§ 203-42. Health Care Benefits.  


Latest version.
  • (a)

    In addition to other benefits provided in this chapter, the health care benefits described in this Section shall be provided to the following persons:

    (i)

    A Member who retired on or before July 1, 2011 and whose eligibility for health care benefits was determined on their Retirement Effective Date according to the provisions of this chapter in effect on such date, or

    (ii)

    A Member of Group C who retires on or after August 1, 2011 with 15 years of Membership Service, or

    (iii)

    A Member of Group D, E, or F whose most recent membership enrollment date is before January 9, 1997 and who retired on or after August 1, 2011 and on or before January 1, 2016 with 15 years of Membership Service, or

    (iv)

    Persons receiving the benefits of a retirement optional allowance under Section 203-63 and who are eligible for benefits under Section 203-48 of this chapter, provided that the Member satisfied the health care eligibility requirements of paragraph (i), (ii) or (iii) above at the time the Member retired, or

    (v)

    A surviving spouse, eligible dependent child and orphan, receiving survivor benefits as provided in Section 203-49 of this chapter on or before January 1, 2016.

    (b)

    The benefits to be provided under this Section are:

    (i)

    Medical and prescription drug coverage similar to coverage in effect for eligible Retirees on January 1, 2014, and Member premium contributions are not to exceed 5% of the full funding rate for each tier of coverage:

    (A)

    For in-network benefits:

    (I)

    An annual deductible of $300 per person and $600 per family;

    (II)

    A maximum annual medical out-of-pocket expense of $1,500 per person and $3,000 per family; and

    (III)

    Prescription co-pays: $10 for generic; $20 for brand name; $30 for non-formulary; with no out-of-pocket limit.

    (B)

    For out-of-network benefits:

    (I)

    An annual deductible of $600 per person and $1,200 per family;

    (II)

    A maximum annual medical out-of-pocket expense of $3000 per person and $6,000 per family; and

    (III)

    Limited out-of-network coverage for prescription drugs.

    (ii)

    Dental and vision insurance coverage which shall be purchased and fully paid for by the Retirees, their surviving spouse, their eligible dependents or orphans, as provided in Section 203-48 of this chapter.

    (c)

    Members who retired before September 1, 2007, and their surviving spouse as provided in Section 203-48 of this chapter, who met the requirements of former Section 203-43(d), subsections (i), (ii), (iii), or (iv) as in effect prior to July 1, 2011, and who as of January 1, 2012, and annually thereafter, meet the requirements of subsection (i) below are entitled to the benefits described in subsection (ii) below.

    (i)

    Members must establish that their annual household income is less than $30,000 by annually submitting to the Retirement System a copy of their federal income tax return or any other or additional documentation the Retirement System requires to determine annually whether the Member's household income is less than $30,000. For purposes of this Section, "household income" shall mean the total income of the Member, including the income of the Member's spouse if married, after adding back the nontaxable portion of interest, dividends, pensions, annuities, IRA distributions and social security benefits. Business or investment losses are not included in "household income" and may not be used to reduce the amount of "household income" for purposes of this Section. Members must submit a copy of their federal income tax return (and that of their spouse, if applicable) for the prior year to the Retirement System no later than the date determined by the Retirement System each year, or any other or additional documentation the Retirement System requires. Failure to submit the required documentation shall result in the Member becoming permanently ineligible for the benefits described in (c)(ii) of this Section. The Member will be eligible for coverage as described in (b) of this Section.

    (ii)

    Members who meet the requirements of subsection (i), above shall receive medical and prescription drug coverage with no premium cost with the following benefits:

    (A)

    For in-network benefits:

    (I)

    An annual deductible of $0;

    (II)

    A maximum annual medical out-of-pocket expense of $500 per person and $1,000 per family;

    (III)

    A maximum annual prescription drug out-of-pocket expense of $500 per person; and

    (IV)

    Prescription drug tiers: $5 for generic; $15 for brand name; $30 for non-formulary.

    (B)

    For out-of-network benefits:

    (I)

    An annual deductible of $0;

    (II)

    A maximum annual medical out-of-pocket expense of $1000 per person and $2,000 per family; and

    (III)

    Limited out-of-network coverage for prescription drugs.

    Members who meet the requirements of subsection (i) above shall be provided dental and vision coverage to be purchased and fully paid for by the Retirees, their surviving spouse, their dependents or orphans.

    (d)

    To the extent allowable under applicable federal law, coverage under this Section for any person who is eligible to be covered under Medicare shall be secondary to coverage of such person under Medicare. The benefit payable under this Section shall be reduced by the greater of: (a) the amount actually paid by Medicare Part A and Part B; or (b) the amount Medicare would pay if the person were enrolled in Medicare Part A and Part B. A person is considered eligible for Medicare for these purposes during any period such person has coverage under Medicare Part A or Part B or, while otherwise qualifying for coverage under Medicare Part A (premium free) or Part B, does not have such coverage under Medicare Part A or Part B solely because such person has refused, discontinued, or failed to make any necessary application or applicable payment for Medicare Part A or Part B coverage.

(Ordained by Ord. No. 336-2016, § 2, eff. Nov. 26, 2016)