator (TPA) contract.54-52.1-04.1.Health maintenance organization contract - Membership option.Notwithstanding the provisions of section 54-52.1-04, the board may contract with one or more
health maintenance organizations to provide eligible employees the option of membership in a
health maintenance organization. If it makes such a contract, the board may not require that the
health maintenance organization be federally qualified if the health maintenance organization has
a certificate of authority issued by the North Dakota insurance commissioner. The contract or
contracts must be included in the uniform group insurance program.54-52.1-04.2. Self-insurance plan for hospital and medical benefits coverage. Theboard may establish a self-insurance plan for providing health insurance benefits coverage under
an administrative services only (ASO) contract or a third-party administrator (TPA) contract under
the uniform group insurance program, if it is determined by the board that an administrative
services only or third-party administrator plan is less costly than the lowest bid submitted by a
carrier for underwriting the plan with equivalent contract benefits.Upon establishing aself-insurance plan, the board shall solicit bids for an administrative services only or third-party
administrator contract only every other biennium, and the board is authorized to renegotiate an
existing administrative services only or third-party administrator contract during the interim. In
addition, individual stop-loss coverage insured by a carrier authorized to do business in this state
must be made part of any self-insured plan. All bids under this section are due no later than
January first, and must be awarded no later than March first, preceding the end of each
biennium. All bids under this section must be opened at a public meeting of the board.54-52.1-04.3. Contingency reserve fund - Continuing appropriation. The board shallestablish under a self-insurance plan a contingency reserve fund to provide for adverse
fluctuations in future charges, claims, costs, or expenses of the uniform group insurance
program.The board shall determine the amount necessary to provide a balance in thecontingency reserve fund equal to three and one-half months of claims paid based on the
average monthly claims paid during the twelve-month period immediately preceding March first
of each year. The board may arrange for the services of an actuarial consultant to assist the
board in making the determination. All moneys in the contingency reserve fund, not otherwisePage No. 7appropriated, are appropriated for the payment of claims and other costs of the uniform group
insurance program during periods of adverse claims or cost fluctuations.54-52.1-04.4.Insurance to cover mammogram examinations.The board shallprovide medical benefits coverage under a contract for insurance pursuant to section 54-52.1-04
or under a self-insurance plan pursuant to section 54-52.1-04.2 for:1.One baseline mammogram examination for each woman who is at least thirty-five
but less than forty years of age.2.One mammogram examination every year, or more frequently if ordered by a
physician, for each woman who is at least forty years of age.54-52.1-04.5. Insurance to cover involuntary complications of pregnancy. Medicalbenefits coverage provided under either a contract for insurance pursuant to section 54-52.1-04
or under a self-insurance plan pursuant to section 54-52.1-04.2 may not contain any exclusion,
reduction, or other limitation as to coverage, deductible, or coinsurance provision, as to
involuntary complications of pregnancy unless the provisions apply generally to all benefits paid
under the coverage. If a fixed amount is specified for in the coverage for surgery, the fixed
amounts for surgical procedures involving involuntary complications of pregnancy must be
commensurate with other fixed amounts payable for procedures of comparable difficulty and
severity.In a case when a fixed amount is payable for maternity benefits, involuntarycomplications of pregnancy are an illness and entitled to benefits otherwise provided by the
coverage. When the coverage contains a maternity deductible, the maternity deductible applies
only to expenses resulting from normal delivery and caesarean section delivery; however,
expenses for caesarean section delivery in excess of the deductible must be treated as expenses
for any other illness under the coverage. For purposes of this section, "involuntary complications
of pregnancy" includes nonelective caesarean section delivery.54-52.1-04.6. Coverage for treatment of certain disorders. The board shall providecoverage under either a contract for insurance pursuant to section 54-52.1-04 or under a
self-insurance plan pursuant to section 54-52.1-04.2 for coverage for surgical and nonsurgical
treatment of temporomandibular joint disorder and craniomandibular disorder. Coverage must
be the same as that for treatment to any other joint in the body, and applies if the treatment is
administered or prescribed by a physician or a dentist. Benefits for the coverage may be limited
