Part 14 — MEDICAL BENEFITS FOR CERTAIN PERSONS

Subject to the provisions of this chapter, a member or former member may be entitled to medical insurance coverage in an eligible medical plan as specified in Section 3.36.1940 if the requirements of Subsection A.,

B., C., or D. of this Section 3.36.1900 are satisfied.

Effective March 31, 2017, this Part 14 shall not be applicable to tier 2 members and new employees and they shall not be eligible for medical insurance coverage under this Part 14. Notwithstanding the preceding sentence, the city manager has the authority and discretion to terminate tier 2 retiree medical benefits under this Part 14 prior to the implementation of Chapter 3.57. In the event the city manager exercises this authority, tier 2 members shall not be entitled to any benefits or make any additional contributions under this Part 14. Unless expressly stated otherwise, the term "member" or "former member" includes a tier 2 member and former tier 2 member for purposes of this Part 14. Effective March 31, 2017, tier 2 members and new employees shall be covered under the provisions of Chapter 3.57. Members who would otherwise be eligible for coverage under this Part 14 shall be provided a one-time irrevocable election to instead by covered under Chapter 3.57, in accordance with the process described in Chapter 3.57. Coverage under Chapter 3.57 shall not become effective until receipt of IRS approval to transfer member contributions previously contributed under Part 14 and Part 15 to the funding vehicle established under Chapter 3.57. The contributions to the plan by members and the city shall be as determined under Section 3.36.576.

A.

The member is retired for service under Part 6 of this chapter or for disability under Part 7 of this chapter and at the time of such retirement either:

Is entitled to credit for fifteen or more years of service; or

Receives a retirement allowance equal to at least thirty-seven and one-half percent of such member's final compensation.

B.

The member is retired pursuant to Section 3.36.760 of this chapter; or

C.

The former member separates from city service on or after July 5, 1992, prior to retirement, and satisfies all of the following requirements:

At the time of separation from city service, the former member is entitled to credit for twenty or more years of service; and

The former member elects to allow his or her accumulated contributions to remain in the retirement fund pursuant to Section 3.36.1640; and

The former member receives a monthly allowance pursuant to Section 3.36.1640.

D.

The former member separated from city service prior to July 5, 1992, and prior to retirement, and satisfies all of the following requirements:

At the time of separation from city service the former member was entitled to credit for twenty or more years of service; and

The former member elected to allow his or her accumulated contributions to remain in the retirement fund pursuant to Section 3.36.1640; and

As of April 1, 2002, the former member was receiving a monthly allowance pursuant to Section 3.36.1640; and

The former member is receiving a monthly allowance pursuant to Section 3.36.1640 at the time the former member applies for medical insurance coverage.

E.

Any member who meets the requirements of Subsection A., B., C. or D. of this Section 3.36.1900 and is thereby eligible for coverage but instead elects to participate in the "in lieu" premium credit option described in Section 3.36.1955, and later elects to again be covered under the city's medical coverage during the annual open enrollment period or upon the occurrence of another event identified by the medical plans as providing such individuals with an opportunity to elect to be covered under the city's medical coverage shall be required to pay the full cost of the member's portion of coverage under this Part 14.

F.

Notwithstanding the exclusion of tier 2 members and new employees from coverage under Part 14, if a tier 2 member or new employee covered under Chapter 3.57 meets the requirements of Section 3.57.300, such person shall be entitled to receive a benefit as described under Section 3.57.310. The benefit described under Section 3.57.310 shall be paid from the assets set aside to provide benefits under this Part 14. Such benefits shall cease at the time the tier 2 member or new employee becomes eligible for coverage under Medicare.

(Ords. 21686, 23889, 24093, 25615, 26641, 29266, 29879, 30044.)

