Allocation of costs of providing medical insurance coverage to members or survivors.
San José Municipal Code § 3.28.1980
in effect3.28.1980 - Allocation of costs of providing medical insurance coverage to members or survivors.
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 3.28.380 or from the trust fund established by Chapter 3.52 and by deductions from monthly allowances paid by the Plan in accordance with this Section 3.28.1980. 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, 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 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 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. A surviving spouse or surviving domestic partner who is otherwise eligible only for single coverage, but who elects family coverage pursuant to Section 3.28.1970.D., shall be required to pay that portion of the medical premium which exceeds the sum of the amount payable by the surviving spouse or surviving domestic partner and the amount payable from the medical benefits account or the trust fund established by Chapter 3.52 for single coverage as provided in subsection B. above. The portion of the premium required to be paid by the surviving spouse or surviving domestic partner shall be deducted from the monthly allowances otherwise payable to the surviving spouse or surviving domestic partner.
D. To the extent that any member (including Tier 2 members), or their survivors, are eligible for medical insurance coverage as provided under Section 3.28.1955, 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 3.28.1955. In the same manner as other members and eligible survivors under subsection C. above, to the extent members (including Tier 2 members) or their eligible survivors are eligible for benefits under Part 16 as specified under Section 3.28.1955, they shall be required to pay that portion of the premium which represents the difference between the cost of the premium payable for the medical 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 City of San José defined contribution plan participant, or their survivors, shall be deducted from the retirement or survivor allowance payable under this Chapter.
E. For the purposes of this Section, "lowest of the premiums" means that medical plan (single or family coverage as applicable to the coverage selected by the member, former member or survivor):
1. Which is an eligible medical plan as defined in Section 3.28.1990(A); and
2. Which has the lowest monthly premium of all eligible medical plans as defined in Section 3.28.1990(A) then in effect, determined as of the time the premium is due and owing. The lowest of the premiums 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 seventy percent (70%) (the "floor") but no more than seventy-nine percent (79%) (the "ceiling") of healthcare expenses (actuarial valuation) per the current ACA "silver" definition.
(Ords. 21763, 26642, 27521, 27838, 28914, 29283, 29904, 30087.)
Source: City of San José, Municipal Code (Municode Library, library.municode.com)URL: https://library.municode.com/ca/san_jose/codes/code_of_ordinances?nodeId=TIT3PE_IIREPL_CH3.281975FEEMREPL_PT16MEBECERESU_3.28.1980ALCOPRMEINCOMESUFetched: 11/1/2026