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Health Program State Employee Health Benefits Updated:  August  26, 2008 All 50 states provide health insurance coverage for their state employees. Most have done so for decades. However, the amount of coverage, who is eligible to enroll, and the portions paid by the state employer and by the individual worker always have varied from state to state.

In the past four years these state benefit plans have attracted much more attention among legislators, governors and policymakers. Often, this is because:

1. Rapidly rising commercial premiums are impacting state budgets;
2. State fiscal pressures are leading to more proposals to increase employee share of costs;
3. Co-payments and deductibles are on the rise in many places, separate from the established premiums.

A few general facts about state employee health plans, based on two national surveys: 1

States provided coverage for about 3.4 million state government employees and retirees. State and local employee health plans cover about 10 percent of the total U.S. workforce and hold more than 20 percent of the nation’s total pension assets. (Center for Retirement Research at Boston College, 11/13/07.) Nearly all full-time state workers were eligible for coverage (97%), and take-up was high across most plans, averaging 91%. 74% of part-time state employees had the option of electing health benefits (compared to 48% nationally.) 37 of the state plans experienced double-digit premium growth, averaging 12.8% (compared to 12.7% nationally.)  The highest premium increase in 2005 was in Wyoming at 38%, the lowest was Georgia, where premiums decreased by 1.3%. In 2006, sixteen states paid for 100 percent of the monthly premium costs for a basic or "standard" health plan for some or all individual state employees; five states paid for 100 percent of the monthly premium costs for families of state employees. (New Hampshire, New Jersey, North Dakota, Oklahoma and Oregon); for 2007-08 Oklahoma no longer offers 100% payment coverage, making the total only four states. In state employee plans, 37% of workers were in HMOs, 42% in PPOs, 16% in POS plans and 5% were in conventional indemnity coverage. However, Indemnity plans enrolled a majority of retirees in the Midwest, Northeast and South. 2 Elected state legislators naturally are state employees; however within state personnel definitions, some are considered part-time employees.  The following states offer health insurance to legislators but describe it as "optional at legislator's expense" -- Nebraska, Nevada, New Hampshire, Vermont and West Virginia.  New Mexico, South Dakota and Wyoming do not offer health benefits to legislators, but do cover legislative staff. (data as of 2005.)3 As of July 2008, more than 30 states face revenue shortfalls of about $40 billion as a result of problems associated with the housing bubble, fuel prices and economic slowdown. This reality places pressure on health benefit programs to seek fiscal savings. (Source: Arturo Perez, fiscal expert with NCSL)

At times states have used their employee benefit plans as a demonstration for a policy or idea - for example several states have a mental health coverage mandate specific to the state plan. At least half the states provide for selected non-state employees to be covered under the same, or parallel, health benefit plans.  Most commonly, states include: city, town and/or county workers; public school teachers or employees, or public higher education employees.  A few states have experimented with including segments of the general population in their state plan - see the examples from Connecticut and West Virginia, below.   In the past three years there also are some trends or innovations listed and linked below, including:

Health Savings Accounts	Domestic Partner Benefits	Wellness Programs for Employees
Retiree Benefit cutbacks	Premium Surcharges for smoking	State Contractors to Provide Health Ins.

This web-based report seeks to pull together diverse resources on this growing area of health and personnel policy.

NCSL Charts & Other Documents "2008 State Legislator Compensation- Health, Dental and Optical Benefits" - newly compiled and researched by NCSL Legislative Management Program.  Request your copy by email  4/08 Chart of State Employee Health Premiums - compares cost of family coverage from 1999-2006, compiled by NCSL. Updated May 2006. 3  (Xcel in PDF format for download) "Impact of Medicare law on States as Employers and Plan Sponsors - by Derek Guyton & Jean Schumacher" - Mercer Human Resources Consulting, presented at NCSL Health Conference, 12/8/04.   Source: Post Gazette, 9/26/06

In The News... The following reports and news articles are examples of the policy discussions in individual states.  NCSL is not responsible for the content or opinions expressed in these outside linked articles. The new Commonwealth Fund report What Public Employee Health Plans Can Do to Improve Health Care Quality: Examples from the States is designed to help state public employee health plans and other large purchasers make strategic decisions about developing or coordinating quality improvement initiatives. NCSL provided advice to this survey.  2/4/08. Retiree Health Care: News and Reports The CA Legislative Analyst's Office (LAO) has a new Web site, designed to be an information resource addressing issues concerning public sector retiree health benefits and the associated unfunded liabilities. "The Other Benefits Mess" - A new regulation forces government retirement plans to reveal the cost of their health-benefit promises for the first time. (Kiplinger Benefits Magazine,  9/07) Coping with the Costs of Retiree Health Benefits - by Ron Snell, NCSL 8/07. [member password required] High Noon In The Accounting Department: States Confront GASB 45- NCSL State Health Notes, 9/17/07 CT: Health insurance pool bill passed & vetoed  In May 29 a bill, HB 5536, was enacted and sent to Gov. Rell’s office that provides an opportunity for small businesses, municipalities and nonprofits to pool together to obtain the same insurance plan offered to state employees. The bill was vetoed  (NH Register, 5/30/08)

List of State Employee Health Plan Agencies with Links

Each of the states has evolved a distinct structure for administering state employee health benefits.  Many states offer a relatively complex matrix of plans and premiums, varied by family size, type of plan (HMO, PPO, Indemnity).  A majority of states have some type of employee unions or collective bargaining units that may play a substantial role in defining benefits and costs.  The table below provides some examples from the agencies that run these state programs. 

