Part 23

MEDICAL BENEFITS FOR CERTAIN RETIREES AND SURVIVORS

Sections:

Subject to the provisions of this chapter, if a member is retired for service or disability and at the time of such retirement is entitled to credit for fifteen or more years of service, or is receiving an allowance equal to at least thirty-seven and onehalf percent of the final compensation of said member, said member may be entitled to medical insurance coverage in an eligible medical plan as specified in Section 3.24.2270, below. (Ord. 21763.)

Subject to the provisions of this chapter, if a surviving husband, wife, child and/or children, as those terms are defined in Section 3.24.2040 of this chapter, is receiving a monthly survivorship allowance pursuant to Part 20 of this chapter because of the death of a member, and the member either died before receiving retirement pay or was retired for either service or disability, and such member was at the time of death entitled to credit for fifteen or more years of service or was receiving an allowance of at least thirty-seven and one-half percent of final compensation, then in said event, the surviving husband, wife, child and/or children may be entitled to medical insurance coverage in an eligible insurance plan as specified in Section 3.24.2270, below.

(Ord. 21763.)

• A. A member, as specified in Section 3.24.2250, above, is eligible to participate in a medical

T3:118

PERSONNEL

§ 3.24.2280

insurance plan sponsored by the city provided that the member satisfies the following requirements:

1. The member retires for service or disability pursuant to the provisions of this chapter; and

2. The member applies for medical insurance coverage at the time of his or her retirement in accordance with the provisions of the medical insurance plan, and agrees to pay any applicable premiums.

• B. A survivor, as specified in Section 3.24.2260, above, is eligible to participate in a medical insurance plan sponsored by the city provided that the following conditions are satisfied:

  1. The survivor is receiving a monthly survivorship allowance because of the death of a member who either died during his or her employment with the city or died after he or she terminated city employment and was retired pursuant to the provisions of this chapter; and

  2. At the time of the member's death, the member and the survivor were enrolled in one of the medical insurance plans sponsored by the city; and

  3. The survivor applies to continue medical insurance coverage at the time of the member's death, and agrees to pay any applicable premiums.

• C. A member may secure medical insurance coverage for a spouse only if the spouse and member were married at the time of said member's retirement for service or disability. A surviving husband or wife shall be eligible for single coverage only, unless at least one unmarried child of the member, or of the member's husband or wife, under the age of eighteen years, is surviving the death of the member; in such case, if at the of the member's death such child was enrolled in a medical insurance plan sponsored by the city, then the surviving husband or wife shall be eligible for family coverage.

• D. As used in this section, "medical insurance plan sponsored by the city" means an eligible medical plan as described in Section 3.24.2290, below.

• E. Notwithstanding the provisions of Sections 3.24.2270.A.1., 2., and 3., and 3.24.2270.B.1., 2., and 3., members or their survivors who would otherwise qualify for participation in a medical insurance plan pursuant to the provisions of this part, but who, at the time of retirement or death, could not enroll because the benefits provided in this part were not available at the time of the member's retirement for service or disability or death of the member, may enroll in an eligible insurance plan as provided for in this part on or before October 31, 1984. If a member or survivor does not enroll on or before October 31, 1984, then said members or their survivors must otherwise comply with the coverage limitations provided in Section 3.24.2270 and with all other provisions of this part.

• (Ords. 21763, 22807.)

Premiums for medical insurance coverage under this part shall be paid as follows:

1. The city shall pay that portion of the premium which represents an amount equivalent to the lowest of the premiums for single or family medical insurance coverage for which the member or survivor is eligible and in which the member or survivor enrolls under the provisions of this part, which is available to an employee of the city at such time as said premium is due and owing.

2. Members or survivors shall be required to pay that portion of the premium which represents the difference between the cost of the premium for the medical plan selected by the member or the survivors and the portion paid by the city. Such

T3:119

SAN JOSÉ CODE

§ 3.24.2280

premium as is required to be paid by a member or survivor shall be deducted from the allowance payable to such member or survivor under this chapter.

(Ord. 21763.)

For purposes of this Part, members or their survivors may secure medical insurance coverage only from:

• A. Medical Plans Offered to Active City Employees - an eligible medical plan which is a plan in which the City has entered into a contract for the provision of hospital, medical, surgical and related benefits as part of the City's benefits to City employees; or

• B. Medicare Medical Plans - an eligible medical plan which is a plan in which the City has entered into a contract for a Medicare coverage medical plan for the provision of hospital, medical, surgical and related benefits for Medicare recipients; or

• C. Medical Plans Not Offered to Active City Employees - an eligible medical plan which is a plan in which the City has entered into a contract for medical plans for the provision of hospital, medical, surgical and related benefits which are not part of the City's benefits to City employees.

(Ords. 21763, 30087.)