Los Angeles Municipal Code Art. 3 Programs for Tier 2 Members

Section 4.1123 Medicare Part B Basic Premium Reimbursement Program. 4.1124 Dental Plan Subsidy.

For purposes of this Article 3, the following words and phrases shall have the meaning ascribed to them in this section:

Employee shall refer to an employee who is a member of Tier 2 of LACERS.

Member shall refer to a person who is a member of Tier 2 of LACERS.

Retired Employee or Retiree shall refer to a person who is a retired member of Tier 2 of LACERS and is receiving either a service retirement allowance or a disability retirement allowance pursuant to the provisions of Article 2 of Chapter 10 of Division 4 of this Code.

SECTION HISTORY

Added by Ord. No. 182,629, Eff. 7-25-13.

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 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. The maximum monthly medical plan premium subsidy for retirees is $596.00.

The Board shall, by resolution, adjust the maximum monthly amount of the medical plan premium subsidy provided to retirees to maintain a monthly amount equal to the single-party premium for the lowest cost standard plan, as defined by the Board, available to participants without Medicare Parts A and B.

(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 Health Service Credit and who are age fifty-five (55) years or older, shall have paid to their approved medical 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

medical plan premium subsidy amount established pursuant to the provisions of Subsection (b).

(2) Additional Monthly Subsidy. For more than ten (10) years of Health Service Credit add three percent (3%) of the

maximum monthly medical 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 retiree shall have paid to the retiree’s medical plan carrier an amount exceeding the

maximum monthly amount established pursuant to Subsection (b) or receive an amount in excess of the premium of the plan in which they are enrolled.

(4) Dependent Monthly Subsidy. None of the subsidy may be applied toward coverage for dependents of retirees.

(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 Health Service Credit 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 have paid to the medical plan carrier providing them with a Medicare supplemental or coordinated plan the following amount:

(1) Monthly Subsidy (75%). For ten (10) years but less than fifteen (15) years of Health 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) years or more but less than twenty (20) years of Health Service Credit, ninety percent (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 years of Health 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 Monthly Subsidy. None of the subsidy may be applied toward coverage for dependents of retirees.

(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 Department of Water and Power or the Fire and Police Pension Plan, exceed the maximum amount established in Subsection (b).

SECTION HISTORY

Added by Ord. No. 182,629, Eff. 7-25-13.

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.