Subject to the provisions of this chapter, the surviving spouse, surviving domestic partner, child and/or children, as those terms are defined in Section 3.36.1200 of this chapter, may be entitled to medical insurance coverage in an eligible insurance plan as specified in Section 3.36.1940 if the requirements of Subsection A., B., or C. of this Section 3.36.1910 are satisfied. Effective March 31, 2017, this Part 14 shall not be applicable to the surviving spouse, surviving domestic partner, child and/or children, of new employees and they shall not be eligible for medical insurance coverage under this Part 14.

A.

The surviving spouse, surviving domestic partner, surviving child and/or children are receiving a monthly allowance pursuant to Part 8 of this chapter because of the death of a member and:

The member either died before receiving retirement pay or was retired for service under Part 6 of this chapter or for disability under Part 7 of this chapter; and

At the time of the member's death:

a.

The member was entitled to credit for fifteen or more years of service; or

b.

The member was retired pursuant to Section 3.36.760 of this chapter; or

c.

The surviving spouse, surviving domestic partner, surviving child and/or children were entitled to a survivorship allowance of at least thirty-seven and one-half percent of the member's final compensation.

B.

The surviving spouse, surviving domestic partner, surviving child and/or children are receiving a monthly allowance pursuant to Part 11 of this chapter because of the death of a former member who separated from city service on or after July 5, 1992, and who was entitled to credit for twenty or more years of service at the time of such separation from service.

C.

The surviving spouse, surviving domestic partner, surviving child and/or children are receiving a monthly allowance pursuant to Part 11 of this chapter because of the death of a former member who separated from city service prior to July 5, 1992, and who met all of the requirements of Subsection D. of Section 3.36.1900.

D.

Any survivor who meets the requirements of Subsection A., B. or C. of this Section 3.36.1910 and is thereby eligible for coverage but instead elects to participate in the "in lieu" premium credit option described in Section 3.36.1955, and later elects to again be covered under the city's medical coverage during the annual open enrollment period or the occurrence of another event identified by the medical plans as providing such survivors with an opportunity to elect to be covered under the city's medical coverage shall be required to pay the full portion of the member's cost of coverage under this Part 14.

(Ords. 21686, 23807, 23889, 24093, 26641, 27712, 29879.)

A.

A member or former member, as specified in Section 3.36.1900, above, is eligible to participate in a medical insurance plan sponsored by the City provided that the member or former member satisfies the following requirements:

The member retires for service or disability pursuant to the provisions of this Chapter and at the time of retirement the member applies for medical insurance coverage in accordance with the applicable provisions of the medical insurance plan and agrees to pay any applicable premiums; or

The former member receives a monthly allowance pursuant to Section 3.36.1640 and within thirty (30) days of first receiving such monthly allowance the former member applies for medical insurance coverage in accordance with the applicable provisions of the medical insurance plan and agrees to pay any applicable premiums; or

The member retires for service or disability pursuant to the provisions of this Chapter and waives coverage in the form and manner prescribed by the City indicating that he or she has medical coverage at the time of retirement other than coverage under the City's medical insurance coverage and later applies for medical insurance coverage upon the occurrence of an event identified by the medical plans as providing such individuals with an opportunity to elect to be covered under the City's medical coverage, or if there is no qualifying event, applies for medical insurance coverage during the annual open enrollment period, and agrees to pay any applicable premiums within thirty (30) days of the termination of the prior coverage or the commencement of coverage following open enrollment as applicable; or

The former member receives a monthly allowance pursuant to Section 3.36.1640 and executes a waiver of coverage in the form and manner prescribed by the City indicating that he or she has medical coverage at the time he or she first receives such monthly allowance other than coverage under the City's medical insurance coverage and later applies for medical insurance coverage upon the occurrence of an event identified by the medical plans as providing such individuals with an opportunity to elect to be covered

under the City's medical coverage, or if there is no qualifying event, applies for medical insurance coverage during the annual open enrollment period, and agrees to pay any applicable premiums within thirty (30) days of the termination of the prior coverage or the commencement of coverage following open enrollment as applicable.

B.

