Los Angeles Municipal Code Ch. 11.5 Health Insurance and Other Benefits for Fire and

POLICE PENSION PLANS

(Title Amended by Ord. No. 173,028, Eff. 1-17-00;

Reference to Article 10 Deleted and Chapter Amended by Ord. No. 179,538, Eff. 3-2-08.)

Section 4.1150.1 Los Angeles Fire and Police Pensions Retiree Health Care Fund. 4.1151 Purpose of the Program. 4.1152 Administration. 4.1153 Subsidies to Be Provided for Approved Plans Only. 4.1154 Eligibility for a Health Insurance Premium Subsidy. 4.1155 Verification of Health Insurance Coverage. 4.1157 Director of the Office of the City Administrative Officer to Review Health Insurance Program. 4.1161 Surviving Spouse’s and Domestic Partner’s Eligibility for Health Insurance Premium Subsidy. 4.1162 Additional Subsidy for Reimbursement of Medicare Part B Basic Premium.

Spouses or Qualified Domestic Partners. 4.1164 Dental Insurance Premium Subsidy for Retired Members. 4.1166 2011 Medical Plan Premium Subsidy and Reimbursement Freeze.

Reimbursements for Retiree Health Benefits.

It is the purpose of this Chapter to provide a program whereby retired members or beneficiaries, if eligible, pursuant to the terms and conditions hereinafter set forth in this Chapter, shall have subsidy payments made on their behalf for such benefit program or programs specified in Sections 1330, 1428, 1518, 1618, or 1718 of the Charter or Section 4.2018 of the Administrative Code as may be authorized by the Council by ordinance, subject to such conditions of entitlement as may be set forth in such ordinance in accordance with the provisions and limitations of Sections 1330, 1428, 1518, 1618, or 1718 of the Charter or Section 4.2018 of the Administrative Code.

The cost of the subsidies provided in this Chapter and the Board’s administrative costs connected therewith shall be provided from the Health Care Coverage Account established in Section 4.1150 of this Chapter and/or the LAFPP Health Care Fund established in Section 4.1150.1 of this Chapter. Notwithstanding all of the foregoing, the cost of the subsidies provided in this Chapter, including all administrative costs, shall be paid first from the Health Care Coverage Account, until it is depleted. Upon depletion of the Health Care Coverage Account, the LAFPP Health Care Fund shall fund the cost of the subsidies provided in this Chapter, including all administrative costs. The Board shall establish the policies and/or procedures necessary to implement this section.

SECTION HISTORY

Added by Ord. No. 147,014, Eff. 3-21-75. Renumbered and Relocated by Ord. No. 154,536, Eff. 11-30-80. Amended by: Ord. No. 172,040, Eff. 7-3-98; Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00; Ord. No. 176,731, Eff. 6-21-05; Ord. No. 179,538, Eff. 3-2-08; Ord. No. 181,770, Eff. 7-8-11; Second para. added, Ord. No. 182,628, Eff. 7-16-13; In Entirety, Ord. No. 187,351, Eff. 2-21-22.

Any program established by this chapter shall be administered by the Board of Fire and Police Pension Commissioners (hereinafter referred to as “the Board”). In furtherance thereof, the Board shall provide suitable health, medical, hospital or other plans as may be authorized by ordinance, and shall have the power to adopt such rules as it deems necessary to administer the program. The Board shall have the authority to contract for suitable health, medical, hospital, dental or vision plans to be made available to retired members and their eligible beneficiaries. The Board may also contract with third-party administrators that provide or contract for suitable plans (such as health care exchanges). The Board shall adopt rules necessary to administer any such plans.

Notwithstanding the foregoing provisions, the Board may in its discretion, and subject to the approval of the City Council and the Mayor, authorize the Personnel Department to administer any program, in which case such authorization may include the power to negotiate and establish health, medical and hospital plan or plans; provided, however, that the Board shall retain the power to sign necessary service agreements or to execute contracts and that the Board shall reimburse the General Fund of the City of Los Angeles for all necessary expenses incurred by the Personnel Department in the administration of such program.

