Los Angeles Municipal Code § 4.310 Reimbursement to Specified Employees of Moneys Paid As Premiums for Part B…

Reimbursement from currently appropriated funds for the City health insurance subsidy may be made to any active City employee 65 or more years of age, who is enrolled in and covered by Parts A and B of Medicare, of the amount of any money paid by such employee as premium for Part B coverage (Medical Insurance) for an insured or covered period beginning on or after April 1, 1973, when sufficient proof of the employee’s enrollment and coverage and of the premium’s payment has been made as required by the Personnel Department. The Controller shall, upon request of the Personnel Department and receipt of its written certification that said proof has been duly made, effectuate such reimbursement.

SECTION HISTORY

Added by Ord. No. 144,707, Eff. 6-17-73.

(a) The Personnel Department shall verify eligibility for any dependent enrolled in the employee benefits program and require employees to provide required documentation to establish dependent eligibility. Ineligible employees and dependents shall be terminated from employee benefits effective the date of ineligibility as determined by the Personnel Department.

(b) The Personnel Department shall administer on behalf of the City of Los Angeles, a dependent eligibility verification program, as authorized by the City Council, for employees and dependents enrolled in employee benefits programs.

(c) Upon finding by the Personnel Department during the designated dependent eligibility verification program period that an employee or employee dependents are ineligible to enroll in the employee benefits program or not entitled to a City premium subsidy, the Personnel Department shall terminate the ineligible employee or ineligible dependent from the employee benefits plan effective prospectively as established by the Personnel Department.

(d) Employees who fail to submit the dependent eligibility verification program required documentation for a dependent(s) by the verification deadline established by the Personnel Department shall be considered as ineligible dependents and terminated form the employee benefits plan effective prospectively as established by the Personnel Department.

(e) Employees who have ineligible dependent(s) removed from the employee benefits plan pursuant to Sections 4.310.1(c) and (d) shall be granted a waiver from collection of overpayment of City premium subsidy and any claims costs associated with covering an ineligible dependent(s). The waiver shall not apply to employees or dependents who received benefits coverage or City premium subsidies based on fraud or intentional misrepresentation of material fact.

SECTION HISTORY

Added by Ord. No. 183,096, Eff. 6-16-14.

(a) Definitions. The following words used in this section shall be construed as defined herein:

(1) “Catastrophic Illness” shall mean a non- work-related catastrophic illness/injury or life-threatening disease of an Employee or

an Employee’s Family Member where other types of monetary benefits are not reasonably available, as determined by the Personnel Department’s Employee Benefits Division.

(2) “City” shall mean the City of Los Angeles.

(3) “Charter” shall the charter of the City of Los Angles.

(4) “Employee” shall mean all City employees who are eligible members of civilian benefit programs under the responsibility of

the Personnel Department and the Joint Labor-Management Benefits Committee (JLMBC) as provided under Article 5 of Chapter 7 of Division 4 of the LAAC, except as regard to employees covered by MOUs 29, 31, or 32, and Ordinance No. 181,014.

(5) “Employee Benefits Division” shall mean the division within the Personnel Department that administers the City’s benefits

program under this article.

(6) “Family Member” shall have the same meaning as provided in the applicable MOU of an Employee or as defined under

Section 4.127 of Article 10 of Chapter 2 of Division 4 of the LAAC.

(7) “JLMBC” shall mean the Joint Labor- Management Benefits Committee established under Section 4.303 of this article.

(8) “LAAC” shall mean the City of Los Angeles Administrative Code.

(9) “Leave Program” shall mean the Catastrophic Illness Leave Program described under this section.

(10) “MOU” shall mean the Memorandum of Understanding that is applicable to the Employee.

(11) “Personnel Department” shall mean department created under Section 540 of the Charter.

(b) Purpose. The Leave Program is designed to provide Employees who are experiencing or suffering from Catastrophic Illness or caring for a Family Member who is experiencing or suffering from a Catastrophic Illness additional compensated leave to continue meeting the minimum eligibility criteria required to continue receiving benefits provided through the civilian benefit programs, as administered and overseen by the Personnel Department and the JLMBC.

(c) Eligibility and Rules for Leave Program. An Employee shall be eligible to participate in the Leave Program after submitting an

application to the Employee Benefits Division, provided the Employee has met all the following applicable conditions:

(1) Passed probation and be a permanently employed full-time or half-time employee;

(2) On active payroll status;

(3) Exhausted all monetary benefits such as sick leave, vacation hours, floating holiday(s), and accrued compensatory time-off;

(4) Experiencing or suffering from Catastrophic Illness or caring for a Family Member(s) who is experiencing or suffering from Catastrophic Illness;

(5) Executed a signed attestation that discloses the pertinent medical information related to the Catastrophic Illness described under Subdivisions (3) and/or (4) of this subsection to the Employee Benefits Office;

(6) Exhausted all enrolled disability insurance benefits offered by civilian benefit programs under the responsibility of the
Personnel Department and the JLMBC with respect to the same Catastrophic Illness for which the Leave Program is being requested;
and

(7) Not currently receiving disability insurance benefits from any other disability insurance program.

(d) Compensated Leave.

(1) An Employee, who meets the eligibility provision described under Subsection (c), may be compensated up to an aggregate

maximum of 480 hours during the Employee’s employment with the City without regard to any break in service with the City, to be paid as authorized by the Employee Benefits Division and to be funded within the budgeted funds of the employing City department, office, or bureau.

(2) The amount of compensation received by the Employee from the Leave Program will be equivalent to the number of hours

claimed by the Employee or as otherwise authorized by the Employee Benefits Division under the Leave Program at such Employee’s rate of pay.

(3) An Employee cannot receive compensation through the Leave Program concurrently with other compensatory time; use of

compensation through the Leave Program shall be at the direction of the Employee Benefits Division.

SECTION HISTORY

Added by Ord. No. 187,929, Eff. 7-7-23.