A survivor, as specified in Section 3.36.1910, above, is eligible to participate in a medical insurance plan sponsored by the City provided that the following conditions are satisfied:

At the time of the death of the member or former member, the member or former member and the survivor were both enrolled in one (1) of the medical insurance plans sponsored by the City; and

The survivor applies to continue medical insurance coverage within sixty (60) days of the death of the member or former member; and

The survivor agrees to pay any applicable premiums.

Notwithstanding the foregoing, if at the time of member's or former member's death, the survivor was not enrolled in a medical insurance plan sponsored by the City, but the survivor would have been eligible to have been enrolled at the time of the member or former member's death, and the survivor applies to continue medical insurance coverage within sixty (60) days of the death of the member or former member and the survivor agrees to pay any applicable premiums, such survivor shall be treated as if the survivor had been enrolled in a medical insurance plan sponsored by the City at the time of the member or former member's death for purposes of continued coverage under the City's medical insurance coverage.

C.

A member or former member may secure medical insurance coverage for a spouse under the following conditions:

The spouse and member are married at the time of said member's retirement for service or disability; or

The spouse and the former member are married at the time the former member first begins receiving a monthly allowance pursuant to Section 3.36.1640; or

The member marries subsequent to his or her retirement and applies to add such spouse in accordance with the terms of the eligible medical plan; or

The former member marries while receiving monthly allowances pursuant to Section 3.36.1640 and applies to add such spouse in accordance with the terms of the eligible medical plan.

D.

A member or former member may secure medical insurance coverage for a domestic partner under the following conditions:

The domestic partner and the member are members of a domestic partnership at the time of said member's retirement for service or disability; or

The domestic partner and the member are members of a domestic partnership at the time the former member first begins receiving a monthly allowance pursuant to Section 3.36.1640; or

The member establishes a domestic partnership subsequent to his or her retirement and applies to add such domestic partner in accordance with the terms of the eligible medical plan; or

The former member establishes a domestic partnership while receiving monthly allowances pursuant to Section 3.36.1640 and applies to add such domestic partner in accordance with the terms of the eligible medical plan.

E.

A surviving spouse or surviving domestic partner shall be eligible for single coverage only, except as follows:

A surviving spouse or surviving domestic partner shall be eligible for family coverage if a surviving child or children as defined in Section 3.36.1200, or an eligible surviving child for purposes of receiving a school allowance pursuant to Part 9 of this Chapter, are surviving the death of the member.

A surviving spouse or surviving domestic partner shall be eligible for family coverage if the surviving spouse or the surviving domestic partner is the court-appointed guardian of the person of a minor child or children and such minor child or children are eligible for coverage under the terms of the eligible medical plan. A

surviving spouse or surviving domestic partner may continue family coverage after such child reaches the age of majority in any case where, if such child had been a surviving child of the member or former member, such child would be an eligible surviving child for purposes of receiving a school allowance pursuant to Part 9 of this Chapter.

F.

Notwithstanding the provisions of subsections A. and B. of Section 3.36.1920, members or their survivors who would otherwise qualify for participation in a medical insurance plan pursuant to the provisions of this Part 14, but who, at the time of retirement or death, could not enroll because the benefits provided in this Part 14 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 14 until or on August 31, 1984, only; said members or their survivors must otherwise comply with the coverage limitations provided in subsections C. and D. of Section 3.36.1920 and with all provisions of this Part 14.

G.

Notwithstanding the provisions of Section 3.36.1920.C., a spouse who married a member subsequent to the member's retirement and would otherwise qualify for participation in a medical insurance plan pursuant to this Part 14 but who, at the time of marriage, could not enroll because the benefits provided in this Part 14 were not available for spouses married subsequent to a member's retirement, may enroll in an eligible insurance plan as provided in this Part 14 until or on December 30, 1991, only. Such spouse must otherwise comply with all other provisions of this Part 14.

H.

