22830-22849

GOVERNMENT CODE
SECTION 22830-22849




22830.  (a) An employee or annuitant, under eligibility rules as
prescribed by board regulations, may enroll in a health benefit plan
approved or maintained by the board either as an individual or for
self and family.
   (b) Enrollment shall serve as authorization of the deduction of
the contributions required under this part from the salary of an
employee or allowance of an annuitant.



22831.  (a) An annuitant may, as provided by regulations of the
board, continue his or her enrollment, enroll within 60 days of
retirement, enroll within 60 days of the death of the member, or
enroll during any future open enrollment period without
discrimination as to premium rates or benefit coverage. If the
survivor of an annuitant is also an annuitant as defined in this
part, he or she may enroll within 60 days of the annuitant's death or
during any future open enrollment period, as provided by regulations
of the board.
   (b) Board rules and regulations shall provide whatever provisions
necessary to eliminate or minimize the impact of adverse selection
because of the enrollment of annuitants that would affect any health
benefit plans approved or maintained. This may include the
reimbursement of surcharges for late enrollment in Part B of Medicare
if the board determines that payment of the surcharge would be less
costly than continued enrollment in a basic plan.



22832.  A permanent intermittent employee and an employee who works
less than full time may continue his or her enrollment while retired
from state employment if he or she was enrolled prior to separation
from state employment, and he or she lost eligibility prior to
separation but continued his or her coverage under federal law.




22834.  (a) An out-of-state employee who separates from service and
becomes an annuitant may continue his or her enrollment in a
board-approved out-of-state health benefit plan or may transfer to
any other health benefit plan approved or maintained by the board, in
which the employee would otherwise be eligible to enroll. He or she
must enroll in that health benefit plan within 60 days in order for
health benefits to continue.
   (b) An annuitant who leaves this state and elects to reside in
another state in which a health benefit plan is approved or
maintained by the board may transfer his or her enrollment to that
health benefit plan and shall be entitled to the employer
contribution as provided in this part.
   (c) When an out-of-state employee receiving benefits pursuant to
Section 22803 is permanently reassigned to perform his or her duties
within the state, the benefits may be continued only until the
employee has had reasonable opportunity to enroll in a health benefit
plan within the state that is approved or maintained by the board.




22836.  An employee enrolled in a health benefit plan who is removed
or suspended without pay and later reinstated or restored to duty on
the ground that the removal or suspension was unjustified,
unwarranted, or illegal may not be deprived of coverage or benefits
for the interim. Any contributions otherwise payable by the employer
that were actually paid by the employee shall be restored to the same
extent and effect as though the removal or suspension had not taken
place, and any other equitable adjustments necessary and proper under
the circumstances shall be made in premiums, claims, and other
charges.


22837.  In the case of the death of an employee after an application
has been filed for the enrollment of family members, but prior to
the effective date of coverage, the family members are deemed to have
been covered on the date of the death of the employee. If one of the
family members becomes an annuitant, enrollment shall continue
without discrimination as to premium rates or benefit coverage.




22839.  Thirty days prior to, or 60 days following, retirement and
during the open enrollment period, a state employee enrolled in a
flexible benefit plan administered by the state shall be given the
option to enroll in a health benefit plan approved or maintained by
the board and receive the applicable employer contribution, if the
state employee would otherwise qualify as an annuitant.



22840.  (a) Notwithstanding any other provision of law, a state
employee participating in a flexible benefits program administered by
the state, who either terminated enrollment in a health benefit plan
approved or maintained by the board in reliance on other medical
coverage or who was enrolled in a board-approved health benefit plan
for self only, may enroll in a health benefit plan without regard to
the open enrollment period for either of the following purposes:
   (1) For self only or self and all eligible dependents, if the
flexible cash option is discontinued.
   (2) To add all eligible dependents, upon loss of coverage, where
the flexible cash option has not been selected.
   (b) Enrollment shall be requested within 60 calendar days of the
loss of other coverage and submitted to the system by the employer.
The effective date of enrollment shall be the first day of the month
following the loss of other coverage. Enrollment shall entitle the
employee to receive the benefit of the applicable employer
contribution.


22841.  (a) A transfer of enrollment from one health benefit plan to
another may be made by an employee or annuitant at times and under
conditions as may be prescribed by regulations of the board.
   (b) In the case of a health benefit plan in which services are
provided by a limited panel of physicians associated with the plan,
it is recognized that it may be impossible or impractical to maintain
acceptable physician-patient relationships with particular
employees, annuitants, or family members. In those cases, the
employee or annuitant may submit the question of ability to maintain
adequate physician-patient relationships for consideration under the
grievance procedure provided pursuant to subdivision (d) of Section
22853. If the grievance procedure results in a determination that an
adequate physician-patient relationship cannot reasonably be
maintained, then the employee or annuitant may, in accordance with
regulations of the board, change his or her enrollment to another
health benefit plan without regard to physical condition, age, race,
or other status.



