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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 have at least ten (10) years of Health Service Credit, 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 premium free Medicare Part A in the same manner as in Section 4.1121(b) of this Article. Retirees who are eligible to enroll in Medicare Part B must do so in order to be entitled to reimbursement.
(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 ten (10) years of Health 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 more than ten (10) years of Health Service Credit add three percent (3%) of the maximum monthly medical plan premium reimbursement amount to the Basic Monthly Reimbursement for each whole year of Health Service Credit in excess of ten (10) years.
(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. Premium reimbursement may not be applied toward coverage for dependents of retirees.
(d) Maximum Medical Premium Reimbursement for Retirees Enrolled in Parts A and B of Medicare. 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.
(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 Parts A and Part B of Medicare, shall be reimbursed the following amount:
(1) Monthly Reimbursement (75%). For ten (10) years or more, but less than fifteen (15) years of Health 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) years or more but less than twenty (20) years of Health 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 years of Health 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. Premium reimbursement may not be applied toward coverage for dependents of retirees.
(f) Medicare Enrollment. Retirees 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) and (e) of this section. Retirees who are not entitled to premium free Part A of Medicare are not required to enroll in Part A.
(g) 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.
SECTION HISTORY
Added by Ord. No. 182,629, Eff. 7-25-13.
This program is provided to reimburse the cost of the Medicare Part B basic premium to eligible retirees, as hereafter defined.
(a) Reimbursement. Reimbursement shall be limited to the Medicare Part B basic premium (Medical Insurance). No reimbursement shall be paid for Medicare Part B costs that exceed the basic premium.
(b) Eligible Retiree. In order to participate in the Medicare Part B Basic Premium Reimbursement Program, a retiree must be eligible to receive a medical plan premium subsidy, enrolled in Medicare Parts A and B, and either enrolled in a Medicare supplemental or coordinated plan administered by the Board or be a participant in the Medical Premium Reimbursement Program. Only retirees may participate in this program.
(c) Verification of Eligibility for Reimbursement. Premium reimbursement shall be paid to a retiree who qualifies to participate in this program when sufficient proof of the retiree’s Medicare Part A and Part B enrollment, coverage, and premium payment has been made as required by the Board.
SECTION HISTORY
Added by Ord. No. 182,629, Eff. 7-25-13.
In order for a dental plan premium subsidy to be provided for a retiree, the retiree must be enrolled in a dental plan administered by the Board as part of the Dental Plan Program. The dental plan premium subsidy will be provided upon the conditions set forth below in order to lessen or defray part or all of the cost of such dental plan to such eligible retiree, as hereinafter defined.
(a) Maximum Dental Plan Premium Subsidy. The maximum subsidy shall be the amount provided by the Council for active employees. The Board, in its discretion, may, by resolution, increase or decrease the monthly amount of dental subsidy to reflect changes in the subsidy provided by the City for active employees, or to offset any increases or decreases in the level of benefits or the cost thereof, as the result of changes in existing benefits or the addition of newly created benefits by federal or state funded programs.
(b) Eligibility for Dental Plan Premium Subsidy. Those retirees who are receiving a service retirement allowance or a disability retirement allowance, have at least ten (10) years of Health Service Credit as members, and are age fifty-five (55) years or older, shall have paid to their approved dental plan carrier on their behalf the following amount:
(1) Basic Monthly Subsidy. For ten (10) years of Health Service Credit, forty percent (40%) of the maximum monthly dental plan premium subsidy amount established pursuant to the provisions of Subsection (a).
(2) Additional Monthly Subsidy. For more than ten (10) years of Health Service Credit, add three percent (3%) of the maximum monthly dental plan premium subsidy to the Basic Monthly Subsidy for each whole year of Health Service Credit in excess of ten (10) years.
(3) Maximum Monthly Subsidy. No retired employee shall have paid to the retired employee’s dental plan carrier an amount exceeding the maximum monthly amount established pursuant to Subsection (a) or receive an amount in excess of the premium of the plan in which they are enrolled.
(4) Dependent Monthly Subsidy. There is no dental plan premium subsidy for dependents.