Notwithstanding the provisions of Section 3.36.1920.D., a domestic partner who established a domestic partnership with a member subsequent to the member's retirement and would otherwise qualify for participation in a medical insurance plan pursuant to this Part 14 but who, at the time of establishing the domestic partnership, could not enroll because the benefits provided in this Part 14 were not available for domestic partnerships where the partnership was established subsequent to a member's retirement, may enroll in an eligible insurance plan as provided in this Part 14 until or on January 31, 2007, only. Such domestic partner must otherwise comply with all other provisions of this Part 14.

I.

Notwithstanding the provisions of subsections A. and B. of Section 3.36.1920, a member who retired pursuant to Section 3.36.760, or survivors of such member, who would otherwise qualify for participation in a medical insurance plan pursuant to the provisions of this Part 14 but who, at the time of retirement or death, could not enroll because the benefits provided in this Part 14 were not available to such member or such survivors at the time of such member's retirement or death, may enroll in an eligible insurance plan as provided for in this Part 14 until or on December 30, 1991, only. Said member or survivors must otherwise comply with the coverage limitations provided in Section 3.36.1920 and with all other provisions of this Part 14.

J.

A surviving spouse who would otherwise qualify for family coverage because the surviving spouse is the court-appointed guardian of the person of a minor child or children but who, at the time of the member's or former member's death, could not enroll because the family coverage provided in this Part 14 was not available to such surviving spouse at the time of the member's or former member's death, may enroll in family coverage in an eligible insurance plan as provided for in this Part 14 until June 30, 2002, only. Said surviving spouse must otherwise comply with the coverage limitations provided in Section 3.36.1920 and with all other provisions of this Part 14.

K.

A domestic partner who would otherwise qualify for family coverage because the domestic partner is the court-appointed guardian of the person of a minor child or children but who, at the time of the member's or former member's death, could not enroll because the family coverage provided in this Part 14 was not available to such surviving domestic partner at the time of the member's or former member's death, may enroll in family coverage in an eligible insurance plan as provided for in this Part 14 until January 31, 2007, only. Said surviving domestic partner must otherwise comply with the coverage limitations provided in Section 3.36.1920 and with all other provisions of this Part 14.

L.

Notwithstanding the provisions of subsection A. of Section 3.36.1920, a former member who meets the requirements of subsection D. of Section 3.36.1900 but who, within thirty (30) days of first receiving a monthly allowance, could not enroll in a medical insurance plan because the benefits provided in this Part 14 were not then available to such former member, may enroll in an eligible insurance plan as provided for in this Part 14 until or on December 31, 2002, only. Upon the death of such former member, the former member's survivors shall be eligible for continued medical insurance coverage. Such former member or survivors must otherwise comply with the coverage limitations provided in Section 3.36.1920 and with all other provisions of this Part 14.

M.

Effective March 31, 2017, a member and/or dependent and/or survivor who is eligible for retiree healthcare benefits in this Plan and who is eligible for Medicare coverage shall be required to enroll in Medicare Part A and B during the individual's "initial enrollment period" under the applicable federal rules. The initial enrollment period shall begin three (3) months before the Plan member and/or dependent and/or survivor's sixty-fifth (65th) birthday (or other event providing eligibility for enrollment in Medicare) and concludes four (4) months after the Plan member and/or dependent and/or survivor's sixty-fifth (65th) birthday (or other event providing eligibility for enrollment in Medicare). However, if a member is already retired and age sixty- five (65) or older on the date this Section of the Ordinance becomes effective for such member and is eligible for Medicare coverage then the member shall be required to enroll in Medicare Part A and B by July 1, 2018. Additionally, the Plan member and/or dependent and/or survivor who is eligible for Medicare shall be required to enroll in a Medicare Plan provided by the City under this Part 14 and assign Medicare Parts A and B benefits to the Medicare Plan if required by the healthcare coverage provider. If any member who retires for service or disability pursuant to the provisions of this Chapter or is a former member receiving a monthly allowance pursuant to Section 3.36.1640 waives coverage, he or she will not be required to enroll in Medicare Parts A or B. However, if such member or former member later joins a City plan, he or she will

be required to enroll in Medicare Parts A and B and any charges or penalties associated with enrollment outside the "initial enrollment period" shall be borne by such member or former member.