to a lifetime maximum of ten thousand dollars per person for surgery, and two thousand five
hundred dollars for nonsurgical treatment.54-52.1-04.7. Uniform group insurance program - Vision and dental plans. Theboard may establish a dental plan, a vision plan, or both, for eligible employees. The board shall
receive bids for the plan or plans pursuant to section 54-52.1-04. The board may reject any or all
bids and provide a plan of self-insurance. Premiums for this coverage must be paid by the
eligible employee. Any refund, rebate, dividend, experience rating allowance, discount, or other
reduction of premium must be credited as provided by section 54-52.1-06.54-52.1-04.8. Uniform group insurance program - Long-term care plan. The boardmay establish a long-term care plan for eligible employees. The board shall receive bids for the
plan under section 54-52.1-04.The board may reject any or all bids and provide a plan ofself-insurance. Premiums for this plan must be paid by the eligible employee.Any refund,rebate, dividend, experience rating allowance, discount, or other reduction of premium must be
credited as provided by section 54-52.1-06.54-52.1-04.9. Uniform group insurance program - Employee assistance program.The board shall establish an employee assistance program available to persons in the medical
and hospital benefits coverage group. The premium for this coverage must be paid as provided
by section 54-52.1-06. The board shall receive bids for this program under section 54-52.1-04.
Each department, board, or agency shall obtain employee assistance program services through
the board for eligible employees and may not enter into any agreement to obtain employee
assistance program services with a third-party provider except that a department, board, orPage No. 8agency may use its own employee assistance program services to the extent such services are
provided by personnel of that department, board, or agency. As used in this section, "employee
assistance program" means an employer-sponsored service for employees under which a
professional employee assistance program staff assists employees and their families in finding
help for emotional, drug, alcohol, family, health, and other personal or job-related problems that
may be affecting their work performance.54-52.1-04.10. Insurance to cover dental anesthesia and hospitalization. The boardshall provide medical benefits coverage under a contract for insurance pursuant to section
54-52.1-04 or under a self-insurance plan pursuant to section 54-52.1-04.2 for dental anesthesia
and hospitalization in the same manner as provided under section 26.1-36-09.9.54-52.1-04.11. Insurance to cover foods and food products for inherited metabolicdiseases. The board shall provide medical benefits coverage under a contract for insurance
pursuant to section 54-52.1-04 or under a self-insurance plan pursuant to section 54-52.1-04.2
for foods and food products for inherited metabolic diseases in the same manner as provided for
under section 26.1-36-09.7.54-52.1-04.12. Insurance to cover medical services related to intoxication.Theboard shall provide medical benefits coverage under a contract for insurance pursuant to section
54-52.1-04 or under a self-insurance plan pursuant to section 54-52-04.2 for medical services
related to intoxication in the same manner as provided for under subsection 15 of section
26.1-36-05 and section 26.1-36-09.13.54-52.1-05. Provisions of contract. Each uniform group insurance contract enteredinto by the board must be consistent with the provisions of this chapter, must be signed for the
state of North Dakota by the chairman of the board, and must include the following:1.As many optional coverages as deemed feasible and advantageous by the board.2.A detailed statement of benefits offered, including maximum limitations and
exclusions, and such other provisions as the board may deem necessary or
desirable.54-52.1-06. State contribution. Each department, board, or agency shall pay to theboard each month from its funds appropriated for payroll and salary amounts a state contribution
in the amount as determined by the primary carrier of the group contract for the full single rate
monthly premium for each of its eligible employees enrolled in the uniform group insurance
program and the full rate monthly premium, in an amount equal to that contributed under the
alternate family contract, including major medical coverage, for hospital and medical benefits
coverage for spouses and dependent children of its eligible employees enrolled in the uniform
group insurance program pursuant to section 54-52.1-07.The board shall then pay thenecessary and proper premium amount for the uniform group insurance program to the proper
carrier or carriers on a monthly basis. Any refund, rebate, dividend, experience rating allowance,
discount, or other reduction of premium amount must be credited at least annually to a separate
fund of the uniform group insurance program to be used by the board to reimburse the
