San Jose Municipal Code Part 17 Dental Benefits for Retired Members and Survivors

A. Subject to the provisions of this Chapter, if a member of this System is retired for service or disability and at the time of such retirement is: (i) entitled to credit for five (5) or more years of service; or (ii) is receiving an allowance equal to at least thirty-seven and one-half percent (37.5%) of the final compensation of said member; or (iii) would be receiving an allowance equal to at least thirty-seven and one-half percent (37.5%) of the final compensation of said member if the workers' compensation offset set forth in Section 3.28.1040 did not apply, then said member may be entitled to dental insurance coverage in an eligible dental plan as specified in this Part.

B. Any member who is eligible for dental coverage but instead elects to participate in the "In Lieu" premium credit option described in Section 3.28.1965, and later elects to again be covered under the City's medical and dental coverage during the annual open enrollment period or upon qualifying events 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 shall be required to pay the full portion of the member cost of coverage under this Part 17.

C. Effective on or after June 16, 2017 any dental insurance coverage that may be provided to an employee who is a participant in the City of San José defined contribution plan for employees in Unit 99 under Chapter 3.49 shall be determined only as provided under Section 3.28.2005.

D. Effective June 16, 2017, this Part 17 shall not be applicable to new employees and they shall not be eligible for dental insurance coverage under this Part 17. Notwithstanding the preceding sentence, new employees hired before September 27, 2013 who are represented by the Operating Engineers, Local 3 or the Association of Building, Mechanical and Electrical Inspectors shall be eligible for benefits under this Section 3.28.2000 if he or she meets the requirements of subsection 3.28.2000.A.

(Ords. 22261, 29184, 29283, 29904.)

A. Effective June 16, 2017, new employees and their respective survivors shall not be eligible for dental insurance coverage in an eligible dental plan under this Part 17. Except to the extent specifically provided in Section 3.28.2005.B. and Section 3.28.2005.C. below, effective as of the date the provisions of Chapter 3.58 become effective, new employees and their surviving spouse, surviving domestic partner, surviving child and/or children may be eligible for dental coverage under Chapter 3.58, if applicable.

B. If insurance coverage under Part 17 for Tier 2 members is terminated by the City Manager prior to the establishment of benefits under Chapter 3.58, affected Tier 2 members shall not be entitled to any benefits or make any additional contributions under this Part 17 once participation is terminated and affected Tier 2 members shall not be entitled to any retiree dental benefits nor make dental benefit contributions during the gap period between termination of benefits under Part 17 and establishment of the VEBA under Chapter 3.58. Notwithstanding the preceding sentences, new employees hired prior to September 27, 2013 who are represented by the Operating Engineers, Local 3 or the Association of Building, Mechanical, and Electrical Inspectors who do not make a one-time irrevocable election to participate in the retiree healthcare benefits provided under Chapter 3.58 and who meet the requirements of Section 3.28.2000.A. shall be eligible for dental benefits under this Part 17.

C. Members rehired or reinstated prior to the effective date of the provisions of Chapter 3.58 shall be treated as Tier 2 members for purposes of this Part 17 and shall not be entitled to dental insurance coverage under this Part 17. Instead, such members shall be entitled to dental coverage under the provisions of Chapter 3.58, if eligible. Provided however, effective as of the date the provisions of Chapter 3.58 become effective, a rehired or reinstated member who was a non-Tier 2 member during his or her previous employment with the City and, at the time of his or her prior termination, satisfied the requirements of Section 3.28.2000.A., shall remain entitled to dental insurance coverage for which the member or survivor would have been eligible under the provisions of Part 17 based upon such member's eligibility at the prior termination date as if the member had not been rehired or reinstated.

D. Defined Contribution Plan Participants and Their Survivors. Employees who are participants in the City of San José defined contribution plan for employees in Unit 99 under Chapter 3.49 and their survivors shall not be entitled to dental insurance coverage under this Part 17.

(Ords. 29283, 29904.)

Subject to the provisions of this Chapter, if a surviving spouse, surviving domestic partner, or surviving child and/or children, as those terms are defined in Sections 3.28.1460, 3.28.1560, and 3.28.1750 of this Chapter, whichever is applicable, is receiving a monthly survivorship allowance pursuant to Part 11, Part 12 or Part 14 of this Chapter or is receiving an optional settlement allowance pursuant to Part 13 of this Chapter because of the death of a member of this System, other than the death of a Tier 2 member effective on or after September 27, 2013 or a participant under the City of San José defined contribution plan for employees in Unit 99 under Chapter 3.49, then said surviving spouse, surviving domestic partner, or surviving child and/or children may be entitled to dental insurance coverage in an eligible dental plan as specified in this Part if the following conditions are satisfied:

A. The member either died before receiving retirement pay or was retired for either service or disability; and

B. Such member was at the time of death:

1. Entitled to credit for five (5) or more years of service; or

2. Was receiving an allowance equal to at least thirty-seven and one-half percent (37.5%) of final compensation; or

3. Would have been receiving an allowance equal to at least thirty-seven and one-half percent (37.5%) of final compensation if the workers' compensation offset set forth in Section 3.28.1040 did not apply.