If a member is not eligible for Medicare Part A at no cost or a Plan member for any reason is not eligible for Medicare, the member shall be required to provide such verification from the U.S. Social Security Administration to the Department of Retirement Services. Unless such verification is provided, Plan members shall be required to enroll in a Medicare Plan provided by this Plan upon reaching age sixty-five (65). This provision shall not apply to those who waive coverage,

If a member fails to meet the requirements set forth above within the member's (or dependent or survivor's) "initial enrollment period" which begins three (3) months before the Plan member and/or dependent and/or survivor's sixty-fifth (65th) birthday (or other event providing eligibility for enrollment in Medicare) and concludes four (4) months after the Plan member and/or dependent and/or survivor's sixty-fifth (65th) birthday (or other event providing eligibility for enrollment in Medicare), the Plan shall cease to provide retiree healthcare benefits until the Plan member (or dependent or survivor) completes such requirements. This means that the member and any qualifying dependents shall not receive retiree healthcare benefits. The Plan member and qualifying dependents shall be re-enrolled in retiree healthcare benefits beginning the first day of the following month after such requirements have been completed.

If the member dies during the period which the Plan member failed to complete the requirements set forth above, the eligible spouse or domestic partner and any qualifying child(ren) shall be re-enrolled in a health insurance plan. When the spouse or domestic partner is age sixty-five (65), the requirements described above regarding enrollment in Medicare Parts A and B and enrollment in a Medicare Plan provided for City retirees and dependents, and assignment of Medicare Parts A and B benefits to the Medicare Plan must be fulfilled, unless verification is provided that the spouse or domestic partner is not eligible for Medicare coverage as described in this Section. If such requirements are not met, retiree healthcare coverage will cease until such requirements are completed, in the same manner set forth above with respect to members.

N.

Subject to the provisions of this Chapter, effective March 31, 2017 and upon IRS approval of the VEBA, a member of the VEBA who meets the requirements of Section 3.57.300 may be entitled to receive a benefits similar to those established under Parts 14 and 15 of Chapter 3.36. These provisions entitle a VEBA member to a benefit equal to the amount of the premium for single coverage under the lowest cost medical insurance coverage available under the City's retiree medical program. VEBA members with at least five years of service with the City may be eligible to purchase medical benefits under the City's healthcare plans, however, such medical plan purchases will be at a retiree only rate that is not a rate blended with active City employees. Such benefit shall cease at the time that such member is eligible for coverage under Medicare and subject to the provisions of Section 3.57.320. The catastrophic disability healthcare benefit provided under Chapter 3.57 shall be paid from the Police Department Healthcare Trust Fund or the Fire Department Healthcare Trust Fund, as applicable.

(Ords. 21686, 23807, 23889, 24093, 25615, 26566, 26641, 27712, 29879, 30007.)

A.

The plan will reimburse members, former members and survivors for the amounts paid by them for Medicare Part B coverage, subject to the following limitations:

The member, former member or survivor must be eligible for medical insurance coverage under the provisions of the plan and must be enrolled in an eligible medical plan.

The total amount paid by from the medical benefits account or the trusts established by Chapters 3.54 and 3.56 for medical benefits pursuant to Section 3.36.1930 plus the Medicare Part B reimbursement shall not exceed the premium for the lowest cost medical plan, as defined in Section 3.36.1930D., available to the member, former member or survivor.

The reimbursement shall be only for Medicare Part B payments made after February 4, 2000.

The member, former member, or survivor must submit proof of payment for Medicare Part B. Except for Medicare Part B payments made during calendar year 2000, proof of payment must be submitted no later than the April 1 immediately following the calendar year for which reimbursement is sought. For Medicare Part B payments made during calendar year 2000, proof of payment must be submitted no later than November 30, 2001.