STATE	Agency Administering State Employee Health                      also see 50-state Personnel Departments (NASPE link)	Examples of premiums & benefits (state web links*)
Alabama	Alabama State Employees Insurance Board (37,527 employees, 7/08)
Alaska	Alaska Benefits Section, Department of Administration	2007-08 | 2008-09
Arizona	Arizona Benefit Options (AzBO), Dept. of Administration	2006-07 | 2007-08
Arkansas	Arkansas Employee Benefits Division	2007 | 2008
California	CalPERS - California Public Employees Retirement System	2007 | 2008 | 2009
Colorado	Colorado Dept. of Personnel & Administration, Division of Human Resources	2008-09
Connecticut	CT Retirement and Benefits Services Division, State Controller	2006-07 | 2007-08 | 2008-09
Delaware	Delaware Statewide Benefits Office, Office of Management and Budget	2007 | 2008
Florida	Florida Div. of State Group Insurance
Georgia	Public Employee Health Benefit Plan (SHBP) Division,  Dept. of Community Health  (690,440 people, 6/08)	2007 | 2008
Hawai'i	Hawaii Employer-Union Health Benefits Trust Fund (EUTF)	FY 2007
Idaho	Dept. of Administration: Employee Group Insurance Benefits	FY 2007
Illinois	Bureau of Benefits, Dept. of Central Management Services	FY 2007 | FY 2008
Indiana	State Personnel Dept.: Benefit Information	2007 | 2008
Iowa	Department of Administrative Services, Human Resources Enterprise	2007 | 2008
Kansas	State Employee Health Benefit Plans Administration (SEHBP), Kansas Health Policy Authority	2007  Benefits
Kentucky	Dept. for Employee Insurance, Kentucky Personnel Cabinet   (245,000 people covered 11/07)	2007 | 2008
Louisiana	Louisiana State Employee Office of Group Benefits
Maine	Maine Div. of Employee Health and Benefits
Maryland	Employee Benefits Division, Dept. of Budget & Management	2006-07
Massachusetts	Massachusetts Group Insurance Commission (GIC) (286,000 enrollees w/ local)	2007-08 | Full cost
Michigan	Michigan Employee Benefits Division	2007
Minnesota	Dept. of Employee Relations, Benefits Division	2006-07
Missouri	MO Consolidated Health Care Plan	2006 | 2007
Mississippi	State Insurance Admin., Department of Finance and Administration
Montana	Employee Benefits Bureau, Health Care and Benefits Division
Nebraska	NE Administrative Services-Employee Benefits;   Office of Risk Management	2008
Nevada	Public Employees Benefit Program	2006-07 | 2007-08
New Hampshire	Human Resources, Department of Administrative Services | Health Benefits
New Jersey	Health Benefits Bureau, Div. of Pensions and Benefits	2006
New Mexico	General Services Division
New York	Employee Benefits Division, Dept. of Civil Service | Governor's Employee Rel.
North Carolina	NC State Health Plan	2006-07 | 2007-09
North Dakota	North Dakota Public Employee Retirement System: Group Health Insurance Plan	2007-09 benefits
Ohio	Ohio Benefits Administration Services  [updated 3/08]	2006-07 | 2007-08
Oklahoma	OK Employee Benefits Council	2007 | '07 benefits
Oregon	Public Employees Benefit Board (PEBB)	2007
Pennsylvania	PA Employees Benefit Trust Fund (PEBTF)   (144,000 state employees, retirees, dependents)
Rhode Island	Chief of Employee Benefits
South Carolina	Employee Insurance Program, SC Budget and Control Board. (244,000 employees covered)	2006 | 2007
South Dakota	Bureau of Personnel	2007-08
Tennessee	Insurance Administration, Dept. of Finance & Administration	2007
Texas	Texas Employees Group Benefits Program (GBP), Employees Retirement System (ERS)	2006-07 | 2007-08 (to 9/30)
Utah	Public Employees Health Program
Vermont	Department of Human Resources, State Employee Center	2006 | 2007
Virginia	Benefits, Department of Human Resource Management	2006-07 | 2007-08
Washington	Public Employees Benefit Board (PEBB)	2007
West Virginia	West Virginia PEIA	2005-06 | 2007-08
Wisconsin	Division of Insurance, Dept. of Employee Trust Funds	2008
Wyoming	Employees' Group Insurance
State	Agency Administering State Employee Health                      also see 50-state Personnel Departments (NASPE link)

Notes: Plan benefits vary widely from state to state. Numerous states offer a range of plans from basic HMO, to comprehensive HMO, plus PPO and an Indemnity plan. Some have regional pricing as well. Family size almost always affects premiums. For example Louisiana has scaled prices for 1) Single, 2) Single with spouse, 3) Single with children, and 4) Family.  Retirees often have separate premiums and benefits.  Premium rate links (above) connect to state agencies' pages that may change or be deleted without notice.

Health Care Reimbursement Accounts (HRA) - The pre-tax flexible spending accounts that many employees use to cover expenses not covered by insurance, as allowed by IRS Section 125.
Voluntary Employee Beneficiary Association (VEBA) - The federal government allows entities to receive favorable tax treatment on contributions to a trust set up under section 501(c)(9), IRC. Contributions to this trust may be made on a pre-tax basis, assets in the trust may be invested and earnings are tax-exempt, and certain qualified benefits may be paid out on a tax-exempt basis. States also may allow favorable tax treatment for a VEBA trust.  See Montana's example and explanation: http://www.montanaveba.org/

__________________________________________________________
Examples of 2003-2008 Plan Features and Changes

• PREMIUM SURCHARGE FOR SMOKERS. At least six states now charge or authorize lower premiums to non-smoker state employees and higher premiums to smokers. 
  • West Virginia first included such a feature in part several years ago. [view employee affidavit form]  
  • Kentucky in late 2004, (in H1a) created a smoker surcharge of $15/month for individuals and $30/month for family coverage.
  • Alabama in December 2004 (in HB 2) authorized smoker rates during special legislative sessions.  For 2007 the smoker surcharge increased from $20 to $22 per month.  In August 2008, Alabama added a premium for obesity [see description below]
  • Georgia initiated a smoker surcharge.  GA: State employees who smoke pay extra for insurance  Beginning July 2005, more than 54,000 people covered by the insurance plan for state employees are paying an extra $40 per month because they smoke or use tobacco. Tobacco Q & A.
  • Indiana added a non-smoker rate incentive in 2006.  For 2007, enrollees save up to $500 /year on annual deductibles when the Tobacco Incentive is applied.
  • Kansas has a smoker surcharge authorized in 2008.

  • Missouri law generally provides that public and private employers may provide health insurance at a reduced premium rate and reduced deductible level for employees who do not smoke or use tobacco products.

  • South Carolina's Budget and Control Board voted in August 2008 to impose a $25 monthly surcharge for state public employees and their family members who smoke or chew tobacco, effective 2010.  According to the Augusta Chronicle, an estimated 58,600 people, or roughly 20 percent of the state's more than 400,000 insurance participants, will pay the surcharge.

  • South Dakota has a smoker surcharge authorized in 2008.

• SMOKING CESSATION PROGRAMS - A growing number of states have launched tobacco cessation programs and policies, primarily using positive incentives, high visibility marketing and some assessment requirements to meet reduced tobacco use goals.  Two examples:

  • Idaho’s Wellness Program: First Phase -Tobacco Cessation. For 2008 there will be a $10 co-payment for every thirty-day supply of quit aids.  Pharmacists will  require a state Blue Cross of Idaho identification card to dispense the quit aids.

  • North Carolina, "37 percent of all preventable deaths are attributed to tobacco. Each smoker represents approximately $1, 623 in excess medical expenditures. By making nicotine replacement therapy patches free with counseling, the State Health Plan anticipates improved member health and significant long-term savings for the plan and for taxpayers". - NC State Employee Smoking Cessation Plan, 2008.

