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Chapter 4. Medicare Premium Payment Program of California Education Code >> Division 1. >> Title 1. >> Part 13.5. >> Chapter 4.
(a) Effective July 1, 2001, the system shall pay to the
federal Centers for Medicare and Medicaid Services or a successor
agency the premiums associated with Medicare Part A for retired or
disabled members described in this section.
(b) This section shall apply only to a retired member of the Defined Benefit Program who meets all of the following requirements:
(1) The member retired prior to January 1, 2001, or began receiving a disability allowance prior to January 1, 2001, and has been continually disabled since January 1, 2001.
(2) The member is not eligible for Medicare Part A without payment of a premium.
(3) The member is at least 65 years of age.
(4) The member enrolled in Medicare Parts A and B.
(c) The board may extend eligibility for the payments described in this section to members of the Defined Benefit Program who meet the requirements of subdivision (d) and who retire or begin receiving a disability allowance on or after January 1, 2001, within a school year specified by the board, if the board finds that the cost of the payments for members who retire or begin receiving a disability allowance during the specified school year may be paid within the anticipated resources available in the fund, as determined by the actuarial valuation of the program established by this chapter. Any extension of eligibility to members who retire or begin receiving a disability allowance on or after January 1, 2001, shall be provided equally to any member who meets the requirements of subdivision (d) and retires or begins receiving a disability allowance during the school year specified by the board.
(d) (1) Eligibility for the payments described in this section pursuant to subdivision (c) shall be limited to members of the Defined Benefit Program who do either of the following:
(A) Retires from an employer that does either of the following:
(i) Completed a division pursuant to Section 22156 of the Government Code prior to January 1, 2001.
(ii) Completed or is conducting a division pursuant to Section 22156 of the Government Code on or after January 1, 2001, and, if the member was less than 58 years of age at the time of the division, the member elected to be covered by Medicare.
(B) Began receiving a disability allowance and continuously receives a disability allowance until 65 years of age or older and the member's last employer does any of the following:
(i) Completed a division pursuant to Section 22156 of the Government Code prior to January 1, 2001.
(ii) Completed or is conducting a division pursuant to Section 22156 of the Government Code on or after January 1, 2001, and, if the member was still actively employed and less than 58 years of age at the time of the division, the member elected to be covered by Medicare.
(iii) Completed or is conducting a division pursuant to Section 22156 of the Government Code on or after January 1, 2001, and, if the member is no longer actively employed, the division was completed prior to the time the member reached normal retirement age.
(2) For purposes of paragraph (1), a division occurs during the 10-day period during which the member has the opportunity to elect to be covered by Medicare pursuant to Section 22156 of the Government Code.
(3) This subdivision does not apply to a member who retires from a district, or is receiving a disability allowance and the member was last employed in a district, that either as of January 1, 2001, had no members who were less than 58 years of age and who were hired prior to April 1, 1986, or was created pursuant to a formation or a reorganization on or after April 1, 1986, and prior to January 1, 2001.
(e) The amount paid to the federal Centers for Medicare and Medicaid Services or a successor agency pursuant to this section shall include any surcharges applicable to enrollment in Medicare Part A or Part B by members who retired prior to January 1, 2001, and who enrolled in Medicare Parts A and B after the age of 65 years and prior to July 1, 2001. If the system pays the Part A premium and Part B surcharges on behalf of a member and that member later becomes eligible for Part A coverage without payment of a premium, the system shall continue to pay any applicable Part B surcharges on behalf of that member. The board may require a member on whose behalf a surcharge would be paid pursuant to this subdivision to authorize the system to deduct the Part B premium from the member's retirement allowance as a condition of having the system pay the Part A premium pursuant to this section.
(f) For the purposes of this section, if a retirement date is used to determine eligibility pursuant to subdivisions (b) and (c), the system shall use the member's most recent retirement date for eligibility purposes.
(b) This section shall apply only to a retired member of the Defined Benefit Program who meets all of the following requirements:
(1) The member retired prior to January 1, 2001, or began receiving a disability allowance prior to January 1, 2001, and has been continually disabled since January 1, 2001.
(2) The member is not eligible for Medicare Part A without payment of a premium.
(3) The member is at least 65 years of age.
(4) The member enrolled in Medicare Parts A and B.