administrative expense and benefit fund of the public employees retirement program for the costs
of administration of the uniform group insurance program.In the event an enrolled eligibleemployee is not entitled to receive salary, wages, or other compensation for a particular calendar
month, that employee may make direct payment of the required premium to the board to
continue the employee's coverage, and the employing department, board, or agency shall
provide for the giving of a timely notice to the employee of that person's right to make such
payment at the time the right arises.54-52.1-06.1.Uniformgroupinsuranceprogrambenefits-Continuingappropriation. The funds necessary to pay the consulting fees and health insurance benefits
related to the uniform group insurance program are hereby appropriated from insurance
premiums received by the board.Page No. 954-52.1-07.Optional coverage for employee's family.Each eligible employeeenrolled in the uniform group insurance program may elect to include that person's spouse and
all qualified dependents, as provided for in the plan, within the hospital benefits coverage and
medical benefits coverage, the state to pay the cost of such coverage as provided in section
54-52.1-06.54-52.1-08. Administration - Board to promulgate rules and regulations. It is theresponsibility of the board to account for and disburse premium payments, maintain records,
prepare reports, and to perform such other functions as may be necessary to carry out the
provisions of this chapter. The board may promulgate such rules and regulations as may be
necessary to carry out the provisions of this chapter.54-52.1-08.1.Administrative - Nondiscrimination testing for health and lifeinsurance programs. The board shall be responsible for the nondiscrimination testing required
under section 89 of the Internal Revenue Code.The board may engage the services of aconsultant to assist the board in its administration of this section. The various state departments,
boards, agencies, and commissions shall provide the board with requested information so the
board may carry out its duties under this section.54-52.1-08.2.Uniform group insurance program - Compliance with federalrequirements - Group purchasing arrangements. If the board determines that any section or
the phraseology of any section of this chapter does not comply with applicable federal statutes or
rules, the board shall adopt appropriate terminology with respect to that section to comply with
the federal statutes or rules, subject to the approval of the legislative management's employee
benefits programs committee.The board may assume responsibility for group purchasingarrangements as provided by federal law. Any plan modifications made by the board under this
section are effective until the effective date of any measure enacted by the legislative assembly
providing the necessary amendments to this chapter to ensure compliance with the federal
statutes or rules.54-52.1-09.Reports.Each department, board, or agency shall keep such records,make such certifications, and furnish the board or carriers with such information and reports as
may be necessary to enable the board or carriers to carry out their functions under the provisions
of this chapter. Carriers that have entered into a contract with the board are required to furnish
such reasonable reports as the board determines to be necessary, and to permit the board to
examine those records that relate to the uniform group insurance program.54-52.1-10.Exemption from state premium tax.All premiums, consideration forannuities, policy fees, and membership fees collected under this chapter are exempt from the tax
payable pursuant to section 26.1-03-17.54-52.1-11. Confidentiality of employee records. Information pertaining to an eligibleemployee's group medical records for claims, employee premium payments made, salary
reduction amounts taken, history of any available insurance coverage purchased, and amounts
and types of insurance applied for under the supplemental life insurance coverage under this
chapter is confidential and is not a public record. The information and records may be disclosed,
under rules adopted by the board, only to:1.A person to whom the eligible employee has given written authorization to have the
information disclosed.2.A person legally representing the eligible employee, upon proper proof of
representation, and unless the eligible employee specifically withholds authorization.3.A person authorized by a court order.4.A person or entity to which the board is required to disclose information pursuant to
federal or state statutes or regulations.Page No. 105.Any person or entity if the purpose of the disclosure is for treatment, payment, or
health care operations.54-52.1-12. Ownership and confidentiality of the uniform group health insurancemedical records of employees, retirees, and dependents. The medical records and related
data of the employees, retirees, and dependents, obtained as the result of enrollment in the
uniform group insurance program, are the property of the public employees retirement system.