22842.  A change in coverage based on a change in the family status
of an employee, annuitant, or family member enrolled in a health
benefit plan may be requested by the employee or annuitant by filing
an application within 30 days after the occurrence of the change in
family status or at other times and according to conditions as may be
prescribed by regulations of the board.



22843.  If an employee or annuitant has a spouse or a domestic
partner who is an employee or annuitant, each spouse or domestic
partner may enroll as an individual. No person may be enrolled both
as an employee or annuitant and as a family member. A family member
may be enrolled in respect to only one employee or annuitant.




22844.  (a) Employees, annuitants, and family members who become
eligible to enroll on or after January 1, 1985, in Part A and Part B
of Medicare may not be enrolled in a basic health benefit plan. If
the employee, annuitant, or family member is enrolled in Part A and
Part B of Medicare, he or she may enroll in a Medicare health benefit
plan.
   (b) Employees, annuitants, and family members enrolled in a
prescription drug plan under Part D of Medicare may not be enrolled
in a board-approved health benefit plan. This subdivision does not
apply to an individual enrolled in a board-approved or offered health
benefit plan that provides a prescription drug plan or qualified
prescription drug coverage under Part D of Medicare as part of its
benefit design.
   (c) This section does not apply to employees and family members
that are specifically excluded from enrollment in a Medicare health
benefit plan by federal law or regulation.



22846.  (a) The regulations of the board shall provide for the
beginning and ending dates of coverage of employees, annuitants, and
family members enrolled in a health benefit plan. The regulations may
permit coverage to continue, in addition to any temporary extension
of coverage otherwise authorized under this part, until the end of
the pay period in which an employee is separated from service or
until the end of the month in which an annuitant ceases to be
entitled to an allowance. In case of the death of an employee or
annuitant, the regulations may permit a temporary extension of the
coverage of family members for a period of more than 30 days.
   (b) Notwithstanding any other provision of this part, an employee
terminating his or her service by voluntary separation or due to
dismissal for cause, prior to eligibility for retirement, may extend
enrollment until the end of the month following the month in which
his or her service is terminated.



22847.  (a) Subject to subdivisions (b) and (c), if the eligible
family members of a deceased peace officer or firefighter of a
contracting agency, as described in subdivision (a) of Section 22820,
are validly enrolled under this part on the date of the employee's
death, the contracting agency shall continue to pay the employer
contribution applicable to active employees for the continued
enrollment of those eligible family members for a period not to
exceed 120 days, beginning in the month of the employee's death.
   (b) A contracting agency shall remit the amounts required under
Section 22901 as well as the total amount of premium required from
the employer under this part in accordance with regulations of the
board. Enrollment of the eligible family members shall be continuous
following the death of the employee.
   (c) Notwithstanding subdivision (a), the contracting agency's
obligation to pay the employer contribution pursuant to this section
shall terminate upon either of the following:
   (1) Enrollment of the eligible family members pursuant to Section
22820.
   (2) A final determination of the board that the deceased employee'
s family members are not eligible to enroll or continue enrollment
under this part.
   (d) During the period that enrollment is continued pursuant to
this section, the surviving spouse or eldest eligible family member
shall retain the rights and obligations that otherwise would be
applicable to the employee under this part.



22848.  An employee or annuitant who is dissatisfied with any action
or failure to act in connection with his or her coverage or the
coverage of his or her family members under this part shall have the
right of appeal to the board and shall be accorded an opportunity for
a fair hearing. The hearings shall be conducted, insofar as
practicable, pursuant to the provisions of Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3.



22849.  (a) The board shall conduct a study to examine the
feasibility and cost-effectiveness of creating a single statewide
health care pool that would cover all public school employees working
in school districts, county offices of education, community
colleges, and in entities created or established by those school
employers, including, but not limited to, joint powers agencies,
regional occupational centers, and regional occupational programs.
   (b) The health care school pool study shall, at a minimum, include
the following:
   (1) A review and analysis of the costs, cost savings, benefits,
and drawbacks of creating a health care pool for all public school
employees in California, including retirees.
   (2) An analysis of rates, including both a regional rating
structure and a single statewide rating structure.
   (3) An analysis and reporting of any and all cost savings in the
administration of a single health care pool for all school employees
compared to the current process that includes hundreds of different
plans.
   (4) An examination of plan design options in the health care
school pool.
   (5) An analysis of the feasibility and cost savings of including
all school employees under this part, as the health care pool for all
school employees.
   (6) An analysis of the feasibility and cost savings of creating a
pool operated exclusively for school employees.
   (7) An analysis and comparison of a mandatory pool versus a
voluntary pool.
   (c) The completion of the health care school pool study shall be
contingent upon the ability to secure or budget for funding to cover
the costs of the study. The completed study shall be reported to the
Legislature within one year after funding is secured or budgeted.
   (d) The board shall consult with the Teachers' Retirement Board of
the State Teachers' Retirement System in preparing the study.