(c) The board may extend eligibility for the payments described in this section to members of the Defined Benefit Program who meet the requirements of subdivision (d) and who retire or begin receiving a disability allowance on or after January 1, 2001, within a school year specified by the board, if the board finds that the cost of the payments for members who retire or begin receiving a disability allowance during the specified school year may be paid within the anticipated resources available in the fund, as determined by the actuarial valuation of the program established by this chapter. Any extension of eligibility to members who retire or begin receiving a disability allowance on or after January 1, 2001, shall be provided equally to any member who meets the requirements of subdivision (d) and retires or begins receiving a disability allowance during the school year specified by the board.
(d) (1) Eligibility for the payments described in this section pursuant to subdivision (c) shall be limited to members of the Defined Benefit Program who do either of the following:
(A) Retires from an employer that does either of the following:
(i) Completed a division pursuant to Section 22156 of the Government Code prior to January 1, 2001.
(ii) Completed or is conducting a division pursuant to Section 22156 of the Government Code on or after January 1, 2001, and, if the member was less than 58 years of age at the time of the division, the member elected to be covered by Medicare.
(B) Began receiving a disability allowance and continuously receives a disability allowance until 65 years of age or older and the member's last employer does any of the following:
(i) Completed a division pursuant to Section 22156 of the Government Code prior to January 1, 2001.
(ii) Completed or is conducting a division pursuant to Section 22156 of the Government Code on or after January 1, 2001, and, if the member was still actively employed and less than 58 years of age at the time of the division, the member elected to be covered by Medicare.
(iii) Completed or is conducting a division pursuant to Section 22156 of the Government Code on or after January 1, 2001, and, if the member is no longer actively employed, the division was completed prior to the time the member reached normal retirement age.
(2) For purposes of paragraph (1), a division occurs during the 10-day period during which the member has the opportunity to elect to be covered by Medicare pursuant to Section 22156 of the Government Code.
(3) This subdivision does not apply to a member who retires from a district, or is receiving a disability allowance and the member was last employed in a district, that either as of January 1, 2001, had no members who were less than 58 years of age and who were hired prior to April 1, 1986, or was created pursuant to a formation or a reorganization on or after April 1, 1986, and prior to January 1, 2001.
(e) The amount paid to the federal Centers for Medicare and Medicaid Services or a successor agency pursuant to this section shall include any surcharges applicable to enrollment in Medicare Part A or Part B by members who retired prior to January 1, 2001, and who enrolled in Medicare Parts A and B after the age of 65 years and prior to July 1, 2001. If the system pays the Part A premium and Part B surcharges on behalf of a member and that member later becomes eligible for Part A coverage without payment of a premium, the system shall continue to pay any applicable Part B surcharges on behalf of that member. The board may require a member on whose behalf a surcharge would be paid pursuant to this subdivision to authorize the system to deduct the Part B premium from the member's retirement allowance as a condition of having the system pay the Part A premium pursuant to this section.
(f) For the purposes of this section, if a retirement date is used to determine eligibility pursuant to subdivisions (b) and (c), the system shall use the member's most recent retirement date for eligibility purposes.
On or before April 1, 2001, the board shall report to the
Legislature on a prescription drug program and a program to provide
health benefits to retired members. The report shall include an
analysis of all potential methods of financing and administering the
programs. These shall include, but are not limited to, (1) the system
providing those health benefits under contracts with carriers or
other entities that administer health benefits plans, (2) reimbursing
employers for the costs of providing those health benefits to
retired employees, and (3) crediting employers and employing
agencies, against the amount contributed pursuant to Section 22950, a
monthly amount, adjusted annually, for each retiree the employer or
employing agency certifies is enrolled in one or more health care
benefits programs administered or sponsored by the employer or
employing agency. The report shall include an estimate of the fiscal
impact of each program on the system, including administration and
program costs, and recommended statutory language to implement each
program.
To recover an amount overpaid under this part, the monthly
allowance payable under the Defined Benefit Program may be reduced by
the amount of the overpayment. If the overpayment is not due to
fraud or intentional misrepresentation of facts by the recipient of
the allowance or benefit, the monthly allowance may be reduced by no
more than 5 percent if the overpayment was due to error by the
system, the county superintendent of schools, a school district, or a
community college district, and by no more than 15 percent if the
error was due to inaccurate or omitted information from the recipient
of the allowance or benefit.