SECTION HISTORY

Added by Ord. No. 147,014, Eff. 3-21-75.

Renumbered and Relocated by Ord. No. 154,536, Eff. 11-30-80. Amended by: Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00; Ord. No. 179,538, Eff. 3-2-08; Ord. No. 184,853, Eff. 4-6-17.

In order that a subsidy be paid on behalf of a beneficiary as hereinafter provided, said beneficiary must be enrolled in a plan approved by the Board or by the Personnel Department if so authorized by the Board.

SECTION HISTORY

Added by Ord No. 140,714, Eff. 3-21-75. Renumbered and Relocated by Ord. No. 154,536, Eff. 11-30-80. Amended by: Last unnumbered para, Ord. No. 172,040, Eff. 7-3-98; Second Para., Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00; Second Para., Ord. No. 176,731, Eff. 6-21-05; Second Para., Ord. No. 181,770, Eff. 7-8-11; Second Para. Deleted, Ord. No. 182,628, Eff. 7-16-13.

Eligible retired members who are receiving a health insurance subsidy payable to their health insurance carrier pursuant to the provisions of this chapter, may be required from time to time to provide evidence satisfactory to the Board that their health insurance coverage or Medicare or other federal or state funded health insurance plan is in full force and effect.

SECTION HISTORY

Added by Ord. No. 147,014, Eff. 3-21-75. Amended by: Renumbered and Relocated by Ord. No. 154,536, Eff. 11-30-80; Ord. No. 179,538, Eff. 3-2-08.

SECTION HISTORY

Added by Ord. No. 147,014, Eff. 3-21-75. Amended by: Renumbered and Relocated by Ord. No. 154,536, Eff. 11-30-80. Deleted by Ord. No. 179,538, Eff. 3-2-08.

The Office of the City Administrative Officer shall periodically review the Health Insurance Program established by this chapter and shall recommend such changes in said program to the Board as the Office of the City Administrative Officer deems appropriate.

SECTION HISTORY

Added by Ord. No. 147,014, Eff. 3-21-75. Amended by: Renumbered and Relocated by Ord. No. 154,536, Eff. 11-30-80; Title and Sec., Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00; Title and Sec., Ord. No. 184,853, Eff. 4-6-17.

SECTION HISTORY

Added by Ord. No. 147,014, Eff. 3-21-75. Amended by: Renumbered and Relocated by Ord. No. 154,536, Eff. 11-30-80. Deleted by Ord. No. 179,538, Eff. 3-2-08.

SECTION HISTORY

Added by Ord. No. 173,028, Eff. 1-17-00. Amended by: Sec. Number, Ord. No. 173,136, Eff. 3-24-00; Subsec. (a)(1), Ord. No. 176,731, Eff. 6-21-05. Renumbered as Sec. 4.2204 by Ord. No. 179,538, Eff. 3-2-08.

SECTION HISTORY

Added by Ord. No. 173,028, Eff. 1-17-00. Amended by: Sec. Number, Ord. No. 173,136, Eff. 3-24-00; Subsec. (a), Ord. No. 176,731, Eff. 6-21-05; Subsec. (e) added, Ord. No. 177,900, Eff. 9-28-06. Renumbered as Sec. 4.2206 by Ord. No. 179,538, Eff. 3-2-08.

(a) Effective January 1, 2000, a qualified surviving spouse or qualified surviving domestic partner of a deceased member of the Fire and Police Pension Plans shall be entitled to a health insurance subsidy if, at the time of the member’s death, the member was retired and receiving a health subsidy. Effective January 1, 2000, if a member dies after retirement, but prior to receiving a health subsidy, or if the member dies prior to retirement, then the qualified surviving spouse or qualified surviving domestic partner shall be eligible to receive a health insurance subsidy upon the date when the member would have attained age 55, or on January 1, 2000, whichever occurs later, provided the member had a minimum of 10 years of service in the retirement system. Notwithstanding the foregoing, a qualified surviving spouse or qualified surviving domestic partner of a deceased Tier 6 Plan Member retired under the provisions of 1706(a) with less than ten (10) years of service shall not be eligible for a health insurance subsidy.

