Final Text
CHAPTER 30
LONG-TERM CARE REGULATIONS (REPEALED)
1VAC55-30-10. Definitions. (Repealed.)
The following words and terms when used in this chapter
shall have the following meanings unless the context clearly indicates
otherwise.
"Actively at work" means that an employee cannot
be both disabled and away from work on the effective date of the long-term care
coverage.
"Administrative services arrangement" means an
arrangement whereby a third-party provider agrees to administer all or part of
the long-term care program.
"Department" means the Department of Human
Resource Management.
"Director" means the Director of the Department
of Human Resource Management.
"Effective date of coverage" means the date on
which the long-term care coverage begins.
"Employee" means a person employed by an employer
participating in the long-term care program or, where demanded by the context
of this chapter, a retired employee of such an employer.
"Employer" means the entity with which a person
maintains a common law employee-employer relationship. The term
"employer" is inclusive of each state agency and of a local employer.
"Evidence of good health" means a statement or
proof of a person's physical condition or other factors that could affect his acceptance
for the long-term care program.
"Insured arrangement" means an accident or health
plan underwritten by an insurance company wherein the department's only
obligation as it may relate to claims is the payment of insurance company
premiums.
"Local employees" or "employees of local
governments" means all officers and employees of the governing body of any
county, city, or town, and the directing or governing body of any political
entity, subdivision, branch, or unit of the Commonwealth or of any commission
or public authority or body corporate created by or under an act of the General
Assembly specifying the power or powers, privileges or authority capable of
exercise by the commission or public authority or body corporate, as
distinguished from § 15.2-1300 or 15.2-1303 of the Code of Virginia or similar
statutes, provided that the officers and employees of a social services
department, welfare board, mental health and mental retardation services board,
or library board of a county, city, or town shall be deemed to be the employees
of local government.
"Local employer" means any county, city, or town,
school board, and the directing or governing body of any political entity,
subdivision, branch or unit of the Commonwealth or of any commission or public authority
or body corporate created by or under an act of the General Assembly specifying
the power or powers, privileges or authority capable of exercise by the
commission or public authority or body corporate, as distinguished from §
15.2-1300 or 15.2-1303 of the Code of Virginia, or similar statutes.
"Local officer" means the treasurer, registrar,
commissioner of revenue, attorney for the Commonwealth, clerk of a circuit
court, sheriff, or constable of any county or city or deputies or employees of
any of the preceding local officers.
"Local retiree" means a former local employee who
has met the terms and conditions for early, normal or late retirement from a
local employer.
"Long-term care program" or "program"
means, individually or collectively, the plan or plans the department may
establish pursuant to §§ 2.2-1207 and 2.2-1208 of the Code of Virginia.
"Part-time local employee," as defined by each
local employer, means an employee working less than full time who a local
employer has determined to be eligible to participate in the program. The
conditions of participation for these employees shall be decided by the local
employer.
"Participant" means any person actively enrolled
and covered by the long-term care program.
"Participating local employer" means a local
employer who offers the long-term care program, sponsored by the Department of
Human Resource Management, to their employees and retirees.
"Plan administrator" means the company
responsible for administering the long-term care program including such
services as accounting, issuance of certificates and settlement of claims.
"Rating" the process that determines how much a
particular package of benefits will cost and what will be charged to cover
those expected costs for a specific group of people.
"Self-insured arrangement" means a facility
through which the plan sponsor agrees to assume the risk associated with the
type of benefit provided without using an insurance company.
"Spouse" means the legally married husband or
wife of an employee or retiree as recognized by the Commonwealth of Virginia.
"State" means the Commonwealth of Virginia.
"State agency" means a court, department,
institution, office, board, council, or other unit of state government located
in the legislative, judicial or executive departments or group of independent
agencies, as shown in the appropriation act, and which is designated in the
appropriation act by title and a three-digit agency code.
"State employee" means any person who is
regularly employed on a salaried basis, whose tenure is not restricted as to
temporary or provisional appointment, in the service of, and whose compensation
is payable, no more often than biweekly, in whole or in part, by the
Commonwealth or any department, institution, or agency thereof. "State employee"
shall include the Governor, Lieutenant Governor, Attorney General, and members
of the General Assembly. It includes "judge" as defined in § 51.1-301
of the Code of Virginia and judges, clerks and deputy clerks of regional
juvenile and domestic relations, county juvenile and domestic relations, and
district courts of the Commonwealth.
