The medical premium reimbursement program will be provided upon the conditions set forth below in order to lessen or defray part or all of the cost of medical plans to eligible retirees, as hereinafter defined.
(a) Eligibility for Medical Premium Reimbursement. Upon written application and verification, as required by the Board, those retirees who are receiving a service retirement benefit or disability retirement benefit from LACERS under Chapter 10, have at least ten (10) years of Service, are age fifty-five (55) years or older, and reside more than three (3) months of the year:
(1) Outside the state of California; or
(2) In the state of California, but not within a LACERS administered HMO medical plan zip code service area,
and are enrolled in a federally qualified HMO or a state regulated health insurance plan, shall be eligible for the medical plan premium reimbursement as provided in Subsection (c) or Subsection (e), as applicable.
(b) Maximum Medical Premium Reimbursement for Retirees Without Medicare Part A. The Board shall set the maximum medical plan premium reimbursement for retirees not eligible for Medicare or retirees not eligible for Medicare Part A premium free in the same manner as in Section 4.1111, Subsection (b) or Section 4.1111, Subsection (c), as applicable, of this Article.
(c) Reimbursement for Eligible Retirees Without medicare Part A. Those retirees who are receiving a service retirement allowance or a disability retirement allowance, and who either are not eligible for Medicare or do not qualify for benefits under Part A of Medicare premium free, shall be reimbursed the following amount:
(1) Basic Monthly Reimbursement. For one (1) to ten (10) whole years of Service Credit, forty percent (40%) of the maximum monthly medical plan premium reimbursement amount established pursuant to the provisions of Subsection (b) herein.
(2) Additional Monthly Reimbursement. For each additional whole year of Service Credit in excess of ten (10) years, add four percent (4%) of the maximum monthly medical plan premium reimbursement amount to the Basic Monthly Reimbursement.
(3) Maximum Monthly Reimbursement. The amount paid shall not exceed the maximum monthly medical plan premium reimbursement established pursuant to the provisions of Subsection (b) herein or the amount of the plan premium being reimbursed.
(4) Dependent Reimbursement. The monthly medical plan premium reimbursement shall be applied first to the retiree’s medical plan coverage with any balance applied toward the coverage of the retiree’s dependent(s) under the same medical plan.
(d) Maximum Medical Premium Reimbursement for Retirees Enrolled in Parts A and B of Medicare. Effective January 1, 2011, the maximum monthly medical plan premium reimbursement for retirees enrolled in Parts A and B of Medicare shall be $480.41. The Board, in its discretion, may, by resolution, increase the monthly amount of medical plan premium reimbursement of retirees enrolled in Parts A and B of Medicare, provided that the amount of the maximum monthly medical plan premium reimbursement shall not exceed one hundred percent (100%) of the single-party monthly premium of the highest cost approved Medicare supplemental or coordinated plan provided by LACERS.
Effective July 1, 2011, no increases in the maximum reimbursement amount paid to retired members under this Subsection (d) shall be provided to members who retired on or after July 1, 2011, except that former members who terminated employment prior to July 1, 2011 and retire on or after July 1, 2011, on a deferred vested basis without returning to membership shall be entitled to increases in the maximum reimbursement amount as herein provided regardless of the date of retirement. Notwithstanding all of the foregoing, increases in the reimbursement amount provided to retired members subject to Section 4.1111(c) shall be governed by the provisions of this Subsection (d) regardless of the date of the member’s retirement.
(e) Reimbursement for Eligible Retirees Enrolled in Medicare Part A and Part B. Those retirees who are receiving a service retirement allowance or a disability retirement allowance and who qualify for benefits under Part A and Part B of Medicare, shall be reimbursed the following amount:
(1) Monthly Reimbursement (75%). For one (1) whole year of Service Credit, but less than fifteen (15) whole years of Service Credit, seventy-five percent (75%) of the monthly medical plan premium reimbursement amount established pursuant to the provisions of Subsection (d) herein.
(2) Monthly Reimbursement (90%). For fifteen (15) whole years or more but less than twenty (20) whole years of Service Credit, ninety percent (90%) of the monthly medical plan premium reimbursement amount established pursuant to the provisions of Subsection (d) herein.
(3) Monthly Reimbursement (100%). For twenty (20) or more whole years of Service Credit, one hundred percent (100%) of the monthly medical plan premium reimbursement amount established pursuant to the provisions of Subsection (d) herein.
(4) Dependent Reimbursement. The Board shall establish the reimbursement policy for dependents of these eligible retirees.
(f) Payment Limitation. In no event shall the reimbursement provided in this section, when added to any other medical plan subsidy provided by the Department of Water and Power or the Fire and Police Pension Plan, exceed the maximum amount established in Subsection (b) herein.
(g) Reimbursement for Survivors. Any person who is eligible to receive the survivor medical plan premium subsidy provided in Section 4.1115 of this Article and who lives outside the state of California or in the state of California, but not within a LACERS administered HMO medical plan zip code service area, may qualify for the medical premium reimbursement program provided in this section, except that the amount of reimbursement shall not exceed the amount that he or she would have received as a medical plan premium subsidy under Section 4.1115.
(h) Medicare Enrollment. Retirees or survivors who are eligible to enroll in Medicare Part B must do so in order to qualify for the medical premium reimbursement provided in Subsections (c), (e) and (g) of this section. Retirees or survivors who are not entitled to premium free Part A of Medicare are not required to enroll in Part A.
SECTION HISTORY
Added by Ord. No. 182,629, Eff. 7-25-13.
Amended by: Ord. No. 184,134, Eff. 1-22-16.