  • North Dakota's Public Employees Retirement System recently received a grant to help state employees and their dependents age 18 and older quit smoking or chewing tobacco. The grant will help pay for participating in one of more than 20 approved smoking cessation programs. Most of these programs are available through public health departments across the state of North Dakota. This project is administered by Blue Cross Blue Shield of North Dakota. The program will pay 100 percent of your out-of-pocket expenses for your office visit and prescription and over-the-counter medication up to $500, for a total benefit of $700. The program will end April 30, 2009.  Program description.

           For summer 2008, NCSL will be examining these programs in more detail and publicizing the results.

• WELLNESS PROGRAMS for state employees becoming more widespread.
  U.S. Dept. of Labor ISSUES CHECKLIST FOR WELLNESS PROGRAMS.  Wellness programs must be carefully reviewed to assure that they fit within a variety of legal boundaries. Particularly important for 2008 and beyond are the nondiscrimination rules under HIPAA. The Department of Labor (DOL) has issued helpful guidance in Field Assistance Bulletin 2008-02 (FAB 2008-02), including a useful checklist. This guidance can be reviewed by any policymaker or plan sponsor implementing a wellness program or considering one. ["CheckUp" by Sibson, 3/10/08)
  

  • Alabama will be the first state to charge overweight state workers who don't work on slimming down.  The State Employees' Insurance Board in August 2008 approved a plan to charge state workers starting in January 2010 if they don't have free health screenings. If the screenings turn up serious problems with blood pressure, cholesterol, glucose or obesity, employees will have a year to see a doctor at no cost, enroll in a wellness program, or take steps on their own to improve their health. If they show progress in a follow-up screening, they won't be charged. But if they don't, they must pay starting in January 2011.  Article: "Extra pounds mean insurance fees for Ala. workers" by AP, 8/22/08.

  • Arkansas has an expanded Healthy Lifestyle program, whereby state employees can earn up to three days per year for participating in a voluntary program that focuses on increasing physical activity, increasing consumption of fruits and vegetables and decreasing or eliminating the use of tobacco products.  See savings examples in the 2008 premium rate chart.

  • Delaware officially launched DelaWELL on April 1, 2007, as a new comprehensive wellness program for state employees. This statewide initiative is available free to all full-time State employees, school district, charter school and higher education employees and pre-65 retirees currently enrolled in group health insurance programs. The program will assess employee health risks and provide confidential, personalized feedback, and coaching interventional strategies that target lifestyle topics such as back care, blood pressure management, exercise, nutrition, and stress management through various modes of communication and health-related events.

  • Kansas, in September 2007, launched a program so that state workers will be able to volunteer for personal health-risk assessments.

  • Minnesota highlights various health improvement services offered through the Minnesota Advantage Health Plan for insurance-eligible state employees and their covered family members. An online wellness chart provides details for 2008. [2/08]

  • Missouri has incentive rates for employees, saving up to $25 /mo, who take the PHA and participate in Lifestyle Ladder or Smart Steps® to be eligible for the incentive rate.

  • Montana announced Wellness Programs including new for 2007 all State employees and their adult dependents have access to free health coaching, intended to "help individuals make permanent changes in their lives."  The wellness program also offers options such as health screenings, spring fitness, and lunch and learn programs, which are designed to maintain and promote healthy lifestyles for members.

  • New Hampshire's wellness program includes a risk assessment, run by Anthem. (2008)
  • North Dakota wellness services are included in the state BC/BS managed plan.
  • Ohio: The Healthy Ohioans initiative, which includes wellness activities and resources, is sponsored by the State Employee Health and Fitness Taskforce. The taskforce was charged with: (1) developing guidelines for state agency health and fitness programs; (2) identifying tools to annually measure the effectiveness of such programs; (3) identifying models for on-site wellness programs; and (4) identifying community partnerships or resources that might be utilized to further wellness programming for state employees.  For 2008, "Take Charge! Live Well! Road Show Events" can earn employees a $25-$200 incentive payment.
  • Oklahoma in 2006 launched "OK Health wellness program," providing "All active state employees the opportunity to participate in the state's wellness mentoring program offered by the Employees Benefits Council State Wellness Program.  The goal of OK Health is to give you the right tools to help you feel better and improve your health."  Enrollment in the OK Health Program,  involves completing an online health risk assessment (HRA). An OK Health representative will call and arrange an initial visit with your Primary Care Physician for some basic measurements and labs.  They say, "As a program participant, the initial cost to visit your physician and receive lab work (specific to OK Health) will be waived by your health care provider.  Following your initial PCP visit, you will receive your first orientation call from a professional health mentor."
  • Virginia: (2007-08):  Routine wellness care is covered for children through age 6 and for children and adults age 7 and over. There is no deductible, copayment or coinsurance for the member to pay before the plan pays for routine wellness coverage.  Routine well child care through age 6 covers at no cost office visits at specified intervals, immunizations, routine lab tests and x-rays at facilities and doctors’ offices. Routine well adult care age 7 and older includes a routine annual wellness check-up at no cost, as well as routine lab tests, immunizations and x-rays at facilities and doctors’ offices.  Preventive care benefits include for specified ages at no cost an annual gynecological exam or prostate exam, and the following services once per calendar year: a Pap test, mammography screening, prostate specific antigen (PSA) test and colorectal cancer screening.
  • Washington: Wellness Initiative, 2006: King County, which comprises the greater Seattle area and is the 12th largest county in the nation, is projecting a reduction in rising healthcare costs by as much as $40 million over the 2007-2009 period due to wellness initiatives. (10/17/06)
  • West Virginia also created the Pathways to Wellness program by law (W. Va. Code § 5-16-8). It requires the Public Employee Insurance Plan to provide wellness programs and activities which include benefit plan incentives to discourage tobacco, alcohol and chemical abuse and an educational program to encourage proper diet and exercise.
    
• HEALTH SAVINGS ACCOUNTS: Examples of several states offering HSA's to their state employees for 2005-07:
• • Arkansas: (2004) For teachers, open enrollment in 2004 results were reported as "disappointing." 
  • Florida: (2005) The state will contribute $500 for an individual, $1,000 for a family account and pair that with a $1,250 (individual) $2,500 (family) deductible plan.
  • Indiana: (2007) The state offers two HDHP/HSA choices.  Plan 1 has a $2,000 individual/$5,000 family deductible; the state's annual contribution includes up to $1,375 for single or $2,750 annually for family to the HSA for active employees; the out-of-pocket annual maximum is $8,000.  Plan 2 has a $3,400 family deductible.
  • Kansas: (2006) is adding an HSA/HDHP choice with a $1,500/$3,000 deductible if network providers are used and a $2,000/$4,000 deductible if non network providers are used. [KS HSA plan]
  • Nebraska: (2007) offers a PPO Consumer Driven Health Plan. The CDHP has a $1,000 per calendar year deductible for in-network expenses with a $2,000 per calendar year maximum out of pocket. In addition, the new CDHP implements a four-tier formulary prescription plan with higher co-pays and/or co-insurance.
  • South Carolina: (2004) The plan conducted state employee open enrollment at the end of October 2004.
  • South Dakota offers a $2000 deductible HSA-compatible plan for 2007; employees selecting this options receive $300 per plan year in Flex Credits in a Medical Expense Spending Account.  An offered $1000 deductible plan is not HSA compatible.  
  • Utah: (2006) HB 76 requires a High Deductible Health Plan and HSA option for Public Employees Benefit and Insurance Program (PEHP).
  • Virginia: For benefit year 2007-08, the state will pay 100 percent of the premium cost for a high-deductible health plan (individual or family), with other plans requiring modest employee contribution.
  • Wyoming: (2006) implemented a federally-qualified high deductible health plan.  Employees may select a state HSA vendor or their own. HSA contributions are 100% from employees.
    
