3.28.1970 - Requirements for participation in medical insurance plan.
A. A member who, as specified in Section 3.28.1950 or 3.28.1955.B.1. above, is eligible to participate in a medical insurance plan sponsored by the City, provided the member (or Tier 2 member, as applicable) must satisfy 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; and
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 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.
B. A survivor who, as specified in Section 3.28.1960 above, or to the extent the survivor of a member (including a Tier 2 member) specified in Section 3.28.1955 above, is eligible to participate in a medical insurance plan sponsored by the City, such survivor must satisfy the following conditions:
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 (1) 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. 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 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.
D. A member may secure medical insurance coverage for a domestic partner only if the domestic partner and member had established a registered domestic partnership pursuant to Division 2.5 of the California Family Code or had formed a legal union other than a marriage that is recognized as a domestic partnership pursuant to California Family Code Section 299.2 at the time of said member's retirement for service or disability.
E. A surviving spouse or surviving domestic partner shall be eligible for single coverage only, except as follows:
1. A surviving spouse or surviving domestic partner shall be eligible for family coverage if at least one (1) surviving child as defined in Section 3.28.1460.D., or at least one (1) child of the surviving spouse or surviving domestic partner who is unmarried, not a member of a registered domestic partnership and under the age of eighteen (18) years, or an eligible surviving child for purposes of receiving a school allowance as defined in Section 3.28.1750, is surviving the death of a member; in such case, if such child was enrolled in a medical insurance plan sponsored by the City at the time of the member's death. Notwithstanding the foregoing, if at the time of the death of the member, such surviving child of the member was not enrolled in a medical insurance plan sponsored by the City, but such surviving child would have been eligible to have been enrolled at the time of the member's death, and such surviving child applies to continue medical insurance coverage within sixty (60) days of the death of the member and the surviving child (or the surviving spouse or domestic partner on behalf of the surviving child) agrees to pay any applicable premiums, such surviving child shall be treated as if the surviving child had been enrolled in a medical insurance plan sponsored by the City at the time of the member's death for purposes of continued coverage under the City's medical insurance coverage.
2. A surviving spouse or surviving domestic partner shall be eligible for family coverage if the surviving spouse or 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, such child would be an eligible surviving child for purposes of receiving a school allowance pursuant to Part 14 of this Chapter.
F. As used in this Section, "medical insurance plan sponsored by the City" means an eligible medical plan as described in Section 3.28.1990, below.
G. Notwithstanding the provisions of Sections 3.28.1970.A.1., 2., and 3., and 3.28.1970.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 3.28.1970 and with all other provisions of this Part.
H. 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 could not enroll because the family coverage provided in subsection E. above was not available to the surviving spouse at the time of the member's death, may enroll in family coverage in an eligible insurance plan as provided for in this Part until December 30, 2002, only. Said surviving spouse must otherwise comply with the coverage limitations set forth in this Section 3.28.1970 and with all other provisions of this Part.
I. Effective September 30, 2012 for Tier 2 members and effective January 4, 2013 for non-Tier 2 members, a member and/or dependent and/or survivor who is eligible for retiree healthcare benefits in the Federated City Employees' Retirement System and who is eligible for Medicare coverage, including any Tier 2 member and/or dependents and/or survivors of such Tier 2 member to the extent they may be eligible for retiree healthcare benefits under Section 3.28.1955, 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 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). Additionally, the plan member and/or dependent and/or survivor who is eligible for Medicare coverage shall be required to enroll in a Medicare Plan provided by the Federated City Employees' Retirement System and assign Medicare Part A and B benefits to the Medicare Plan if required by the healthcare provider. 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 Plan member was hired before March 1986 and is not eligible for Medicare Part A at no cost or a Plan member for any reason is not eligible for Medicare, the Plan 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 the Federated City Employees' Retirement System within six (6) months of the "initial enrollment period." This provision shall not apply to those who waive coverage.
If a Plan member fails to meet the requirements set forth above within six (6) months from the date of the member's (or dependent or survivor's) "initial enrollment period," the Plan shall cease to provide retiree healthcare benefits until the Plan member 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 Plan 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.
J. Subject to the provisions of this Chapter, effective June 16, 2017 and upon IRS approval of the VEBA, a member of the VEBA who meets the requirements of Section 3.58.300 may be entitled to receive benefits similar to those established under Parts 16 and 17 of Chapter 3.28 as such benefits are described in Chapter 3.58. 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 eligible for any benefits under the City's retiree medical program. VEBA members with less than five years of service with the City are not eligible for the benefits described herein. Such benefit shall cease at the time that such member is eligible for coverage under Medicare and subject to the provisions of Section 3.58.320. The catastrophic disability healthcare benefit provided under Chapter 3.58 shall be paid from the Federated Healthcare Trust Fund, as applicable.
(Ords. 21763, 22807, 26642, 27521, 29120, 29174, 29283, 29904, 30017.)