The records and data are confidential and are not public records. However, the board may allow
administrators of administrative services only contracts or third-party administrators contracts
access to the records and data where it is required in the performance of the administrator's
duties pursuant to the contract. No administrator may be held liable for furnishing to the board
information with respect to any patient, or any physician, hospital, or other health care provider.54-52.1-13. Uniform prescription drug cards. The board shall provide for issuance ofuniform prescription drug cards under a contract for insurance pursuant to section 54-52.1-04 or
under a self-insurance plan pursuant to section 54-52.1-04.2 in the same manner as provided
under section 26.1-36-43.54-52.1-14. Wellness program. The board shall develop an employer-based wellnessprogram.The program must encourage employers to adopt a board-developed wellnessprogram by either charging extra health insurance premium to nonparticipating employers or
reducing premium for participating employers.54-52.1-15.Acceptance and expenditure of third-party payments - Continuingappropriation.The board may receive moneys from third parties, including the federalgovernment, pursuant to one or more federal programs. Any money received from a third party
by the board is appropriated to the board on a continuing basis for the board's use in paying
benefits, premiums, or administrative expenses under the uniform group insurance program.54-52.1-16.Uniform group insurance program - Collaborative drug therapyprogram - Continuing appropriation.1.The board may establish a collaborative drug therapy program available to
individuals in the medical and hospital benefits coverage group. The purpose of the
collaborative drug therapy program is to improve the health of individuals in
identified health populations and to manage health care expenditures.2.Under the program, the board may involve physicians, pharmacists, and other health
professionals to coordinate health care for individuals in identified health populations
in order to improve health outcomes and reduce spending on care for the identified
health problem. Under the program, pharmacists and other health professionals
may be reimbursed for providing face-to-face collaborative drug therapy services to
covered individuals in the identified health population. To encourage enrollment in
the plan, the board may provide incentives to covered individuals in the identified
health population which may include waived or reduced copayment for related
treatment drugs and supplies.3.The board may request the assistance of the North Dakota pharmacists association
or a specified delegate to implement a formalized disease management program
with the approval of the prescriptive practices committee established in section
43-15-31.4, which must serve to standardize chronic disease care and improve
patient outcomes.This program must facilitate enrollment procedures, providestandards of care, enable consistent documentation of clinical and economic
outcomes, and structure an outcomes reporting system.4.The board may seek and accept private contributions, gifts, and grants-in-aid from
the federal government, private industry, and other sources for a collaborative drug
therapy program for identified health populations.Any funds that may becomeavailable through contributions, gifts, grants-in-aid, or other sources to the board forPage No. 11a collaborative drug therapy program are appropriated to the board on a continuing
basis.54-52.1-17.Uniform group insurance program - Collaborative drug therapyprogram - Funding.1.The board shall establish a collaborative drug therapy program that is to be available
to individuals in the medical and hospital benefits coverage group. The purpose of
the collaborative drug therapy program is to improve the health of individuals with
diabetes and to manage health care expenditures.2.The board shall involve physicians, pharmacists, and certified diabetes educators to
coordinate health care for covered individuals with diabetes in order to improve
health outcomes and reduce spending on diabetes care.Under the program,pharmacists and certified diabetes educators may be reimbursed for providing
face-to-face collaborative drug therapy services to covered individuals with diabetes.
To encourage enrollment in the plan, the board shall provide incentives to covered
individuals who have diabetes which may include waived or reduced copayment for
diabetes treatment drugs and supplies.3.The North Dakota pharmacists association or a specified delegate shall implement a
formalized diabetes management program with the approval of the prescriptive
practices committee established in section 43-15-31.4, which must serve to
standardize diabetes care and improve patient outcomes.This program mustfacilitate enrollment procedures, provide standards of diabetes care, enable
consistent documentation of clinical and economic outcomes, and structure an
outcomes reporting system.4.The board shall fund the program from any available funds in the uniform group
insurance program and if necessary the fund may add up to a two dollar per month
charge on the policy premium for medical and hospital benefits coverage. A state
agency shall pay any additional premium from the agency's existing appropriation.Page No. 12Document Outlinechapter 54-52.1 uniform group insurance program