San Jose Municipal Code Part 15 Dental Benefits for Retired Members and Survivors

Subject to the provisions of this chapter, a member or former member of this plan may be entitled to dental insurance coverage in an eligible dental plan as specified in Section 3.36.2040 if the requirements of Subsection A., B., C., or D. of this Section 3.36.2000 are satisfied. Effective March 31, 2017, this Part 15 shall not be applicable to new employees and they shall not be eligible for dental insurance coverage under this Part 15. Notwithstanding the preceding sentence, for tier 2 members who were or are eligible for benefits under this Part 15, the city manager has the authority and discretion to terminate dental benefits under this Part 15 with respect to those tier 2 members prior to the implementation of Chapter 3.57. In the event the city manager exercises this authority, affected tier 2 members shall not be entitled to any benefits or make any additional contributions under this Part 15.

A. The member became a member of this plan prior to July 1, 1998, and is retired for service or disability under the provisions of this chapter; or

B. The member became a member of this plan on or after July 1, 1998, and 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:

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

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

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

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

3. 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:

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

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

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

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

Any member who is eligible for dental 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 and dental coverage during the annual open enrollment period or the occurrence of another event identified by the dental plans as providing such individuals with an opportunity to elect to be covered under the city's dental coverage shall be required to pay the full portion of the member cost of coverage under this Part 15.

(Ords. 22279, 24093, 25617, 26641, 29879.)

Subject to the provisions of this chapter, the surviving spouse, surviving domestic partner, surviving child and/or children, as those terms are defined in Section 3.36.1200 of this chapter, may be entitled to dental insurance coverage in an eligible dental plan as specified in Section 3.36.2040 if the requirements of Subsection A., B., C. or D. are satisfied. Effective March 31, 2017, this Part 15 shall not be applicable to the surviving spouse, surviving domestic partner, surviving child and/or children of new employees and they shall not be eligible for dental insurance coverage under this Part 15.

A. The surviving spouse, surviving domestic partner, surviving child and/or children are receiving a monthly survivorship allowance pursuant to Part 8 of this chapter because of the death of a member who became a member of this plan prior to July 1, 1998, and:

1. Was retired for service or disability; or

2. Died before receiving retirement pay.

B. The surviving spouse, surviving domestic partner, surviving child and/or children are receiving a monthly survivorship allowance pursuant to Part 8 of this chapter because of the death of a member who became a member of this plan on or after July 1, 1998, and:

1. 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

2. 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 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.

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 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.

D. 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 3.36.2000.

Any survivor who is eligible for dental 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 and dental coverage during the annual open enrollment period or the occurrence of another event identified by the dental plans as providing such individuals with an opportunity to elect to be covered under the city's dental coverage shall be required to pay the full portion of the member's cost of coverage under this Part 15.

(Ords. 22279, 23807, 24093, 25617, 26641, 27712, 29879.)

A. A member or former member, as specified in Section 3.36.2000 above, is eligible to participate in a dental insurance plan sponsored by the city provided that the member or former member satisfies the following requirements:

1. The member retires for service or disability pursuant to the provisions of this chapter and at the time of retirement the member applies for dental insurance coverage in one of the dental insurance plans sponsored by the city; or

2. The former member receives a monthly allowance pursuant to Section 3.36.1630 or Section 3.36.1640 and within thirty days of first receiving such monthly allowance the former member applies for dental insurance coverage in one of the dental insurance plans sponsored by the city; or

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

4. 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 dental coverage at the time he or she first receives such monthly allowance other than coverage under the city's dental insurance coverage and later applies for dental insurance coverage due to the occurrence of another event identified by the dental plans as providing such individuals with an opportunity to elect to be covered under the city's dental coverage, or if there is no qualifying event, applies for dental insurance coverage during the annual open enrollment period, and agrees to pay any applicable premiums within thirty 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 3.36.2010 above, is eligible to participate in a dental insurance plan sponsored by the city provided that the survivor satisfies the following requirements:

1. At the time of the death of the member or former member, the member or former member and the survivor were enrolled in one of the dental insurance plans sponsored by the city; and

2. The survivor applies to continue dental insurance coverage within thirty days of the death of the member or former member.

3. Notwithstanding the foregoing, if, at the time of the death of the member or former member, the survivor was not enrolled in a dental 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 dental insurance coverage within sixty 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 dental 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 dental insurance coverage.

C. Notwithstanding the provisions of Subsections A. and B. of this section, all retired members and survivors who receive a retirement or survivorship allowance for the month of July 1986 shall automatically be enrolled in an eligible dental insurance plan as specified in this part.

D. If a member marries subsequent to his or her retirement or if a former member marries while receiving monthly allowances pursuant to Section 3.36.1630 or Section 3.36.1640, the member or former member may secure dental insurance coverage for his or her spouse only if the member or former member applies to add such spouse in accordance with the terms of the eligible dental insurance plan.

E. If a member establishes a domestic partnership subsequent to his or her retirement or if a former member establishes a domestic partnership while receiving monthly allowances pursuant to Section 3.36.1630 or Section 3.36.1640, the member or former member may secure dental insurance coverage for his or her domestic partner only if the member or former member applies to add such domestic partner in accordance with the terms of the eligible dental insurance plan.

F. Notwithstanding the provisions of Subsection A. of this section, a former member who meets the requirements of Subsection D. of Section 3.36.2000 but who, within thirty days of first receiving a monthly allowance, could not enroll in a dental insurance plan because the benefits provided in this Part 15 were not then available to such former member, may enroll in an eligible insurance plan as provided for in this Part 15 until or on December 31, 2002, only. Upon the death of such former member, the former member's survivors shall be eligible for continued dental insurance coverage. Such former member or survivors must otherwise comply with all other provisions of this Part 15.

G. 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. Such benefit shall cease at the time that such member is eligible for coverage under Medicare and subject to the provisions of 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. 22279, 23889, 24093, 26641, 27712, 29879.)

The cost of providing dental insurance coverage as provided in this part shall be borne by and paid from the medical benefits account established by Section 3.36.575 or from the trusts established by Chapters 3.54 and 3.56. 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 trusts established by Chapters 3.54 and 3.56.

(Ords. 22279, 27768, 29065.)

For the purposes of this part, members or their survivors may secure dental insurance coverage only from an eligible dental plan with which the city has entered into a contract for the provision of dental benefits as part of the city's benefits to city employees.

(Ord. 22279.)

A. It is intended that the funding provided to the retirement fund for dental 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 allocate costs of providing dental 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 15 and the medical benefits provided by Part 14, as determined by the board's actuary, would exceed the contribution limit permitted by Internal Revenue Code Section 401(h) and the applicable regulations, then Section 3.36.2030 notwithstanding, all or a portion of the costs set forth in Section 3.36.2030 may be allocated to the retiree, former member or survivor covered by the dental plan 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 allocation to be implemented until this system is amended pursuant to Subsection A. above.

(Ords. 26416, 29065.)