Los Angeles Municipal Code § 4.1154 Eligibility for a Health Insurance Premium Subsidy

Upon written application by eligible retired members not qualified for Medicare or upon written application by eligible retired members and verification that the applicant is and remains enrolled, to the extent of the applicant’s entitlement, in federally-funded Part A or Part B or Part A and Part B of Medicare, the following monthly health subsidy amounts shall be paid:

(a) Those retired members retired pursuant to the provisions of Section 1304 or Section 1408 of the Charter respectively, who are

receiving a service pension in accordance with the terms of either one of said Sections 1304 or 1408 and who are age sixty (60) years or older, shall have paid to their approved health insurance carrier on their behalf the following amount:

Basic Monthly Subsidy: For twenty (20) “years of service” as said term is defined in Section 1406(m) of the Charter, 80% of the maximum monthly health subsidy amount as established in Subsection (e) of this section, subject to the limitation hereinafter set forth in this section.

Additional Monthly Subsidy: For more than twenty (20) years of service, add to the Basic Monthly Subsidy 4% of the

maximum monthly health subsidy for each whole year of service in excess of twenty (20) years.

Maximum Monthly Subsidy: No eligible retired member shall have paid to the eligible retired member’s health insurance carrier an amount exceeding the maximum monthly amount established pursuant to Subsection (e) of this section.

(b) Those eligible retired members who do not qualify for benefits under Part A of the federally- funded Medicare program shall

have paid to their health insurance carrier on their behalf 4% of the maximum monthly subsidy for each whole year of service as hereinabove defined, not to exceed the maximum monthly subsidy set forth in Subsection (a) of this section.

(c) Those eligible members described in Subsection (a) of this section or those retired under the provisions of Sections 1310, 1312,

1412(a), 1412(b), 1504, 1506(a), 1506(b), 1604, 1606(a), 1606(b), 1704, 1706(a), or 1706(b) of the Charter or Sections 4.2004, 4.2006(a), or 4.2006(b) of the Administrative Code with a minimum of ten (10) Years of Service and who qualify for benefits under federally-funded Part A of Medicare, shall have paid to the approved health insurance carrier providing them with a plan supplemental to Medicare coverage the following amount:

For ten (10) but less than fifteen (15) years of service, 75% of the qualifying monthly premium of the approved health insurance plan supplemental to Medicare coverage in which the retired member is enrolled.

For fifteen (15) or more but less than twenty (20) years of service, 90% of the qualifying monthly premium of the approved health insurance plan supplemental to Medicare coverage in which the retired member is enrolled.

For twenty (20) or more years of service, 100% of the qualifying monthly premium of the approved health insurance plan supplemental to Medicare coverage in which the retired member is enrolled.

The qualifying monthly premium for eligible retired members, as used in this Subsection (c) shall mean the monthly premium of the member’s approved plan. However, if the monthly premium exceeds the highest monthly premium of an approved plan supplemental to Part A of Medicare available to retired members of the Los Angeles City Employees’ Retirement System then the premium for the latter shall be the qualifying monthly premium.

The amount of the medical plan premium subsidy applied toward the coverage of dependents of a retired member enrolled in both Part A and Part B of Medicare (“fully enrolled”) shall not exceed the amount which may be applied toward the coverage of the dependent(s) of a retired member who is not enrolled in Medicare or is only enrolled in Part B of Medicare (“partially enrolled”), whichever is greater. The maximum coverage for a fully enrolled retired member’s dependents shall not exceed the highest amount available to a retired member with the same years of service, who is not enrolled or partially enrolled in Medicare but covered by the same medical plan. If the same medical 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.

(d) Those members retired under the provisions of Sections 1310, 1312, 1412(a), 1412(b), 1504, 1506(a), 1506(b), 1604, 1606(a), 1606(b), 1704, 1706(a), or 1706(b) of the Charter or Sections 4.2004, 4.2006(a) or 4.2006(b) of the Administrative Code and receiving a pension under the terms of any of those sections and who are age sixty (60) years or older, shall have paid to their approved health insurance carrier on their behalf the following amount:

Basic Monthly Subsidy: For ten (10) Years of Service as said term is defined in Sections 1406(m), 1502(m), 1602(m), and

1702(p) of the Charter and Section 4.2002(m) of the Administrative Code, 40% of the maximum monthly health subsidy amount as established in Subsection (e) of this Section, subject to the limitations hereinafter set forth in this Section.

Additional Monthly Subsidy: For more than ten (10) Years of Service, add to the Basic Monthly Subsidy 4% of the

maximum monthly health subsidy for each whole year of service in excess of ten (10) years.

Maximum Monthly Subsidy: No eligible retired member under the provisions of this Subsection (d) of this Section shall have paid to the eligible retired member’s health insurance carrier an amount exceeding the maximum monthly amount established pursuant to Subsection (e) of this Section.

(e) The maximum monthly subsidy towards the health insurance premium, effective July 1, 2005, but paid from the June 2005 payroll, is fixed at $735.38 per month for all retired Plan members. The Board is authorized to make discretionary changes, on an annual basis beginning in 2006, to the maximum monthly subsidy, so long as no increase exceeds the lesser of a 7% increase or the actuarial assumed rate for medical inflation for pre-65 health benefits established by the Board for the applicable fiscal year.