• PROMISING PRACTICES  
  The idea of "value driven purchasing" through pooled negotiation, common contracts and purchases is often discussed but less commonly implemented.  Four states have initiated or joined such efforts, and now have handy reports written and published through the Commonwealth Fund in 2006 and 2007. 
  • The Massachusetts Group Insurance Commission (GIC), a state entity that provides and administers health insurance and other benefits to the commonwealth's employees, retirees, and their dependents and survivors, is trying to improve provider performance through "tiering." GIC assigns its health plan members to a particular tier, based on quality and efficiency, and requires these plans to offer their members different levels of cost sharing, depending on which tier their chosen hospital or provider is designated.  8/07. 
  • The Minnesota Smart Buy Alliance is a group of public and private health care purchasers, including the state agencies overseeing Medicaid and public employee health benefits, along with coalitions of businesses and labor unions. The alliance is developing common value-driven principles, and its members are sharing VBP strategies.  8/07 
  • Washington State's Puget Sound Health Alliance, a broad group of public and private health care purchasers, providers, payers (health plans), and consumers, is working to develop public performance reports on health care providers and evidence-based clinical guidelines.
  • The Wisconsin Department of Employee Trust Funds (ETF), the state agency that administers health benefits for state and local government employees, is pursuing value through a variety of purchasing strategies. EFT is also becoming involved in public-private collaboratives such as a statewide health data repository.  ETF is the largest employer purchaser in the state, covering more than 250,000 active state and local employees and 115,000 retirees and their dependents.**
    
• DOMESTIC PARTNER BENEFITS AND TREATMENT
  14 states (plus DC) that have "a law, policy, court decision or union contract that provide state employees with domestic partner benefits":  California, Connecticut, DC, Hawaii, Illinois, Iowa, Maine, Montana, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont and Washington.   Normally health care is covered by the term "benefits." (Human Rights Campaign, 05/06). 
  There are an additional eight states that prohibit discrimination against public employees based on sexual orientation/gender identity.  These states do not necessarily cover health care costs for a same-sex partner.  These states are:  Indiana, Pennsylvania, Alaska, Arizona, Colorado, Louisiana, Michigan, Virginia.
• • State Retiree benefit programs now extend retirement benefits to domestic partners in about a dozen states, with descriptions of policies and debates in other states. See Domestic Partner Retirement Benefits: NCSL Survey of legislative staff (03/06)
  • Example of Hawaii online resources for domestic partners. (2007)
  • Expedited Partner Therapy - State Information - Legal status and barriers by state to providing medications to persons infected with certain STDs to be administered to their sexual partners. The information applies generally, not just to public employees. (compiled by CDC, 11/07)
    
• STATE CONTRACTORS REQUIRED TO PROVIDE HEALTH BENEFITS 
  A few states require their private contractors to compensate their personnel using prevailing wage and benefit standards similar to public employees.
  • Illinois - Contractor employees must be paid prevailing wages and benefits and work under "conditions prevalent in the location where the work is to be performed." This applies to contracting in the areas of public works, printing, janitorial services, window washing and security guard services. 44 Ill. Adm. Code 1.2560.
  • Massachusetts - Contractors are required to provide their employees wages and benefits comparable to those paid to state employees performing similar services. The wages and benefits must be included in the bid and must be reported to the contracting agency on a quarterly basis. M.G.L.A. Ch. 7 Sec. 54.
  • California, Rhode Island and Washington require prevailing rates or wages for state contractors, but do not specify health coverage in statute.  The District of Columbia, Maryland and San Francisco, CA require paying a living wage.
• 2007 RETIREE Program cutbacks:
  

  The retirement of baby boomers — 79 million born from 1946 to 1964 — will make it hard for state and local governments to keep up with the cost of medical benefits for retirees. What governments are doing now:

  • Results of the Segal Medicare Part D Survey of Public Sector Plans. A summer 2006 survey shows that 79% of public employee plans that responded took the federal 28% subsidy, but that more would reevaluate for 2007.

  • West Virginia The state pension board is to vote Wednesday on shifting prescription drug coverage for retirees to Medicare, a federal program. The change, along with making retirees pay more, would slash the state's $8 billion unfunded liability to $5 billion.  "By tackling this early, we hope to save money in the long run," says Ted Cheatham, director of West Virginia's Public Employees Insurance Agency.

  • North Carolina Civil servants hired after Oct. 1 will have to work 20 years before qualifying for 100% state-paid medical coverage. Previously, workers had to wait only five years.

  • Oklahoma's employee and teacher retirement system has become a federally qualified PDP (Medicare Prescription Drug Plan) in order to coordinate Rx services to its members while obtaining federal reimbursement for virtually all transactions.  Pennsylvania's teachers retirement plan has taken as similar PDP direction, as an alternative to simply providing equivalent benefits and getting a 28 percent federal payment.

  • South Carolina Republican Gov. Mark Sanford's next budget will propose putting $245 million in a new trust fund dedicated to retiree medical benefits. Georgia, Vermont, Virginia and New York City also have started trust funds or plan to create them.

