STATE EMPLOYEES’ INSURANCE BOARD
Alabama Legislative Act 1965-833 established the State Employees’ Insurance Board (SEIB) in 1965. Its current operating authority can be found in Section 36-29 Code of Alabama 1975. The SEIB was initially empowered by the Legislature to establish a health insurance plan for State employees. The eleven member Board is composed of the five members of the State Personnel Board, the Director of the Finance Department, the Secretary-Treasurer of the Employees’ Retirement System of Alabama, two elected active State employees and two elected retired State employees.
The SEIB is an agency of the State of Alabama and is responsible for various aspects of the administration of four benefit plans and programs: State Employees’ Health Insurance Program (SEHIP), Local Government Health Insurance Program (LGHIP), Flexible Employees’ Benefit Plan and Alabama Health Insurance Plan (AHIP). The SEIB employs a staff of approximately 50 employees who perform primarily enrollment and accounting functions for all four plans.
State Employees’ Health Insurance Plan & Local Government Health Insurance Program
The SEIB serves as the Plan Administrator for the SEHIP and the LGHIP. These are self-insured comprehensive health benefit plans serving approximately 120,000 active and retired State and local government employees and their dependents. As Plan Administrator, the SEIB is primarily responsible for the control and supervision for the SEHIP and the LGHIP. The SEIB is also responsible for designing benefits and setting premiums.
The SEIB contracts with third parties to carryout various functions of the SEHIP and the LGHIP. Contracts are awarded by the SEIB after a competitive, nationwide bid process. The SEIB currently contracts with the following entities:
- Blue Cross Blue Shield of Alabama - Claims Administrator,
- SHPS/CareWise - Utilization Management Administrator,
- Alabama Department of Public Health – Wellness Program Administrator.
- Customer service,
- Provider network design and service,
- Case management,
- Utilization review,
- Pharmacy benefit management.
As part of its contract with Blue Cross, the SEIB uses the provider networks established by Blue Cross for its book of business. Except for routine vision examinations and mental health and substance abuse treatment, the SEIB does not contract directly with providers.
SHPS/CareWise provides advisory care determinations of medical necessity and appropriateness of quality of medical care to include inpatient precertification and outpatient precertification of the certain procedures. SHPS/CareWise also provides case management services. These services are conducted independently from Blue Cross.
Alabama Department of Public Health administers an onsite wellness program for state employees. The wellness program is comprised of two major components:- Annual on-site health care screenings – survey of personal health data, blood pressure measurement, total cholesterol and glucose check, counseling sessions, referral to physician for members with abnormal screening results.
- Quarterly on-site blood pressure screenings
Flexible Employees’ Benefits Plan
The Flexible Employees’ Benefit Board (FEBB) administers the Flexible Employees’ Benefits Plan offered to state employees. Flexible Employees’ Benefits are available to the employees of the State of Alabama pursuant to Code of Alabama, Section 36-29-20 through 30 as last amended and Internal Revenue Code of 1986 Sections 105, 125 and 129. The IRS regulations enable employees to pay premiums and pay for eligible health care and dependent care expenses with payroll deductions before state and federal taxes are applied. Three benefit options are offered to state employees:
- Health Care Reimbursement Account - allows state employees to set aside tax-free dollars from each paycheck to pay medical expenses not covered by health insurance (deductibles and copays) for themselves and their dependents.
- Dependent Care Reimbursement Account - allows state employees to set aside tax-free dollars from each paycheck to pay for eligible day care expense for their children.
- The Premium Conversion Plan - allows state employees to pay for their dependent health insurance premium with pre-tax dollars.
The FEBB contracted with the SEIB to conduct the day-to-day activities of the Flexible Employees’ Benefits Plan. The SEIB is primarily responsible for enrollment and accounting functions. The FEBB also contracted with Blue Cross Blue Shield of Alabama and Erisa to process claims.
Alabama Health Insurance Plan
Alabama Health Insurance Plan (AHIP) was established by the Alabama legislature Pursuant to Alabama Act No. 97-713 (Senate Bill 688, 1997 Regular Legislative Session). Its operation is governed by Departmental Regulation No. 115 of the Alabama Department of Insurance. The AHIP is a high risk pool established to provide health insurance coverage to eligible individuals as an alternative to federal oversight required in the Health Insurance Portability and Accountability Act of 1996 (H. R. 3103).
The Alabama Health Insurance Board serves as the Plan Administrator and has contracted with the SEIB to perform various operations for the AHIP, primarily enrollment and accounting functions. The Alabama Health Insurance Board also contracts with Blue Cross Blue Shield of Alabama to conduct the same function as it does for the SEHIP and the LGHIP.