Any change made by the Board that exceeds this limitation must be submitted for Council review accompanied by an actuarial report. Any increase that is not acted upon by the Council within 45 days after receipt of the report to Council for consideration of the increase shall be deemed approved. Should the Council reject the subsidy set by the Board, the Council shall determine the amount, if any, by which the subsidy shall be increased and shall adopt this increase by resolution.

Notwithstanding the authority given to the Board in this subsection, the Council retains the right to establish, by ordinance, the

maximum monthly subsidy either if the Board fails to act timely to grant an increase or if the Council desires to approve an increase in excess of the amount authorized by the Board.

The maximum monthly subsidy shall be reduced by the amount of any subsidy a retired Plan member receives from any other City source.

(f) “System Members” or “Plan Members” as defined in Sections 1406(c), 1502(c), 1602(c) or 1702(d) of the Charter or Section

4.2002(c) of the Administrative Code who retire on or after July 1, 1998 shall be eligible for the monthly health subsidy amounts and other benefits provided for in Subsections (a) through (e) above at age fifty-five (55) rather than age sixty (60) if all other conditions of eligibility prescribed in those subsections are met.

(g) Those members retired under the provisions of Section 1706(a) of the Charter with less than ten (10) years of service and who

are age fifty-five (55) years or older shall have paid to their approved health insurance carrier on their behalf the following amount:

(1) For retirees not eligible for Medicare or enrolled in Medicare Part B only, 40% of the maximum monthly health subsidy

amount as established in Subsection (e) of this Section or 40% of the single-party cost of the retiree’s plan, whichever is lower; or

(2) For retirees enrolled in Medicare Parts A and B, 75% of the qualifying monthly premium that would be paid under

Subsection (c) herein for an eligible retiree with ten (10) years of service or 75% of the single-party cost of the retiree’s plan, whichever is lower.

Retirees eligible for a subsidy from any other source shall not be eligible for the subsidy provided in this subsection. Further, no survivor subsidy shall be paid under Section 4.1161 based upon eligibility for the subsidy provided in this Subsection.

SECTION HISTORY

Added by Ord. No. 147,014, Eff. 3-21-75. Amended by: Subsec. (c), Ord. No. 147,952, Eff. 12-26-75; Renumbered and Relocated by Ord. No. 154,536, Eff. 11-30-80; In Entirety and Subsec. (f) added, Ord. No. 172,040, Eff. 7-3-98; Subsecs. (a), (c), (d), (e) and (f), Last Para. of Section, Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00; In Entirety, Ord. No. 176,731, Eff. 6-21-05; Subsec. (e), Ord. No. 177630, Eff. 6-19-06; Subsecs. (c), (d) and (f) amended and Subsec. (g) added, Ord. No. 181,770, Eff. 7-8- 11; Subsec. (c), Ord. No. 188,756, Eff. 11-16-25.

[SUPPLEMENTAL REFERENCES]

For Paragraph (a) re Identification of Members. See also Charter, Sec. 523. For Paragraph (a) re Basic Subsidy. See also Charter, Sec. 521(t). For Paragraphs (c) and (d) re Other Eligible Members. See also Charter, Secs. 531(a) and 531(b). For Paragraph (d) re Basic Subsidy. See also Charter, Sec. 521(t). For Paragraph (e) re Maximum Subsidy. See also Charter, Secs. 521(g) and 523 re applicability to Safety Members Pension Plan Members.

SECTION HISTORY

Supplemental References Added by Ord. No. 158,965, Eff. 6-30-84.

SECTION HISTORY

Added by Ord. No. 164,851, Eff. 6-19-89. Amended by: Subsecs. (h) and (i) added, Ord. No. 170,092, Eff. 12-8-94; Subsec. (j) added, Ord. No. 172,040, Eff. 7-3-98; Subsecs. (a), (c), (f) and (h), Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00. Deleted by Ord. No. 184,853, Eff. 4-7-17.

SECTION HISTORY

Added by Ord. No, 165,333, Eff. 1-14-90. Amended by: Subsecs. (g) and (h) added, Ord. No. 170,418, Eff. 4-16-95; Subsec. (i) added, Ord. No. 172,040, Eff. 7-3-98; Subsecs. (a), (c), (f) and (g), Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00. Deleted by Ord. No. 184,853, Eff. 4-7-17.

SECTION HISTORY

Added by Ord. No. 165,296, Eff. 12-21-89. Amended by: Subsec. (g) added, Ord. No. 169,328, Eff 2-28-94; Subsecs. (h) and (i) added, Ord. No. 170,091, Eff. 12-8-94; Subsec. (j) added, Ord. No. 172,040, Eff. 7-3-98; Subsecs. (a), (c), (f), (g) and (h), Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00. Deleted by Ord. No. 184,853, Eff. 4-7-17.

SECTION HISTORY

Added by Ord. No. 165,488, Eff. 3-5-90. Amended by: Subsecs. (g) and (h) added, Ord. No. 170,160, Eff. 1-16-95; Subsec. (i) added, Ord. No. 172,040, Eff. 7-3-98; Subsecs. (a), (c), (f) and (g), Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00. Deleted by Ord. No. 184,853, Eff. 4-7-17.

SECTION HISTORY

Added by Ord. No. 167,138, Eff. 9-5-91; Subsecs. (a), (c) and (f), Ord. No. 173,272, Eff. 6-25-00, Oper. 7-1-00. Repealed by Ord. No. 173,791, Eff. 3-2-01.