"State retiree" means an employee who worked for
the Commonwealth of Virginia and is retired with the VRS or optional state
retirement program service and is eligible for an immediate annuity.
"Teacher" means any employee of a county, city,
or other local public school board.
"Terminated vested participant" means any former
state or local employee who has five or more years of creditable service with
any retirement plan administered by the Virginia Retirement System but due to
age restrictions was not able to receive an immediate annuity. These
individuals cannot currently be employed by or be retired from a local
employer.
"Underwriting" means the process of identifying and
classifying the potential degree of risk represented by a proposed insured.
1VAC55-30-20. Designee and delegations of authority. (Repealed.)
Pursuant to §§ 2.2-1207 and 2.2-1208 of the Code of Virginia,
the Department of Human Resource Management shall establish a program subject
to the approval of the Governor, for providing long-term care benefits for
employees and retirees of the Commonwealth of Virginia, employees and retirees
of participating local employers, and for terminated vested participants of the
Virginia Retirement System.
The Director of the Department of Human Resource Management
hereby delegates to the Director of the Office of Health Benefits the authority
to:
1. Propose, design, and administer a long-term care plan.
Such plan will at a minimum consist of a plan:
a. Covering employees and retirees of the Commonwealth, as
well as vested terminated participants of the Virginia Retirement System, and
b. Covering the employees and retirees of participating
local employers.
All approved plans will, in the aggregate, constitute the
long-term care program. Any plan or plans proposed by the Office of Health
Benefits shall be subject to the approval of the Director of the Department of
Human Resource Management.
2. Propose regulations at any time for the purpose of the
implementation, communication, funding, and administration of the long-term
care program.
3. Enter into one or more contracts for the purpose of
implementing, communicating, funding or administering the long-term care
program. To this end, but not exclusively, such contract or contracts may be
for the underwriting, funding, and administration, including claims processing
and claims adjudication, of the program. Such contracts may be for accounting
and actuarial services as well as communication, statistical analysis and any
other item that may be needed to effectively review and maintain the long-term
care program.
1VAC55-30-30. Procurement. (Repealed.)
The department shall comply with the Virginia Public Procurement
Act, Chapter 43 (§ 2.2-4300 et seq.) of Title 2.2 of the Code of Virginia, as
it may relate to any services to which such act shall apply.
In an effort to stabilize the administration and
maintenance of the long-term care benefits program, the department may contract
for services applicable to such program for a period of time not exceeding 10
years, with the department reserving the right, in its sole discretion, to
cancel such contracts annually upon 90 days' written notice to the contractor.
1VAC55-30-40. Types of plans. (Repealed.)
A. The administration and underwriting of the plans shall
be at the discretion of the department and may include, but not be limited to
self-funded arrangements, insured arrangements, or administrative services
arrangements. The department is authorized to exercise judgment and discretion
in the establishment, procurement and implementation of all underwriting and
other services necessary for the establishment, maintenance, and administration
of such plans and will be deemed to do so in good faith.
B. The department, as it deems necessary or prudent, may
contract for outside services, including but not limited to actuarial, and
consulting services. The department may contract such services on an individual
basis or in conjunction with other services.
1VAC55-30-50. No presumption of right. (Repealed.)
These regulations and the long-term care benefits program
herein established shall not be deemed to constitute a contract of employment
or retirement between any participating employer and any participant. No
participant in the program shall acquire any right to be retained in the
employer's employ or attain any employment service toward retirement by virtue
participation in the program, nor, upon the participant's dismissal or
voluntary termination of employment, shall the participant have any interest in
any assets of the program other than as may be specifically provided through
the contract with the plan administrator.
Furthermore, these regulations and the long-term care
program herein established shall in no event confer upon any participant any
rights, duties or responsibilities other than those granted herein. The
Commonwealth of Virginia specifically reserves the right to amend, modify or
terminate, inclusive of eligibility, coverage and contributions provisions, the
long-term care benefits program or any plan or plans comprising all or part of
the program, as they may relate to any active or retired participant.
1VAC55-30-60. Confidentiality. (Repealed.)
The department will not disclose identifiable individual health
data without the consent of the individual being provided coverage. Data may be
compiled into statistical reports provided that the identity of individual
persons is not ascertainable by the reader or disclosed by the department.
1VAC55-30-70. Department discretion. (Repealed.)
The department reserves the right to change the plans
offered and benefits provided thereunder at its sole discretion based upon
market and department considerations.
1VAC55-30-80. Eligible participants. (Repealed.)