(c) Payment Limitation. In no event shall the subsidy provided in this section, when added to any other dental plan subsidy provided by the Department of Water and Power or the Fire and Police Pension Plan, exceed the maximum subsidy established in Subsection (a).
SECTION HISTORY
Added by Ord. No. 182,629, Eff. 7-25-13.
For purposes of this Article 4, the following words and phrases shall have the meaning ascribed to them in this section:
Employee. An employee who is a member of Tier 3 of LACERS.
Service. Only those periods during which a member (1) received compensation from the City as an employee or (2) during which the employee both received Workers’ Compensation benefits (Div. IV, Labor Code) for temporary disability on account of any injury or illness arising out of, and in the course of, employment with the City, and made contributions to the Retirement Fund as provided in Charter Section 1162. Service purchased pursuant to the redeposit program set forth in Section 4.1080.19, and Service purchased pursuant to the back contributions program set forth in Section 4.1080.18, may be used to qualify for the benefits provided in this Article, provided that such service is purchased while a member of LACERS and does not exceed any limits imposed under federal tax law. Part-time employee members shall receive full, rather than prorated, Service for purposes of qualifying for benefits under this Article.
Service Credit. Service Credit shall include any Service authorized in Chapter 10 of Division 4 of this Code that may be taken into consideration for purposes of qualifying for benefits provided in Chapter 10, provided that any such service credit does not exceed any limits imposed under federal tax law. Part-time employee members shall have their Service Credit prorated based upon the number of hours worked per pay period for purposes of the calculation of their benefits under this Article.
Member. A person who is a member of Tier 3 of LACERS. A part-time employee member who qualifies for membership under Section 4.1080.2 of this Code shall be eligible for a benefit under this Article 4
when the member is age fifty-five (55) with a minimum of ten (10) years of Service, provided that the member is receiving a service retirement benefit or disability retirement benefit from LACERS under Chapter 10. In calculating the amount of the benefit to which a part-time employee member is entitled, LACERS shall consider the part-time employee member’s Service Credit, which shall be prorated based upon the hours worked per pay period.
Retired Employee or Retiree. A person who is a retired member of Tier 3 of LACERS and is receiving either a service retirement allowance or a disability retirement allowance pursuant to the provisions of Article 3 of Chapter 10 of Division 4 of this Code.
SECTION HISTORY
Added by Ord. No. 184,134, Eff. 1-22-16.
The medical plan premium subsidy 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 Plan Premium Subsidy. A retiree who is enrolled in plan(s) administered by the Board as part of the Medical Plan Program, and who is retired pursuant to Chapter 10 of Division 4 of this Code, shall be eligible for a medical plan premium subsidy as provided in Subsection (d) or Subsection (e), as applicable.
(b) Maximum Medical Plan Premium Subsidy. Eligible retirees shall have a vested right to the maximum medical plan premium subsidy as set by LACERS pursuant to this subsection. The maximum monthly medical plan premium subsidy for retirees is $1,580.08. LACERS shall adjust the maximum monthly amount of the medical plan premium subsidy provided to retirees to maintain a monthly amount equal to the Kaiser two-party non-Medicare Part A and B premium.
(c) Medical Plan Premium Subsidy for Eligible Retirees Without Medicare Part A. Those retirees who are receiving a service retirement allowance or a disability retirement allowance, who either are not eligible for Medicare or do not qualify for benefits under Part A of Medicare premium free, who have at least ten (10) years of Service and who are age fifty-five (55) years or older, shall cause the following amount to be paid to their approved medical plan carrier on their behalf:
(1) Basic Monthly Subsidy. For one (1) to ten (10) whole years of Service Credit, forty percent (40%) of the maximum monthly medical plan premium subsidy amount established pursuant to the provisions of Subsection (b).
(2) Additional Monthly Subsidy. For each additional whole year of Service Credit in excess of ten (10) whole years, add four percent (4%) of the maximum monthly medical plan premium subsidy to the Basic Monthly Subsidy.
(3) Maximum Monthly Subsidy. No retiree shall have paid to the retiree’s medical plan carrier an amount exceeding the maximum monthly amount established pursuant to Sub- section (b) or receive an amount in excess of the premium of the plan in which they are enrolled.
