Retiree health program would report costs and set coverage rules

The Public Employees’ Benefits Program Board would submit a report about the cost of comparable health coverage. The report would cover state-service retirees enrolled in the program who receive Medicare-based individual medical coverage. The report would include Medicare Part B premiums, comparable supplemental coverage, prescription drug coverage, and dental and vision coverage. The Board would submit the report by August 31 of every even-numbered year.

The Board would preserve Medicare retirees’ health reimbursement account balances under specified limits. The rules would apply when the Board deposits subsidies into an account for a retiree covered through an individual Medicare medical plan. Unless federal law requires otherwise, yearly balance limits could not be lower than the retiree’s subsidy from the prior five fiscal years. Money could not return to the Retirees’ Fund until the retiree dies or chooses other coverage for more than two consecutive years. These rules would apply to money deposited into the account after the provision takes effect.

Retirees and eligible surviving spouses could request reinstatement during any open enrollment period, and the Board could ask for proof of other health coverage. The provision would cover eligible retirees and surviving spouses seeking to restore non-life insurance through the Public Employees’ Benefits Program. The Board could require proof of continuous outside coverage for later gaps in program coverage, but not for the first gap. Applicants would have to accept the current plan, pay required premiums, and provide any required coverage evidence. A retiree who reinstates coverage would be eligible for applicable retiree premium or contribution subsidies. Requests would be made during an open enrollment period for the insurance plan.

The measure would set retiree health payment amounts, provide state money for specified costs, and require an interim study of the program. The payment amounts would cover state-service retirees enrolled in the program, including retirees with individual Medicare plans; the study would cover program services and retiree support. The measure would provide $2,003,655 from the State General Fund for costs tied to the listed payment amounts. The study would examine services, a possible ombudsman, Medicare retiree education, reimbursement choices, debit cards, and provider payment limits. Unused appropriation money could not be spent after September 17, 2027 and would return to the General Fund. The payment provision would take effect upon passage and approval, the appropriation on July 1, 2026, and the study would occur during the 2025-2026 interim.