____________________________________________________________

• Alabama: Alabama will be the first state to charge overweight state workers who don't work on slimming down, while a handful of other states reward employees who adopt healthy behaviors. The State Employees' Insurance Board in August 2008 approved a plan to charge state workers starting in January 2010 if they don't have free health screenings. If the screenings turn up serious problems with blood pressure, cholesterol, glucose or obesity, employees will have a year to see a doctor at no cost, enroll in a wellness program, or take steps on their own to improve their health. If they show progress in a follow-up screening, they won't be charged. But if they don't, they must pay starting in January 2011.  Article: "Extra pounds mean insurance fees for Ala. workers" by AP, 8/22/08.
  • The 2005 plan, adopted in a special session in House Bill 2  in November 2004, provides for:  "Section 36-29-19.3. Surcharge on smokers; changes in contributions. A surcharge on smokers and users of tobacco products shall be added to the employee and retiree contribution by the Board to be effective October 1, 2005."
  • Alabama: As of January 1, 2003 plans require a $50 annual per member prescription drug deductible. The plan also requires a 3-tier prescription co-payment of $5 for Generic Drugs, $15 for "Preferred Brand Name Drugs", and $35 for "Non-Preferred" Drugs.
• Alaska:  A 2005 law (SB 141) signed in July 2005 reforms public employees' retirement systems, creating defined contribution and health reimbursement plans for members who are first hired after July 1, 2006.   Employees may select among four medical plans, three dental and three vision plans, life insurance, disability and flex spending accounts.  See rate chart for 2007-08.
  • Alaska: Gov. Murkowski announced he was passing on the same-sex health benefits issue to Governor-elect Sarah Palin.  The Legislature’s passage of two bills that prevent the administration from adopting regulations for those benefits and call for a statewide advisory vote on a potential constitutional amendment banning same-sex benefits. (reported by KTUU-TV, Anchorage).

• Arkansas: State Unveils Health Program for Workers.  In November 2007, Gov. Mike Beebe announced that the state will extend a pilot program offering time off for lifestyle changes to all state employees. Since its 2004 inception, 2,500 people have registered for the program and almost 950 have earned days off for making lifestyle changes that improve their health.

• California: CalPERS, the second-largest U.S. pension fund, is paying 18.4% more for health insurance in 2004 under a draft contract with the HMO networks that provide coverage to its 1.2 million members, as of June, 2003. The increases would be less than the 25 percent rate hike that CalPERS approved for 2003 and below the initial bids that had pointed to a 31 percent insurance rate hike for next year will cost $3.95 billion, up from $3.34 billion in the current year, Calpers said. The HMO package covers about 70 percent of CalPERS' health benefits costs. 
  > Benefits in the Balance: The Uncertain Future of Public Retiree Health Coverage  - released by CA Health Care Foundation,  9/06.
• Connecticut: Public Act 03-149 of 2003 -  Authorizes the agency "To allow small employers and all nonprofit corporations to obtain coverage under the state employee health plan and to provide that such coverage be exempt from the state insurance premium tax." S 353 was signed into law June 2003.
  • Connecticut (effective 2008) provides for a reduced monthly employee contribution when both spouses are employed by the state.  For example, for family coverage a regular employee pays $122.85 per month, while a two-state employee household pays $50.57, a reduction of $72 for their household.
• Delaware: The State Employee Benefits Committee (SEBC) has awarded Blue Cross Blue Shield of Delaware and Aetna the contracts to administer the state group health insurance program, while dropping Coventry Health, effective July 1, 2007. 
• Florida: To state workers: get fit or lose your job? "The state's new secretary of Corrections, Mr. McDonough has proposed mandatory fitness levels for 19,000 of his employees – some of whom have desk jobs. It's meeting resistance from a union representing prison and probation officers and making experts wonder whether requiring workers to become physically fit, or risk losing their jobs, is the best way to tackle the country's growing obesity crisis. - news article, 1/31/07.
• Florida: In May 2004 Governor Bush signed  HB 1837, which established the state employees' prescription drug program. The new program "shall create a preferred drug list" and shall be subject to new copayments (effective 1/1/04) as follows:  For generic drug with card....$10. For preferred brand name drug with card....$25.  For nonpreferred brand name drug with card....$40.  For generic mail order drug....$20.  For preferred brand name mail order drug....$50.  For nonpreferred brand name drug....$80.
• Georgia: for 2005 provides 12 plan choices including one indemnity, two PPOs, nine HMOs and a Medicare+Choice. It was one of the first states to establish a multi-agency preferred drug list, aimed at reducing costs. The same list is applied to Medicaid recipients. The five-page "PDL list" is available to all members online.  The State Health Benefit Plan covered 664,703 people as of January 1, 2007. Teachers and school personnel represent almost 77% of the covered lives.

  • The state requires a $30 monthly "Spousal Surcharge" be applied to members whose spouse is eligible for coverage through his/her (non-state) employer but elects not to take the coverage. (2008)

  • A $40 Tobacco Surcharge applies to any member and/or one of his/her dependents who use(s) tobacco products. This surcharge is designed to encourage tobacco users to a healthier lifestyle. Smoking cessation classes are offered to members and dependents who want to stop using tobacco products. (2008)

• Hawai'i Press Release: Rate Reductions and New Benefit Plan Options for Public Employees to Save $8 Million  [2/13/07]
  • A 2001 law, Chapter 87A of the Hawaii Revised Statutes, established the Hawaii Employer-Union Health Benefits Trust Fund. The Trust Fund "is to provide eligible state and county employees, retirees, and their dependents with health and other benefit plans at a cost affordable to both the public employers and the public employees beginning July 1, 2003." The new office was created because the cost of employer contributions was projected to grow to $949 million in 2013 compared to $266 million in 1998. As of July 2003 the state eliminated the option of having the employer contribution forwarded to an employee's union and enrolling in union plans.
• Idaho: Proposed Medical Plan Changes for FY2008 were amended in May 2007 to abandon plans to increase employee contributions and payments.
• Kansas: 2008 legislation (HB 2172) establishing a pilot project allowing certain small businesses to join the state employee health plan died in committee.
  •  Health assessment program focuses on state employees. All state workers will be able to volunteer for personal health-risk assessments. There will be a variety of assistance offered to those wanting to lose weight, stop smoking and find services for dealing with chronic disease or other problems. (9/07),
  • In October 2005, the headlines read "Workers reap windfall on health premiums." as Kansas lowered health insurance premiums from $7 to $67 less per month, as of 01/06.
• Kentucky:  In September 2004, Governor Fletcher's plan for substantial increases in state employee contributions led to disagreements and alternative proposals.  The result was a call for "an extraordinary legislative session will begin on October 5, 2004. At that time, the General Assembly will convene to address compensation, health insurance and retirement benefits specifically for our public employees, teachers and retirees. This special session is needed because the cost of the Public Employee Health Insurance plan offered to state employees, teachers and retirees has become unsustainable."  9/24/04

  • KY Presentation on 05/24/2005 Regarding Cost Drivers (PDF - 625 KB) KY Presentation Regarding Cost Analysis (7/8/05 PDF - 126 KB)

  • Kentucky: Gov. Ernie Fletcher signed a bill into law Oct. 19 that makes health insurance more affordable for public employees and will stave off a teacher strike planned for later this month. Under the new plan, employees will pay lower premiums, deductibles, out-of-pocket expenses and receive enhanced benefits. The plan is a product of an 11-day special session where leaders in both the House and Senate spent multiple hours working with insurance companies on how to improve upon existing contracts already signed by the state.  -Cincinnati Post (10/21/04)

• Maine: A 2007 law (HP 1093, signed 6/21/07) directs the State Employee Health Commission to evaluate the feasibility of the Legislature being an employer group in the Dirigo Health Program and to evaluate any effect on retirees who are Legislators. 
• Maryland:  In April 2008, the state released "Measuring the Quality of Maryland HMOs and POS Plans: 2008/2009 State Employee Guide" which provides "validated results that compare the performance of the Maryland plans offered to State employees on measures important for ensuring high-quality care and services."
  • Maryland has authorized a new drug program to allow local government and businesses to buy in a pool with state employees.  As of early 2007, price negotiations await a contract ruling and have delayed the drug program. 
• Massachusetts: 

  • A state budget analysis published March 2008 provided a 10-year history of state employee health spending.  It included the following figures, in 2007 state spending dollars (in millions): FY1987 = $464M; FY2006 = $1,012M; 10 year increase = $548M or 118%. The average annual change = +4.2%. "Point of Reckoning," 3/08.

