6.1 Initial District Eligibility Requirements

The High Desert and Inland Trust, in their commitment to growth, should continue to seek districts that meet similar underwriting criteria representative of the current Trust participating districts. The Trust Managers shall use the following criteria to screen perspective new districts:

a. The contract area shall be similar in service cost to current participants in the Trust
b. The prospective district’s base rate shall be comparable to the average base rate of the Trust.
c. The prospective district shall have a proportionately low percentage of retirees and COBRA participants (no more than approximately 10%).
d. The prospective district’s employee opt-out criteria should be limited to only those subscribers who have other insurance coverage, and the district should limit this group to no more than 10% of the eligible membership. The Trust reserves the right to add a load to the rates for these districts.
e. The demographics of the group, such as average age of the employee pool, gender mix and the ratio of dependents should be similar to the existing districts.
f. Medical plan designs shall be limited to those offered by the Trust.
g. A district may only offer the Trust medical plans from a single carrier to participating employee units, with the exception of Kaiser.
h. If Kaiser is a secondary carrier, the participation of all eligible employees in the Trust medical plan should be at least 50%.
i. Districts shall contribute a minimum of 50% of the premium of full time employees in order to participate in the Trust medical plans.
j. If part-time employees are eligible, district shall make some contribution toward coverage.
k. Dependent eligibility may be either IRC 25 or the definition of a full-time student to age 25. It is the District responsibility to monitor dependent eligibility.
l. Domestic Partners shall be same sex partners as identified in the state’s “narrow version” policy definition or opposite sex partners, one of whom is over age 62, registered as Domestic Partners in the State of California.
m. Districts that have a “negative certification” or “qualified certification” by their County Office are not eligible to participate.
n. Classified retiree benefits may be offered to employees prior to age 65 as their primary carrier and after 65 as a secondary to Medicare.
o. District shall enroll for medical coverage in order to be eligible for vision, life and dental plans administered by the Trust.
p. Self-funded dental plans shall establish and maintain an adequate reserve (a minimum of 2 months average claims and related administrative costs) paid to the Trust for reserves. Self-funded districts shall be responsible for any claims beyond their reserves.
q. All renewals shall be effective July 1.
r. The Trust shall strive to receive three years experience reports and large claims directly from the current carrier. Experience rated groups should ideally reflect a loss ratio in the low 80th percentile.
s. A charter school must be funded for two years to be considered for participation.
t. Charter schools seeking participation must submit the most recent audited financial statement and current interim financial reports.

Originally approved on: June 2, 2005
Revision date: March 16, 2010