(b) The maximum health subsidy payment available for a qualified surviving spouse or qualified surviving domestic partner shall not exceed the Los Angeles City Employees’ Retirement System (LACERS) Kaiser single-party premium for retired members without Part A and B of Medicare nor may such subsidy payment be in excess of any amounts allowed active members of the Fire and Police Pension Plans.

(c) The health subsidy provided to a qualified surviving spouse or qualified surviving domestic partner who does not qualify for Part A of Medicare shall be 4% of the maximum survivor subsidy for each year of the retired member’s service, up to 100% of the maximum survivor subsidy.

(d) The health subsidy provided to a qualified surviving spouse or qualified surviving domestic partner with both Parts A and B of Medicare shall be as follows:

(1) For ten (10) to fourteen (14) years of service by the member, 75% of the qualifying monthly premium.

(2) For fifteen (15) to nineteen (19) years of service by the member, 90% of the qualifying monthly premium.

(3) For twenty (20) or more years of service by the member, 100% of the qualifying monthly premium.

(e) The qualifying monthly premium for qualified surviving spouses and qualified surviving domestic partners, as used in Subsection (d), shall mean the single party monthly premium of the qualified surviving spouse or qualified surviving domestic partner’s approved plan. However, if the monthly premium exceeds the highest single party monthly premium of Medicare A & B plans available to retired members of LACERS, then the premium for the latter shall be the qualifying monthly premium.

(f) A qualified surviving spouse or qualified surviving domestic partner who receives a health subsidy pursuant to Subsection (d) above shall also receive a subsidy for reimbursement of the Medicare Part B basic premium on the terms set forth in Section 4.1162 of this chapter.

(g) As a prerequisite to receiving the health subsidy, a qualified surviving spouse or qualified surviving domestic partner must enroll in Medicare to the full extent of their entitlement at the earliest date of eligibility.

(h) A qualified surviving spouse or qualified surviving domestic partner who is also entitled to a health subsidy pursuant to the provisions for active death health benefits from any Memorandum of Understanding (MOU) shall not be entitled to the health subsidy provided herein for as long as they shall receive that other health subsidy.

(i) The health subsidy provided in this section shall only be used to pay the single party premium cost for approved health insurance plans. Any unused subsidy amount can not be received as cash compensation.

(j) This health insurance subsidy will also be provided to current qualified surviving spouses of deceased members who are receiving monthly survivorship benefits on the effective date of this section.

(k) For purposes of this section, the term “qualified surviving spouse” shall also include an eligible widow as defined in the Charter provisions dealing with the Fire and Police Pension Plans.

SECTION HISTORY

Added by Ord. No. 173,028, Eff. 1-17-00. Amended by: Sec. Number, Ord. No. 173,136, Eff. 3-24-00; Subsec. (f), Ord. No. 179,538, Eff. 3-2-08; Last Sentence of Subsec. (a) added, Ord. No. 181,770, Eff. 7-8-11.

In addition to any other subsidies to which a beneficiary may be entitled under this chapter, a subsidy may be paid to reimburse eligible beneficiaries for the Medicare Part B basic/standard premium, provided that no reimbursement shall be paid for any premium in excess of the basic/standard amount due to charges for income-related monthly adjustment amounts or for any other reason, such as delays in applying for coverage or late fees.

In order to be eligible for Medicare Part B reimbursement, a retired member, a qualified surviving spouse, or a qualified surviving domestic partner, must be:

(1) enrolled in Medicare Parts A and B; and

(2) eligible to receive either a health insurance subsidy or a health insurance premium reimbursement from the Fire and Police
Pension Plan.

