32-2. Change of Insurance Carriers
In consultation with the LMCC, the BOARD has conducted an RFP process for Insurance Carriers for the Benefit Plans Described herein and in Appendixes B and E for implementation on January 1, 2017. the BOARD may change insurance carriers, Health Maintenance Organizations or administrators or self-insure all or any part of the coverage provided for herein if such change does not reduce the level of benefits, and provided any such change is in conformity with the following:
The following provisions shall facilitate the BOARD’s responsibility to administer the plan of benefits which is collectively bargained. The purpose is to maximize the strength of the BOARD on behalf of the employees to purchase aggressively health care under the plan of benefits in the marketplace.
- No standing commitment to any carriers, administrator(s), providers or vendors shall be named within the Agreement.
- All commercial relationships can be competitively evaluated, which may include either being competitively bid formally or rigorously evaluated and negotiated without formal bidding, if administratively and/or economically advantageous, and prudent for the BOARD as fiduciary, subject to all applicable law. The UNION shall be advised of such problems that may be addressed in this manner.
- The PPO networks can be altered if necessary should the BOARD re-evaluate the administrative, vendor or provider relationships, should the full responsibilities of the carrier(s) or administrator(s) be bid or should the current responsibilities be unbundled and competitively evaluated and subsequently awarded.
- Current HMO configurations may be altered to take advantage of administrative prerogatives and fiscal requirements, and characteristics of the marketplace.
- Reconfigurations of either the PPO institutions or the number of HMOs under either sections C and D above shall be explicable to the UNION and shall be supported by analyses and not be arbitrary.
- No reconfiguration of PPO institutions or change in the number or identity of HMOs shall be made except in compliance with the following:
- The UNION shall be notified in writing of the intent to change at least ninety calendar days prior to the proposed change where circumstances are within the BOARD’s control. In all other cases, the BOARD will provide the maximum notice as is practicable under the circumstances.
- The UNION and the BOARD shall meet within five school days of receipt of the notice by the UNION or at such other mutually agreeable date consistent with the parties’ desire to expedite such meeting.
- The notice referred to shall, at the time the notice is given, provide sufficient information to explain the contemplated action and shall include, at a minimum, but shall not be limited to, the following:
- the affected PPO institutions or HMOs.
- the precise reason(s) the action is being contemplated.
- the number of covered participants (employees and/or dependents) receiving in-patient service from such affected institutions or HMOs at the time the notice is given.
- the number of covered participants (employees and/or dependents) receiving in-patient service from such affected institutions or HMOs during the preceding twelve months.
- The BOARD shall provide to the UNION all additional relevant information which is reasonably available and shall be responsible for notices to participants.
- In the event the parties are unable to resolve a dispute within five school days of the first meeting or such other time as may be mutually agreed upon, the dispute shall be submitted to arbitration pursuant to the provisions of Article 3-10 of the Agreement on an expedited basis.