  • In July 2007 the Legislature approved a plan, Chapter 67, the Municipal Partnership Act, to allow city and town employees to join in with the state employee program. 7/13/07.

  • MA: Cities, towns urged to join health plan; Statewide pool may save $100m.  Massachusetts cities and towns could save $100 million on the rapidly spiraling cost of health insurance in the fiscal year 2009 alone if they took advantage of a new law allowing them to join the state's health insurance program. According to the report, healthcare costs for municipal employees jumped 63 percent between fiscal year 2001 and 2005, while municipal budgets increased 15 percent. (Boston Globe, 8/20/07).  

  • Municipal Health Reform: Seizing the Moment - Report by Massachusetts Taxpayers Foundation, 8/07. [10 pages]

  • Massachusetts: With "Select & Save GIC Plan", operational in 2004, enrollees are rewarded with lower co-pays or deductibles for choosing providers that "offer the best quality and who use their resources most efficiently."
  • "Pension Pinching" Relatively speaking, Massachusetts is not the public pension "paradise" it's often made out to be. In fiscal 2005, MA ranked 15th in the nation in the total amount of benefits paid per beneficiary. (10/07)
• Michigan:  In November 2007 a contract was rejected by a state workers' union.  The new contract would have required members to pay more for health care costs.  "It was pretty much the straw that broke the camel's back," MSEA President Roberto Mosqueda said.  Read article [From Lansing State Journal, 11/27/07]
  • MI: Center for Excellence to Fund Analysis of Michigan State Retiree Health Care Reforms. 11/14/07
  • MI: Effective 2003, the State Health Plan became a Preferred Provider Organization (PPO). Blue Cross-Blue Shield of Michigan (BCBSM) administers this program. The cost for prescription drugs increased from $5 for generic drugs and $10 for brand name drugs to $7 for generic drugs and $12 for brand name drugs. Effective January 1, 2004, the cost of brand name drugs increased again to $15, while generic drugs will stay at $7.
• Minnesota Governor Tim Pawlenty vetoed HF 1875 in 2008, which would have created a board to design a statewide health insurance pool for local school employees.  The initiative was designed, in part, to assist municipalities that do not currently provide coverage. (6/08)
• • Minnesota Moves to E-Prescriptions for All State Employees One of the first initiatives under a new single pharmacy benefit manager system will be to adopt electronic prescriptions. The move will allow employees to better manage their prescription drugs and provide the information in a more portable, interoperable format. Government Technology. (6/6/07).
  • Minnesota: State Launches Phase Two of Rx Drug Importation: In May 2004 Governor Tim Pawlenty instituted a program allowing state employees and their dependents to purchase prescription medicines from Canada. The state-sponsored website is the second of a two-phase initiative that began earlier this year to help Minnesota citizens purchase safe and less expensive prescription medicines from Canadian pharmacies. State employees who use the website would be able to obtain their medicines with no out-of-pocket expense.
  • Minnesota: "New state health plan has handle on costs"   While most health plans are seeing hefty annual cost increases, one state employee health plan in Minnesota is projecting an increase for the coming year of zero, using tiers for most copays and deductibles.  (8/12/05)
• Mississippi: State May Cover Rising Premiums The Senate Appropriations said the state may need to dedicate $9.4 million in FY 2004 to the state employees insurance program to address rising costs. (3/5/03)
• Nevada:  Public Employees' Benefits Program (A.C.R. 10) -  a 2004 Interim Legislative Study.
• New Jersey: A 2003 statute (P.L.2003, chapter 172 or N.J.S.A. 52:14-17.33a) allows part-time State employees to purchase coverage in the State Health Benefits Program at their own cost (before only full-time employees were in SHBP and usually at the employer's expense). A separate proposal was A-3780 / S-2639, which  passed the Legislature but vetoed by the governor  on 12/11/03. That bill would have allowed certain employees of unions that are majority representatives of public employees to be in SHBP at the unions' expense.
  • New Jersey: Health care drives state costs. "New Jersey, like many employers, pays a large portion of the costs of health insurance for its employees. There are several state health plans, but the most popular one is entirely free to state workers and their families...." - news article, 3/13/05

  • New Jersey: State aims to cut public employees' medical plan.  Thousands of teachers, government workers and their families would face higher costs for prescription drugs and medical services under a state cost-cutting plan unveiled yesterday, the same day lawmakers began to debate ways to rein in public employee benefits.  The Star-Ledger (Newark) 8/9/06.

  • New Jersey: Officials seek bargaining power on state health benefits.  Local officials, school boards and county colleges are urging Gov. Jon Corzine to help them gain the power to negotiate health benefits with their 215,000 active and retired employees, an action they say would save $34 million the first year.  Currently, 55 percent of municipal and county governments, 18 of the 19 county colleges and a large number of school districts participate in the State Health Benefits Plan. The Star-Ledger (Newark) 1/3/07.

• New Mexico: ACLU sues over New Mexico domestic partner retiree health insurance. New Mexican 2/5/07.

• North Carolina: State Health Plan members now have access to two online tools that empower users to monitor and compare average costs for physician office visits, diagnostic procedures and screenings, disease treatments, and prescription drugs. The updated tools are: Blue Cross Blue Shield of North Carolina’s (BCBSNC) Health Cost Estimator and Medco’s “My Rx Choices^®,” listing prescriptions from a Preferred Drug List. 

• North Dakota has a member Rx rebate program, in which a portion of manufacturer rebates will be passed directly to the member to offset their prescription drug out-of-pocket expense.  Effective July 2005, member's out-of-pocket expense will automatically be reduced by the amount available in their MRA at the time of purchase at the pharmacy. Members will not receive rebate checks in the mail.  [Updated 2008]

  • North Dakota BC/BS has 90 percent of the state employee market; it has negotiated a 5.2% administrative fee for FY 2008.