The Medicare Part B reimbursement subsidy and administrative costs will be provided solely by the Fire and Police Pension Plan, as provided in Sections 1320, 1416, 1510, 1610 and 1710 of the Charter and Section 4.2010 of the Administrative Code. Reimbursement shall not be paid until sufficient proof of the eligible beneficiary’s enrollment, coverage and premium payment has been made as required by the Board.

SECTION HISTORY

Added by Ord. No. 173,275, Eff. 6-25-00, Oper. 7-1-00; new Sec. and Title, Ord. No. 179,538, Eff. 3-2-08. Former Sec. 4.1162 renumbered as Sec. 4.2210 by Ord. No. 179,538, Eff. 3-2-08.

Amended by: Last Para., Ord. No. 181,770, Eff. 7-8-11; Ord. No. 184,853, Eff. 4-6-17.

Sec. 4.1163. Eligibility for Reimbursement of Health Insurance Premiums to Eligible Retired Members, Their Qualified Surviving Spouses or Qualified Domestic Partners.

(a) Effective January 1, 2001, upon written application and verification as required by the Department of Fire and Police Pensions and subject to the rules and regulations promulgated by the Board of Fire and Police Pension Commissioners, retired members, their qualified surviving spouses or qualified domestic partners are eligible to receive a health insurance premium reimbursement if all of the following conditions are met:

(1) the eligible member or the member’s qualified surviving spouse or qualified domestic partner is enrolled to the extent of the
member’s entitlement in Medicare;

(2) the eligible member or the member’s qualified surviving spouse or qualified domestic partner is receiving an allowance
pursuant to any benefit tier of the Fire and Police Pension System;

(3) the eligible member is the primary subscriber or a dependent on the medical plan;

(4) the qualified surviving spouse or qualified domestic partner is the primary subscriber;

(5) the eligible member or the member’s qualified surviving spouse or qualified domestic partner is eligible to receive a Fire and
Police Pension Plan health subsidy pursuant to the provisions of this Code; and

(6) the eligible member or the member’s qualified surviving spouse or qualified domestic partner is not enrolled in a Department of Fire and Police Pensions approved medical plan.

(b) The maximum reimbursement available to eligible retired members cannot exceed the lower of:

(1) Any subsidy available to eligible retired members pursuant to this Administrative Code or any applicable Memorandum of Understanding; or

(2) The cost of the health plan the eligible retired members are enrolled in and for which they are seeking reimbursement.

(c) The maximum reimbursement available to qualified surviving spouses or qualified surviving domestic partners cannot exceed the lower of:

(1) Any subsidy available to qualified surviving spouses or qualified surviving domestic partners pursuant to this Administrative

Code or any applicable Memorandum of Understanding, or

(2) The single-party cost of the health plan that the qualified surviving spouses or qualified domestic partners are enrolled in and

for which they are seeking reimbursement.

(d) In no event shall the health insurance reimbursement provided in this section, when added to any health insurance subsidy paid from the funds of the Department of Water and Power and/or the Los Angeles City Employees’ Retirement System (LACERS) exceed the maximum subsidy available pursuant to the provisions of this Administrative Code.

SECTION HISTORY

Added by Ord. No. 174,369, Eff. 12-19-01. Amended by: Subsecs. (b) and (c) amended and Subsec. (d) added, Ord. No. 176,731, Eff. 6-21-05; Ord. No. 184,853, Eff. 4-6-17.

(a) Those members who were retired pursuant to Charter Sections 1304, 1310, 1312, 1408, 1412(a), 1412(b), 1504, 1506(a), 1506(b), 1604, 1606(a), 1606(b), 1704, 1706(a) or 1706(b), or Administrative Code Sections 4.2004, 4.2006(a) or 4.2006(b), and who have at least ten (10) Years of Service, including those years for which they acquired additional retirement service credits from said Plan, and who are age fifty-five (55) years or older, shall have paid to their approved dental insurance carrier on their behalf a monthly subsidy consisting of 4% of the maximum monthly dental subsidy for each whole year of service as defined in their applicable Tier. In no case shall a retired member have paid to the retired member’s dental insurance carrier an amount exceeding the maximum monthly amount established pursuant to paragraph (b) of this Section.