(4) Dependent Monthly Subsidy. The monthly medical plan premium subsidy shall be applied first to the retiree’s medical plan coverage with any balance applied toward the coverage of the retiree’s dependent(s).
(d) Medical Plan Premium Subsidy for Eligible Retirees Enrolled in Parts A and B of Medicare. Those retirees with at least ten (10) years of Service who are receiving a service retirement allowance or disability retirement allowance and who qualify for benefits under Part A and Part B of Medicare shall cause the following amount to be paid on their behalf to the medical plan carrier providing them with a Medicare supplemental or coordinated plan:
(1) Monthly Subsidy (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 single-party monthly premium of the approved Medicare supplemental or coordinated plan in which the retiree is enrolled.
(2) Monthly Subsidy (90%). For fifteen (15) whole years or more but less than twenty (20) whole years of Service Credit, ninety per- cent (90%) of the single-party monthly premium of the approved Medicare supplemental or coordinated plan in which the retiree is enrolled.
(3) Monthly Subsidy (100%). For twenty (20) or more whole years of Service Credit, one hundred percent (100%) of the single-party monthly premium of the approved Medicare supplemental or coordinated plan in which the retiree is enrolled.
(4) Dependent Subsidy. The amount of the medical plan premium subsidy which is applied toward the coverage of dependents of a retiree enrolled in both Part A and Part B of Medicare shall not exceed that amount which may be applied toward the coverage of the dependent(s) of a retiree not enrolled in both Parts A and Part B of Medicare with the same years of Service Credit and covered by the same medical plan. If the same plan does not offer coverage for retirees who do not have both Medicare Parts A and B, the Board shall, by rule, determine the dependent subsidies in a manner that is consistent with plans that do offer both types of coverage.
(e) Medicare Enrollment and Assignment. Retirees who are eligible to enroll in Medicare Part B must do so in order to qualify to receive the subsidy provided in Subsections (c) and (d) of this section. The Board may require retirees to enroll in and assign to LACERS any coverage that is provided by Medicare in order to qualify to receive the subsidy provided in this section, except that retirees who are not entitled to premium free Part A of Medicare are not required to enroll in Part A.
(f) Verification of Medical Plan Coverage. Retirees who are receiving a medical plan premium subsidy payable to their medical plan carrier pursuant to the provisions of this Article may be required, from time to time, to provide evidence satisfactory to the Board that their medical plan coverage or Medicare or other federal or state funded medical plan is in full force and effect.
(g) Payment Limitation. In no event shall the subsidy provided in this section, when added to any other medical plan subsidy provided by the Water and Power Employees’ Retirement Plan or the Fire and Police Pension Plan, exceed the maximum amount established in Subsection (b).
SECTION HISTORY
Added by Ord. No. 184,134, Eff. 1-22-16.
Amended by: Subsec. (a), Ord. No. 184,853, Eff. 4-6-17.
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 premium free Medicare Part A in the same manner as in Section 4.1126(b) of this Article. Retirees who are eligible to enroll in Medicare Part B must do so in order to be entitled to reimbursement.
(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) whole 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. The maximum monthly medical plan premium reimbursement for retirees enrolled in Parts A and B of Medicare shall be $487.71. 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.
(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, who have at least ten (10) years of Service, and who qualify for benefits under Parts A and Part B of Medicare, shall be reimbursed the following amount:
(1) Monthly Reimbursement (75%). For one (1) whole year 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) Medicare Enrollment. Retirees 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) and (e) of this section. Retirees who are not entitled to premium free Part A of Medicare are not required to enroll in Part A.
(g) Reimbursement for Survivors. Any person who is eligible to receive the survivor medical plan premium subsidy provided in Section 4.1129.1 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 the person would have received as a medical plan premium subsidy under Section 4.1129.1.
(h) Payment Limitation. In no event shall the reimbursement provided in this section, when added to any other medical plan subsidy provided by the Water and Power Employees’ Retirement Plan or the Fire and Police Pension Plan, exceed the maximum amount established in Subsection (b) herein.
SECTION HISTORY
Added by Ord. No. 184,134, Eff. 1-22-16.
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