The reimbursement shall not exceed the amount of the Medicare Part B payments for which proof of payment is submitted.

The reimbursement may be reduced or eliminated pursuant to Section 3.36.1950.

B.

All reimbursements for Medicare Part B payments shall be made from the medical benefits account established by Section 3.36.575 or the trusts established by Chapters 3.54 and 3.56.

(Ords. 27768, 29065.)

A.

The costs of premiums for medical insurance coverage in an eligible medical plan shall be paid from the medical benefits account established by Section 3.36.575 or from the trust funds established by Chapters

3.54 and 3.56 and by deductions from monthly allowances paid by the Plan in accordance with this Section

Unless otherwise determined by the Trustees, payment shall be made out of the medical

benefits account until the account is exhausted and thereafter out of the Trust Funds established by Chapters 3.54 and 3.56.

B.

For members who retired prior to February 4, 1996, for former members described in subsection C. of Section 3.36.1900 who separated from City service prior to February 4, 1996, and for survivors of said members and former members who satisfy the requirements of Section 3.36.1910:

For coverage through July 1998, the member, former member or survivor shall be required to pay a premium for medical insurance coverage under this Part in the same amount as is currently paid by an employee of the City in the classification from which the member retired, which the member held at the time of death, or which the former member held at the time of separation from City service. The remaining portion of the premium shall be paid from the medical benefits account.

Effective for coverage beginning in the month of August 1998, the portion of the premium to be paid from the medical benefits account shall be that portion which is equivalent to the premium for the "lowest cost medical plan," but shall not exceed the actual premium for the eligible medical plan in which the member, former member or survivor enrolls. The portion to be paid by deductions from monthly allowances paid to the member, former member, or survivor shall be that portion of the premium for the selected medical plan that exceeds the portion payable from the medical benefits account.

C.

For members who retired on or after February 4, 1996, for former members described in subsection C. of Section 3.36.1900 who separated from City service on or after February 4, 1996, and for survivors of said members and former members who satisfy the requirements of Section 3.36.1910:

For coverage through November 1997, the member, former member or survivor shall be required to pay a premium for medical insurance coverage under this Part in the same amount as was then paid by an employee of the City in the classification from which the member retired, which the member held at the time of death, or which the former member held at the time of separation from City service. The remaining portion of the premium shall be paid from the medical benefits account.

Effective for coverage beginning in the month of December 1997, the portion of the premium to be paid from the medical benefits account shall be the lesser of (a) an amount which is equivalent to the premium for the "lowest cost medical plan" or (b) the actual premium for the eligible medical plan in which the member, former member or survivor enrolls. The portion to be paid by deductions from monthly allowances

paid to the member, former member, or survivor shall be that portion of the premium for the selected medical plan that exceeds the portion payable from the medical benefits account.

D.

For the purposes of this Section, "lowest cost medical plan" means that medical plan (single or family coverage as applicable to the coverage selected by the member, former member or survivor):

Which is an eligible medical plan as defined in Section 3.36.1940(A); and

Which has the lowest monthly premium of all eligible medical plans as defined in Section 3.36.1940(A) then in effect, determined as of the time the premium is due and owing. The "lowest cost plan" for any current or future retiree in the defined benefit retirement healthcare plan shall be permanently set such that it would qualify for "silver" level as specified by the Affordable Healthcare Act (ACA) in effect in July 2015. This specifically includes the provision that the healthcare plan must be estimated to provide at least 70% (the "floor") but no more than 79% (the "ceiling") of healthcare expenses (actuarial valuation) as per the current ACA "silver" definition.

(Ords. 21686, 25615, 26566, 26641, 27768, 29065, 29879, 30087.)

A.

A surviving spouse who is otherwise eligible only for single coverage, but who elects family coverage pursuant to paragraph 2. of Subsection D. of Section 3.36.1920, shall be required to pay that portion of the medical premium which exceeds the amounts payable for single coverage by the surviving spouse and the Medical Benefits Account as provided in Section 3.36.1930.