(b) The maximum monthly subsidy shall be the lower of the Los Angeles City Employees’ Retirement System (LACERS) maximum subsidy or any amount allowed active members of any Fire and Police Plan Tier.

(c) In no event shall the subsidy provided in this section, when added to any other dental subsidy paid from the funds of the Department of Water & Power and/or LACERS exceed the maximum subsidy available pursuant to the provisions of this Administrative Code.

(d) As provided under Charter Sections 1330(d), 1428(d), 1518(d), 1618(d) and 1718(d) and Administrative Code Section 4.2018(d), the Board of Fire and Police Pension Commissioners shall administer the subsidy program established herein.

(e) Entitlement for the subsidy provided herein shall commence with the premiums due for the month of January 2002. There shall be no retroactive entitlement to the dental insurance premium subsidies provided in this section prior to this commencement date.

SECTION HISTORY

Added by Ord. No. 174,368, Eff. 12-19-01. Amended by: Subsec. (b), Ord. No. 176,731, Eff. 6-21-05; Subsecs. (a) and (d), Ord. No. 181,770, Eff. 7-8-11; Subsec. (d), Ord. No. 184,853, Eff. 4-6-17.

SECTION HISTORY

Added by Ord. No. 174,612, Eff. 6-6-02. Renumbered as Sec. 4.2208 by Ord. No. 179,538, Eff. 3-2-08.

Sec. 4.1166. 2011 Medical Plan Premium Subsidy and Reimbursement Freeze.

(a) The maximum monthly subsidies and reimbursements paid toward any health insurance premiums provided pursuant to Chapter 11.5 of Division 4 of the Los Angeles Administrative Code shall be frozen at the rate in effect as of July 1, 2011.

(b) The freeze established in Subsection (a) above shall apply to the following persons:

1. Employees who retire on or after July 15, 2011;

2. Employees who enter the Deferred Retirement Option Plan (DROP) on or after July 15, 2011;

3. Employees who opt not to make a contribution for vesting increases in the Maximum Medical Subsidy as allowed by an

applicable written agreement between the City and the employee’s union.

(c) The freeze established by this Section may be revisited periodically by the City Council, with appropriate discussions with the affected labor organizations, to determine whether, in the Council’s discretion, the freeze may be lifted or adjusted in light of improving economic conditions, or other factors.

(d) The freeze established in Subsection (a) above shall not apply to the following persons:

1. Employees who irrevocably opt to make voluntary Additional Contributions in exchange for vested rights to increases in

subsidies or reimbursements for retiree health benefits as provided in Section 4.1167 of this Chapter.

2. Employees who retire on service connected disability pensions and their survivors who are eligible for health benefits.

3. Survivors receiving service-connected death benefits who are eligible for health benefits.

4. Members of Tier 3 and Tier 5 who separated from City service prior to July 15, 2011, and were eligible for a deferred retirement at the time of separation, based on years of service.

5. All members of Tier 6, since they are required to make an additional contribution to support the City’s ability to fund retiree

health benefits.

(e) The freeze established in Subsection (a) above shall not apply to any subsidy for reimbursement of Medicare Part B basic premium or any dental insurance premium subsidy.

SECTION HISTORY

Added by Ord. No. 181,814, Eff. 7-29-11.

Amended by: Subsec. (b) amended and Subsecs. (d) and (e) added, Ord. No. 181,893, Eff. 10-11-11; Subsec (d)5. added, Ord. No. 183,163, Eff. 8-8-14.

Sec. 4.1167. Election to Make Voluntary Additional Contributions in Exchange for Vested Rights to Increases in Subsidies or Reimbursements for Retiree Health Benefits.