• Oklahoma: The Oklahoma employee and teacher retirement system has become a federally qualified PDP (Medicare Prescription Drug Plan) in order to coordinate Rx services to its members while obtaining federal reimbursement for virtually all transactions.  Pennsylvania's teachers retirement plan has taken as similar PDP direction, as an alternative to simply providing equivalent benefits and getting a 28 percent federal payment.

• • in 2006 launched "OK Health wellness program," providing "All active state employees the opportunity to participate in the state's wellness mentoring program offered by the Employees Benefits Council State Wellness Program.  The goal of OK Health is to give you the right tools to help you feel better and improve your health."  Enrollment in the OK Health Program,  involves completing an online health risk assessment (HRA). An OK Health representative will call and arrange an initial visit with your Primary Care Physician for some basic measurements and labs.  They say, "As a program participant, the initial cost to visit your physician and receive lab work (specific to OK Health) will be waived by your health care provider.  Following your initial PCP visit, you will receive your first Orientation call from a professional health mentor."
• Oregon:  On June 15, 2004 the Public Employees Benefit Board approved recommendations to renew current benefit plans with current carriers for 2005.  As a result, the design of benefits will not change significantly for the coming year. The recommendations approved by the Board for Medical Plans include: Continue the current Kaiser Permanente HMO plan design for 2005 with no changes. Estimated premium rate increase: 9.8 percent. Continue the current Regence BlueCross BlueShield of Oregon(BCBSO) PPO plan design for 2005 with no plan changes subject to final decisions to be made in July on the additional depression management program. Estimated premium rate increase: 18.9%.
• Pennsylvania proposal seeks health insurance savings.  Hoping to save money for his state on health-care costs—and to hold down local property-tax rates used to pay for benefits—Pennsylvania Gov. Edward G. Rendell is proposing to bring all school employees under one insurance plan. Education Week 9/27/07. article. 
  • Pennsylvania: has posted a detailed pharmaceutical Preferred Drug List for 2007 for all active state employees.  The system has been administered by ExpressScripts since 2004.  The program maintains a separate Prior Authorization list that allows use of some non-preferred drugs.
  • Pennsylvania in 2007announced plans for the Pennsylvania Employees Benefit Trust Fund (PEBTF) to withhold payment for “never events”.  The PETBF, anticipates that this action will stimulate performance improvements that can reduce the number of unnecessary infections and other complications
• Rhode Island:
  • A 2008 law (H. 8330) provides a standard $7,000 per year stipend to elected state legislators, to cover purchase of health insurance.  The legislator is permitted to keep any amount not needed or used for health insurance, or it may be "banked" in an HSA account if eligible.  The plan received some criticism from think-tanks, which noted that costs of individual coverage was "around $5,500."
  • RI: State Workers Retiring Early Because of Health-Insurance Costs - (ProJo news, 8/17/08)
  • RI: "More members of General Assembly paying part of health cost -- voluntarily"  - The public spotlight placed on their free health-care benefits has prompted several more state lawmakers to offer to pay 10 percent of the cost of the premiums costing up to $16,233 a year for family coverage. The number of $13,508-a-year lawmakers paying a portion of their health insurance premiums now stands at 26 of 113. Others either get it for free, or they get a $2,002 waiver payment for giving it up.   (Providence Journal, 5/5/08.) 
  • RI: Judge's ruling stymies Carcieri plan on health costs   -  A Superior Court judge has thrown a proverbial monkey wrench in the Carcieri administration’s mid-contract attempt to raise by as much as seven-fold the copays that members of the largest state employees union pay for certain medical expenses, such as emergency room visits from $25 to $150, for urgent care visits from $10 to $75, for visits to specialists from $10 to $25 and for prescription drugs from the current $5/$12/$30 range to $7/$25/$40.  (ProJo news, 11/6/07) 
  • In spring 2003, the governor proposed to impose a cost-shared premium for state employees for the first time. Legislators examined alternatives.
  • Rhode Island:  The state spent about $4 million in 2004 on health-care benefits for 372 part-time state employees, an analysis of state payroll data shows. 
• South Carolina:  Smokers face monthly surcharge; Tobacco users would start paying $25 in 2010.  Roughly 400,000 people are covered by the state plans, including 244,000 employees and their family members. The plans are available to teachers, state workers and local government employees, among others.
• South Dakota:  The state has a carved-out Prescription Drug Plan, emphasizing mail order and administered by Prescription Solutions.  A mandatory generics policy took effect on July 1, 2004. If enrollees choose a name brand drug, and could use a generic, they will pay the generic copayment plus the difference in cost between the generic drug and the cost of the name brand drug.  
• Texas:  Texas law passed in 2005 allows for a Health Insurance Opt-Out Credit, which enables employees and retirees in the Texas Employees Group Benefits Program (GBP) to get money toward optional coverage if they give up their state-provided health insurance.

• Utah: the Public Employee Health Plans (PEHP) has published a price transparency online Treatment Cost Estimator Home and a separate PEHP Average Costs list for infant deliveries, effective 2008.

  • The Public Employees Health Program launched a "Utah Timely Topics" program, which promotes information on topics like Avian Flu, Prostate Cancer and Influenza.  They also publish a separate "Provider Bulletin."

• Washington: Wellness Initiative, 2006: Washington state's King County, which comprises the greater Seattle area and is the 12th largest county in the nation, is projecting a reduction in rising healthcare costs by as much as $40 million over the 2007-2009 period due to wellness initiatives. (10/17/06)

• West Virginia: In March 2004, West Virginia passed legislation (SB 143) intended to help uninsured small businesses provide coverage for their employees. The new law creates a private/public partnership between the West Virginia Public Employees Insurance Agency (PEIA) and insurance companies that choose to offer the plan. West Virginia's plan will allow carriers to access PEIA's reimbursement rates and drug purchasing plan, enabling the new small business coverage cost to be 20-25 percent below the usual market rate. This will expand the pool of insured working West Virginians.
  • West Virginia Preferred Drug List administered by the PBM Express Scripts - effective 1/1/07.  
  • West Virginia: also created the Pathways to Wellness program by law (W. Va. Code § 5-16-8). It requires the Public Employee Insurance Plan to provide wellness programs and activities which include benefit plan incentives to discourage tobacco, alcohol and chemical abuse and an educational program to encourage proper diet and exercise. The cost of the exercise program shall be paid by county boards of education, the public employees insurance agency, or participating employees, their spouses or dependents. All exercise programs shall be made available to all employees, their spouses or dependents and shall not be limited to employees of county boards of education.
  • West Virginia:  After July 1, 2006, family coverage increased more than $400 annually.  Public Employees Insurance Agency Finance Board members approved a 22 percent increase in employee health insurance premiums on Dec. 14, 2005, following two hours of sometimes-heated discussions. The increase, which amounts to $396 a year for family coverage for public employees and teachers with salaries under $30,000, takes effect 7/1/06.

