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Health Plan Administration

The State and School Employees Health Insurance Management Board (Board) is the Plan Sponsor of the State and School Employees’ Health Insurance Plan (Plan). The Board has the sole legal authority to promulgate rules and regulations governing the operations of the Plan within the confines of the law governing the Plan. The Department of Finance and Administration provides the day-to-day management of the Plan through the Office of Insurance.

The Board consists of the following members: the Executive Director of the Department of Finance and Administration, who serves as Chairman; the Chairman of the Workers’ Compensation Commission; the Commissioner of Insurance; the Commissioner of Higher Education; the State Superintendent of Education; the State Personnel Director; two (2) appointees of the Governor whose terms are concurrent with that of the Governor, one (1) of whom has experience in providing actuarial advice to companies that provide health insurance to large groups and one (1) of whom has experience in the day-to-day management and administration of a large self-funded health insurance group; the Chairman of the Senate Insurance Committee or his designee; the Chairman of the House of Representatives Insurance Committee or his designee; the Chairman of the Senate Appropriations Committee or his designee; the Chairman of the House of Representatives Appropriations Committee or his designee. The legislators, or their designees, serve as ex officio, nonvoting members of the Board.

The Board selects, through a competitive bid process, all vendors who provide services under the Plan. These services include claims administration, pharmacy benefits management, provider network administration, utilization management, data management, and actuarial and consulting services.

A Self-Insured Plan The State and School Employees’ Health Insurance Plan is a self-insured plan. When an organization manages a self-insured plan, it means that the organization (or in this case, the State) bears the financial responsibility for its own employee benefit plan. This means that the State is responsible for paying claims and other expenses associated with providing Plan participants with health care coverage. The State, through the Board, determines the benefits and sets the premiums. All costs are paid from the money collected in premiums. There is no direct State appropriation of funds to the Plan.

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