B.

The portion of the premium required to be paid by the surviving spouse shall be deducted from the monthly allowances otherwise payable to the surviving spouse.

(Ord. 26566.)

For purposes of this Part 14, members or their survivors may only be entitled to secure medical insurance coverage 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 the provision of hospital, medical, surgical and related benefits which are not part of the City's benefits to City employees.

(Ords. 21686, 30087.)

A.

It is intended that the funding provided to the retirement fund for medical benefits provided by this system meet the requirements of Internal Revenue Code Section 401(h). Subject to the requirements of the Meyers-Milias-Brown Act (California Government Code Section 3500 et seq.), the city reserves the right to amend this part to limit the funding provided to the retirement fund for the medical benefits as necessary to satisfy the requirements of said Section 401(h).

B.

In the event the contributions required to be paid into the retirement fund to fund the benefits provided by this Part 14 and the dental benefits provided by Part 16, as determined by the board's actuary, would exceed the contribution limit permitted by Internal Revenue Code Section 401(h) and the applicable regulations, the allocation of costs set forth in Section 3.36.1930 shall be adjusted as needed so that the contributions made to fund the portion paid from the medical benefits account comply with Section 401(h). The board, in consultation with its actuary, shall determine the adjustment to be implemented until this part is amended pursuant to Subsection A. above.

(Ords. 26416, 29065.)

A.

Effective March 31, 2017, members and their surviving spouses, surviving domestic partners, and/or children who are eligible for medical insurance coverage under Section 3.36.1900 or 3.36.1910 may instead of receiving such coverage choose to receive a credit for an amount equal to twenty-five percent (25.0%) of the monthly premium of the lowest cost medical plan as defined under Section 3.36.1930.D and the lowest cost dental plan under the coverage provided under Part 15. Such credited amounts must be used only for application toward the cost of such person's healthcare premiums actually incurred in future years under Part 14 and Part 15 of this Plan.

B.

Each year during the annual open enrollment period during which qualifying individuals covered under this Part 14 and Part 15 are provided the opportunity to elect healthcare coverage under this Part 14, or upon the occurrence of another event identified by the medical plans as providing qualifying individuals with an opportunity to elect coverage under this Part 14, such individuals may again elect such coverage and pay the full cost of the member's portion of coverage or instead elect to have the credit described in Section 3.36.1955.A again credited to be used only for application toward the cost of such person's healthcare premiums actually incurred in future years under Part 14 and Part 15 of this Plan.

C.

Individuals receiving credits in lieu of premiums for greater than the cost of single coverage must annually submit substantiation that they continue to be eligible for coverage at greater than the cost of single coverage. Further, eligible retirees who receive retiree healthcare coverage as a dependent of another City employee or retiree are not eligible for the family in lieu premium credit and must elect, if any in lieu election is made, the single in lieu premium credit.

D.

To the extent a member and/or the member's eligible dependents selects to receive the credits under Section 3.36.1955.A or 3.36.1955.B and the member and his surviving dependents do not use the accumulated credits while eligible for healthcare coverage under this Part 14, any remaining credits will be forfeited. In no event can a member, surviving spouse, surviving domestic partner, and/or eligible dependent receive the credits in lieu of coverage under this Part 14 as cash and such credits may only be applied to the cost of future premiums for coverage provided under this Part 14 and Part 15.

E.

Any member who retires for service or disability pursuant to the provisions of this Chapter or is a former member receiving a monthly allowance pursuant to Section 3.36.1640 waives coverage, he or she will not be required to enroll in Medicare Parts A or B. However, if such member or former member later joins a City plan, he or she will be required to enroll in Medicare Parts A and B and any charges or penalties associated with enrollment outside the "initial enrollment period" shall be borne by such member or former member.

(Ords. 29879, 30007.)