  • West Virginia: Surgery abroad an option for 2007?  West Virginia, Republican legislator Ray Canterbury has proposed allowing state employees to go overseas for health care if they want, as long as the cost, including travel and accommodations, is less than the expense in the United States.  The bill is in a special study committee that will take it up next year.  Mr. Canterbury hopes that the state legislature will at least approve a pilot program testing overseas care.  (Post-Gazette, 9/10/06)

  • West Virginia: Financial Report for FY 2008 - detailing projected increases July 1, 2007-June 30 2008 by categories 

• Wisconsin: Millions in state employee benefits on the line  Tens of millions of dollars in benefits for thousands of state employees are hanging in the balance as legislative leaders hammer out a final budget deal.  The Capital Times (Madison), 8/2/07.
  •  In June 2004, Wisconsin announced that required employee contribution rates for health coverage will increase for all employee groups beginning January 2005.  Rates for both the general/teacher (from 9.8% to 10.2%) and executive/elected (from 10.8% to 11.2%)categories of employees increased by .4%. Wisconsin also authorized the Department of Employee Trust Funds (DETF) to contract with a Pharmacy Benefits Manager (PBM) to provide pharmacy benefits services to all State of Wisconsin group health insurance participants.  Effective January 1, 2004, all participants receive their pharmacy benefits from the PBM, Navitus Health Solutions.
• Wyoming: In March 2003 the legislature enacted (in H. 43) the following terms: $23,025,240 for the purpose of paying the state's contribution to the state health insurance plans under W.S. 9-3-210 for each qualifying executive, judicial and legislative branch employee including employees of the University of Wyoming and the community colleges in the following amounts for the specified time periods: (A) For the period beginning March 1, 2003 and ending November 30, 2003: (I) $335.37 per month for any employee electing single coverage; (II) $652.95 per month for an employee electing employee plus one dependent coverage; and (III) $744.75 per month for an employee electing family coverage.  (B) For the period beginning December 1, 2003 an amount to be determined by the employees group health insurance section of the department of administration and information but not to exceed: (I) $384.14 per month for an employee electing single coverage; (II) $751.15 per month for an employee electing employee plus one (1) dependent coverage; and (III) $857.40 per month for an employee electing family coverage.

Additional Professional Resources

• White Paper: State Government Employee Healthcare Benefits by National Association of State Personnel Executives (NASPE).  9/06.
  NASPE State Government Employee White Paper Addendum covering:
     Disease Management and Wellness Programs 
     Cost Containment
     Enrollment Management Strategies
     Procurement Practice Initiatives
     Consumer Driven Health Plans

• "Coverage Conundrum" The challenge of rising state employee health insurance costs is hitting states hard. NCSL State Legislatures Magazine, July-August 2004
• Public Employee Health Benefits Have Survived Threats - So Far - Health Affairs web exclusive 4/18/06 
• "America's Second Civil War: The Public Employment Complex vs. Taxpayers," - Lewis M. Andrews, Yankee Institute, 4/06 [24 pages]
• Public Fund Survey (Retirees): Summary of findings for FY05 - National Association of State Retirement Administrators, 9/06 [ PDF, 15 pp]
• State Employee Health Benefits Overview.  - NCSL PowerPoint presentation from 9/03 by Richard Cauchi.
• Rising insurance costs for public workers puts states in a bind  - Associated Press (10/13/03).
• National Association of State Personnel Executives (NASPE), a non-profit organization, was established in 1977 to enhance communication and the exchange of information among personnel executives. NASPE is an affiliate organization of The Council of State Governments.
• National Association of State Retirement Administrators (NASRA) - online resources.
• Health Care Purchasing Among State Employers by National Health Care Purchasing Institute.  In this report, James Maxwell at JSI Research Inc. chronicles major challenges for state employers, such as premium, drug, and retiree costs, and describe strategies for keeping down costs. 
• "State Government Retiree Health Benefits: Current Status and Potential Impact of New Accounting Standards" - AARP Public Policy Institute reports state and local governments will have to follow new accounting standards for their retiree health benefits.  Compiled by Workplace Economics, 07/04. [29 pages]
  Appendix: 50-state charts 2003 plan data [42 pages]
• NASRA White Paper: Myths and Misperceptions of Defined Benefit and Defined Contribution Plans -
• Defined Benefit / Defined Contribution Fact Sheet, an overview of pension plan types and their use among public employees. NASRA
• Plan Design: A Review of Current Public Pension Issues, report by the Kansas Public Employees Retirement System
• * 2000-2001 State Health Care Expenditure Report: State Employees' Health Benefits - Co-Published by the Milbank Memorial Fund, the National Assoc. of State Budget Officers (NASBO) , and the Reforming States Group, 04/03.

Footnotes

• 1- Kaiser/HRET Survey: 2002 State Employee Health Plans - Kaiser Family Foundation, July 2003.
  State employee health plans provided coverage for 3.4 million state government employees in 2002. The Survey finds that premiums for state employee health plans increased 12.8% in 2002, similar to national averages. It also finds that state employee plan premiums are slightly more expensive than the national average and that state workers? contributions are less expensive than the average U.S. firm. The Survey is a supplement to the larger Kaiser/HRET Employer Health Benefits Survey. [PDF 12 pages].
• 2-2003 Segal State Health Benefits Survey - a comprehensive look at premiums, enrollment and related structure, updated in 2003.
  • Abstract of 2004 Survey Report "Highlights of Segal Survey Conducted at the 2004 Benefits Management Forum & Expo"

  • Abstract of 2004 Survey Report, "Results of the Segal Survey of Massachusetts Jurisdictions' Benefits for Same-Gender Spouses of Employees"

  • Abstract of  2004 Survey Report, 2003 Segal State Health Benefits Survey: Drilling Down on Dental Plan Coverage for Employees

  • Abstract of 2004 Survey Report, 2003 Segal State Health Benefits Survey: Medical Plan Design for Employees and Retirees

  • Abstract of 2004 Survey Report, "Results of Segal's Survey of Top HR and Benefits Issues for Higher Education Institutions"

  • Abstract of Winter 2004 Survey Report, 2003 Segal State Health Benefits Survey: Prescription Drug Coverage for Employees and Retirees
• 3- Workplace Economics "2006 State Employee Benefits Survey" published 4/24/06. This comprehensive annual survey of state features and premiums provides an excellent statistical baseline for 14 categories of benefits including health, dental and vision, life, travel and retirement.  [WorkPlace Economics no longer lists items for sale; their web site is no longer operational as of 3/08].
• 4 - "Table 8A: Health, Dental and Optical Insurance Benefits for State Legislators, 2005", a survey of the 50 states.

• States struggle to cover retirees - USA Today, 12/18/2006

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