A. Active state employees.
1. State employees as defined in 1VAC55-30-10 who are
salaried faculty or salaried classified employees or other similarly situated
employees in the executive, legislative, judicial or independent agencies
who are compensated on a salaried basis and work at least 20 hours,
are eligible for membership in the long-term care program. A salaried employee
is one who receives a paycheck no more often than biweekly and who is not paid
on an hourly basis.
2. Classified positions include employees who are fully
covered by the Virginia Personnel Act, employees excluded from the Virginia
Personnel Act by subdivision 16 of § 2.2-2905 of the Code of Virginia, and
employees on a restricted appointment. A restricted appointment is a classified
appointment to a position that is funded at least 10% from gifts, grants,
donations, or other sources that are not identifiable as continuing in nature.
An employee on a restricted appointment must receive a state paycheck in order
to be eligible.
3. Certain full-time employees in auxiliary enterprises
(such as food services, bookstores, laundry services, etc.) at the University
of Virginia, Virginia Military Institute and the College of William and Mary
are also considered state employees even though they do not receive a salaried
state paycheck. The Athletic Department of Virginia Polytechnic Institute and
State University is a local auxiliary whose members are eligible for the
program.
B. State retirees.
1. Employees who have met the terms and conditions for
early, normal or late retirement from the Commonwealth under the Virginia
Retirement System, State Police Officers' Retirement System, Judicial
Retirement System, Virginia Law Officers' Retirement System, or any retirement
system authorized pursuant to §§ 51.1-126, 51.1-126.1, 51.1-126.3, 51.1-126.4,
51.1-126.5, and 51.1-126.7 of the Code of Virginia are eligible for membership
in the long-term care program.
2. Employees who retired under an optional state retirement
program are eligible for an immediate annuity, and were at least age 50 with 10
years of service or at least age 55 with five years of service.
C. Active employees of participating local employers.
Active full-time and part-time employees of participating local employers are
eligible for membership. A part-time employee must regularly work at least 20
hours per week to maintain eligibility.
D. Retired employees of participating local employers.
1. The participating employer will determine if retirees are
included as an eligible class.
2. If included, retirees are defined as employees who
retired under the local employer's IRS Qualified Retirement Plan, were eligible
to receive an immediate annuity, and were at least age 50 with 10 years of
service or at least age 55 with five years of service as of their last day of
employment.
E. Terminated vested participants.
1. Terminated employees of the Commonwealth or local
employer who have five or more years of creditable service with the Virginia
Retirement System, but due to age requirements were not eligible to receive an
immediate annuity.
2. In order to be eligible to participate in this class an
individual must not be eligible to participate as a member of another class
under this chapter. This includes individuals who are employees or retirees of
local employers who have not elected to participate in the program.
F. Other eligible participants. Other persons eligible to
participate in the long-term care program include:
1. Spouse of an active employee,
2. Parents and parents-in law of the active employee,
3. Spouse or the surviving spouse of a retired employee, and
4. Spouse or the surviving spouse of a terminated vested
participant.
1VAC55-30-90. Administration. (Repealed.)
A. Enrollment of employees.
1. Enrollment will be on-going for all eligible
participants.
2. Newly eligible active employees of the Commonwealth of
Virginia can enroll into the program within 60 days of eligibility without
proof of good health.
3. The enrollment period for new employer groups is as
agreed upon by the program administrator and the participating employer.
4. Newly eligible active employees of the local employer can
enroll into the program within a specific benefit eligibility window, as
determined by the participating employer in conjunction with the program
administrator, without proof of good health.
5. Special open enrollment periods for active employees will
be determined by the plan administrator and agreed to by the department.
6. Eligible active employees who enroll without proof of
good health must be actively at work on the effective date of coverage.
7. All other eligible participants are required to submit
satisfactory evidence of good health, which must be reviewed and approved by
the plan administrator before coverage can become effective.
8. Eligible individuals may be required to submit evidence
that they are members of an eligible class before the plan administrator begins
the enrollment process. Such evidence may include certification from the
member's former employer, or the member's estimate of future annuity benefits
provided by the Virginia Retirement System.
B. Premium payments.
1. Active employees with the employer's concurrence will be
given the option of having the premiums for the long-term care program deducted
from their salary. If both the employee and his spouse are enrolled, both
premiums may be deducted from the employee's salary.
2. All other participants will be billed directed by the
plan administrator or premiums may be made monthly by bank draft (EFT).