C. Notwithstanding any other provision of this Part, new employees, other than new employees represented by the Operating Engineers, Local 3 and the Association of Building, Mechanical and Electrical Inspectors who were hired or rehired before September 27, 2013 and meet the requirements of Section 3.28.2020, and participants in the City of San José defined contribution plan for employees in Unit 99 under Chapter 3.49 and their survivors are not eligible for the benefits provided by this Section 3.28.2010. Instead, any dental insurance coverage that may be provided to these new employees or to employees who are participants in the City of San José defined contribution plan for employees in Unit 99 under Chapter 3.49 who are not eligible for benefits under this Section 3.28.2010, and their respective survivors, shall be determined only as provided under Section 3.28.2005.

D. Any survivor who is eligible for dental coverage but instead elects to participate in the "In Lieu" premium credit option described in Section 3.28.1965, 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 17.

(Ords. 22261, 23736, 27521, 29184, 29283, 29904.)

A. A member who, as specified in Section 3.28.2000 above, is eligible, or to the extent a Tier 2 member is specified in Section 3.28.2005 above as eligible, to participate in a dental insurance plan sponsored by the City, provided the member (or Tier 2 member as applicable) must satisfy the following requirements:

1. The member terminates City employment pursuant to the retirement provisions of this Chapter; and

2. At the time of his or her retirement, the member is enrolled in one of the dental insurance plans sponsored by the City; and

3. If the member retires for service or disability pursuant to the provisions of this Chapter and at the time of his or her retirement 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 (30) days of the termination of the prior coverage or the commencement of coverage following open enrollment as applicable;

B. A survivor of a member who, as specified in Section 3.28.2010 above, or to the extent the survivor of a Tier 2 member as specified in Section 3.28.2005 above, is eligible to participate in a dental insurance plan sponsored by the City, the survivor must satisfy the following requirements:

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 pursuant to the retirement provisions of this Chapter; and

2. At the time of the member's death, the member and the survivor were enrolled in one (1) of the dental insurance plans sponsored by the City and the survivor applies to continue dental insurance coverage within thirty (30) days of the death of the member.

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 (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 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 of members who meet the qualifications set forth in Section 3.28.2000 or Section 3.28.2010 and 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.

(Ords. 22261, 29283, 29904.)

A. 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 3.28.380 or from the trust fund established by Chapter 3.52. 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 fund established by Chapter 3.52.

B. Except as provided in subsections C. and D.:

1. The portion of the premium to be paid from the medical benefits account established under Section 3.28.380, or trust fund established by Chapter 3.52, shall be the portion that represents an amount equivalent to the lowest of the premiums for single or family dental 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 dental plan selected by the member or the survivors and the portion paid from the medical benefits account. Such 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.

C. To the extent that any member (including Tier 2 members) or their survivors, are eligible for dental insurance coverage as provided under Section 3.28.2005, the benefit provided from the medical benefits account, or trust fund established by Chapter 3.52, shall be the benefit that is specified under Section 3.28.2005. In the same manner as other members and eligible survivors under subsection B. above, to the extent members (including Tier 2 members) or their eligible survivors are eligible for benefits under Part 17 as specified under Section 3.28.2005, they shall be required to pay that portion of the premium which represents the difference between the cost of the premium payable for the dental plan selected by the member (including Tier 2 members) and the portion paid from the medical benefits account or the trust fund established by Chapter 3.52. Any such premium required to be paid by a Tier 2 member or their survivors, shall be deducted from the retirement or survivor allowance payable under this Chapter.

D. For the purposes of this Section, "lowest of the premiums" means that dental plan (single or family coverage as applicable to the coverage selected by the member, former member or survivor) which is an eligible dental plan as defined in Section 3.28.2040; and which has the lowest monthly premium of all eligible dental plans.

(Ords. 22261, 27838, 28914, 29283, 29904.)

For the purposes of this part, members or their survivors (including tier 2 members and their survivors to the extent eligible for coverage under Section 3.28.2005) 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.

(Ords. 22261, 29283.)

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 17 and the medical 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, then Section 3.28.2030 notwithstanding, all or a portion of the costs set forth in Section 3.28.2030 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. 27838, 28914, 29283.)