Section 40.10. Public employers health insurance.

 

(1)  An employee of an employer, other than the state, shall be eligible for health insurance under s. 40.51 (7) , Stats., if requirements of ss. 40.02 (46) and 40.22 , Stats., or of s. 40.19 (4) (a) , Stats., are satisfied. An employee of an employer that is not a participating employer shall be eligible for health insurance under s. 40.51 (7) , Stats., if the requirements set forth in s. 40.02 (28) are satisfied and the following requirements are met:

(a) The employee works at least two-thirds of what is considered full-time employment by the department.

(b) Employment in the employee's position is expected to last at least one year.

(2)  As provided in a collective bargaining agreement under subch. IV of ch. 111 , the employer, including an employer that is not a participating employer, shall pay an employer contribution toward the gross health insurance premium based on the lowest cost qualified plan in the service area of the employer, as follows:

(a) For insured part-time employees who are appointed to work less than 1,044 hours per year, an amount not less than 25% of the lowest cost qualified plan.

(b) For eligible employees not specified in par. (a) or (c) , an amount between 50% and, except as provided in par. (d) , 105% of the lowest cost qualified plan.

(c) For a retiree, surviving dependent or an eligible employee on leave of absence or layoff, an employer contribution is optional.

(d) The 105%-of-cost limitation in par. (b) does not apply to an employer that establishes an arrangement for contributing towards the premiums for employee health insurance under s. 40.51 (7) , Stats., under which all of the following apply:

1. The employer contributions towards employee health insurance premiums are based upon the tier into which each available health plan is placed by the group insurance board.

2. The employee required contribution to the health insurance premium for single coverage is the same dollar amount for all plans in the same tier, regardless of the total premium. The employee required contribution to the health insurance premium for family coverage is the same dollar amount for all plans in the same tier, regardless of the total premium.

3. The employee's required contribution to the health insurance premium for a plan classified in a higher cost tier, as compared to a plan in the next lowest cost tier, increases by at least $20 per month for single coverage and $50 per month for family coverage.

4. The employer contribution towards the premium of each qualified plan in the service area of the employer shall be an amount at least equal to the applicable minimum contribution under par. (a) , (b) or (c) . The employer contribution is determined by subtracting the employee contribution amount for the plans in that tier from the total plan premium for the type of coverage.

Example. Assume there are only two qualified plans in the service area of the employer. One plan is a Tier 1 plan, the other is a Tier 2 plan, and the single and family premiums are shown in the following table: - See PDF for table

Under the tiered arrangement, a full-time employee's premium payment for Plan A (and all Tier 1 plans that might be available, but not qualified) may be between $0 and a maximum of $190 for single coverage, depending on whether the employer is contributing the minimum amount allowed, or more. The employer must contribute no less than $200 towards single coverage, but under these circumstances must contribute at least $210 towards single coverage premium for Tier 1 plans, because that is the lowest amount that is at least equal to one-half of the lowest cost plan and also sufficient to assure both 1) that the employee contribution for single coverage under the Tier 2 plan will be at least $20 higher than the Tier 1 amount and 2) that the remainder, paid by the employer, will be at least $200. The employer contribution towards family coverage must be at least $450. This is one-half of the lowest cost plan premium for family coverage and is also sufficient to assure that the difference between the employee premiums for the Tier 1 and Tier 2 coverage is at least $50.

(3)  Except as provided under sub. (2) , the employer shall pay an employer contribution toward the gross health insurance premium based on the average premium of qualified plans in the service area of the employer, as follows:

(a) For insured part-time employees who are appointed to work less than 1,044 hours per year, an amount not less than 25% of the lowest cost qualified plan.

(b) For eligible employees not specified in par. (a) or (c) , an amount between 50% and 88% of the average premium cost of qualified plans.

(c) For a retiree, surviving dependent or an eligible employee on leave of absence or layoff, an employer contribution is optional.

(d) The employer can establish an arrangement for contributing towards the premiums for employee health insurance under s. 40.51 (7) , Stats., pursuant to sub. (2) (d) 1. through 4.

(e) The group insurance board, with the advice of the actuary, may classify a health plan offered to local government employees, including local government employees of employers who are not participating employers, in a tier that is different than that of the health plan of the same name as offered to state employees.

History: Cr. Register, December, 1987, No. 384 , eff. 1-1-88; CR 04-075 : am. (2) (b), cr. (2) (d) and (e) Register November 2004 No. 587 , eff. 1-1-05; CR 11-040 : am. (2) (intro.), r. (2) (e), cr. (3) (intro.), (a) to (e) Register July 2012 No. 679 , eff. 8-1-12; CR 12-054 : renum. (1) to (1) (intro.) and am., cr. (1) (a), (b), am. (2) (intro.), (3) (e) Register October 2013 No. 694 , eff. 11-1-13.