A member who is not represented by an employee union, or who is represented by an employee union which has entered into a written agreement with the City to provide for the election specified herein, may irrevocably elect to make voluntary additional contributions (Additional Contributions) to the member’s tier of the Fire and Police Pension Plan by salary deduction at the rate of 2% of the member’s regular bi-weekly base salary (as distinguished from pay actually received) in order to support the City’s ability to fund retiree health benefits. These Additional Contributions shall be deposited into each such member’s individual contribution account and shall be treated for any and all purposes the same as the member’s regular contributions to the Fire and Police Pension Plan. These Additional Contributions shall be paid by the member on a post-tax basis unless and until the Internal Revenue Service rules that such contributions may be tax-deferred through a

reduction in wages pursuant to the provisions of Sections 4.1505 through 4.1509 of this Code.

Once a member irrevocably elects to make these Additional Contributions, the member shall continue to make such Additional Contributions until the member has done one of the following, whichever is earliest, at which time the member’s obligation to make further Additional Contributions shall terminate: (i) made such Additional Contributions for 25 years, or (ii) retired under the provisions of Sections 1408, 1412(a), 1412(b), 1504, 1506(a), 1506(b), 1604, 1606(a), or 1606(b) of the Charter or Sections 4.2004, 4.2006(a), or 4.2006(b) of the Los Angeles Administrative Code, or (iii) terminated participation in the City’s Deferred Retirement Option Plan (DROP) pursuant to Section 4.2105 of the Los Angeles Administrative Code. In consideration for such Additional Contributions being made for the period specified above, each such member and the member’s survivors shall have a vested right to receive the retiree health benefits that were provided in this Chapter on July 1, 2011, and to receive the maximum amount of annual increases in subsidies or reimbursements for retiree health benefits in all subsequent years thereafter as authorized in this Chapter on June 30, 2011, provided that all conditions of eligibility prescribed in this Chapter are satisfied. The freeze established in Section 4.1166(a) of this Chapter shall not apply to these members and their survivors.

The right to make the irrevocable election provided in this Section 4.1167 shall be limited to a 45-day opt-in period, except as required by applicable law or as otherwise provided below. In order to make such irrevocable election, a member must file with the Department of Fire and Police Pensions (LAFPP) an election form prescribed by the LAFPP. Based upon input from the Office of the City Administrative Officer (CAO), the LAFPP shall establish the 45-day period during which members’ election forms may be accepted. If a member does not file the election form within the 45-day period, the member is assumed to have irrevocably elected to not make the Additional Contributions and the freeze established in Section 4.1166 of this Chapter shall apply to the member and the member’s survivors.

The CAO shall establish a Dispute Resolution Committee (DRC) to review member requests to make an election after the 45-day period. The LAFPP shall have no authority to decide whether or not to accept late election forms after the close of the 45-day period (a late election form) and shall refer members to the DRC for that purpose. The DRC may approve a member’s request to irrevocably elect to make the Additional Contributions only if the DRC determines that the member did not timely elect to make the Additional Contributions due to a personal hardship that occurred outside of the opt-in period. The DRC’s decision to approve or deny a member’s request shall be final and conclusive. If the DRC approves the member’s request, the CAO shall so advise the LAFPP in writing, whereupon the LAFPP shall accept the member’s late election form. The Additional Contributions shall commence after the DRC’s approval of the late election form, and the LAFPP shall be authorized to collect back contributions as determined by the DRC in its sole discretion and communicated in writing to the LAFPP by the CAO. The DRC is not authorized to allow a member to revoke the member’s irrevocable election.

The City Council, on a Motion that is adopted by a two-thirds majority, may authorize the LAFPP to conduct additional opt-in periods during which members shall have the right to make the irrevocable election provided in this Section.

SECTION HISTORY

Added by Ord. No. 181,893, Eff. 10-11-11. Amended by: Second Para., Ord. No. 183,163, Eff. 8-8-14.