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Article 1. Health And Welfare Benefits of California Education Code >> Division 1. >> Title 1. >> Part 5. >> Chapter 1. >> Article 1.
(a) Notwithstanding Article 1 (commencing with Section 53200)
of Chapter 2 of Part 1 of Division 2 of Title 5 of the Government
Code, a county superintendent of schools, a school district, or a
community college district, which provides health and welfare
benefits or dental care benefits for the benefit of its certificated
employees, shall permit enrollment in, respectively, the health and
welfare benefit plan or dental care benefit plan currently provided
for its current certificated employees by any former certificated
employee thereof who retired therefrom under any public retirement
system and his or her spouse and by any surviving spouse of a former
certificated employee thereof who either retired therefrom under any
public retirement system or was, at the time of death, both employed
thereby in a position requiring contributions to the State Teachers'
Retirement System and a member of the State Teachers' Retirement
System.
This subdivision does not apply to either the new spouse upon the
remarriage of a surviving spouse of a former certificated employee or
the children of a certificated or former certificated employee.
(b) A county superintendent of schools or district may develop an experience claims rating for the persons specified in subdivision (a) and may, if appropriate, require those persons to pay different rates as a class. Any plan pursuant to this article shall provide separate single and two-party rates for at least the following classes: for those under 65, for those over 65 who have Medicare A and B, and for those over 65 who do not have Medicare A.
(c) The county superintendent of schools, school district, or community college district shall annually select a one-month period during which persons described by subdivision (a) may elect to enroll in, respectively, the health and welfare benefit plan or the dental care benefit plan or change their enrollment from one to another health and welfare plan or dental care benefit plan, respectively.
(d) A certificated school employee who retired on or before August 24, 1986, the effective date of Chapter 561 of the Statutes of 1986, or the surviving spouse of a certificated employee retired as of August 25, 1986, shall be permitted to enroll in any district health and dental care plan during the 1986, 1987, and 1988 enrollment periods.
(e) A certificated school employee who retires after August 24, 1986, the effective date of Chapter 561 of the Statutes of 1986, or the surviving spouse of a certificated employee retired as of August 25, 1986, shall be allowed to enroll in the coverage provided by this article within 30 days of losing active employee coverage, but if the retiree does not enroll in a district health or dental care plan during this initial enrollment period, the retiree may be denied further opportunity to do so. The enrollment period for retirees under this subdivision shall correspond to that provided to active employees, unless a district chooses to offer an additional enrollment period.
(f) This article shall permit enrollment into any district health and dental care plan only once. A retiree or spouse or surviving spouse of a certificated employee who has been previously covered under this article and who has voluntarily terminated that coverage, thereafter may be excluded from obtaining coverage under this article. This subdivision does not apply to a person who is changing plans within a district during an open enrollment period.
(g) Retirees or surviving spouses of certificated employees may be enrolled in a medical care plan pursuant to this section during periods other than those specified therein if they lose their coverage. With documentation of prior coverage, they may be allowed to enroll in a medical care plan, if they do so within 31 days of losing their other coverage.
(h) Any person described by subdivision (a) who elects, pursuant to this article, to be covered by, respectively, a health and welfare benefit plan or dental care benefit plan, may be required to pay all premiums, dues, and other charges, including any increases in the rate of premiums or dues for these persons, and all costs incurred by the district or county superintendent of schools in administering this article.
(b) A county superintendent of schools or district may develop an experience claims rating for the persons specified in subdivision (a) and may, if appropriate, require those persons to pay different rates as a class. Any plan pursuant to this article shall provide separate single and two-party rates for at least the following classes: for those under 65, for those over 65 who have Medicare A and B, and for those over 65 who do not have Medicare A.
(c) The county superintendent of schools, school district, or community college district shall annually select a one-month period during which persons described by subdivision (a) may elect to enroll in, respectively, the health and welfare benefit plan or the dental care benefit plan or change their enrollment from one to another health and welfare plan or dental care benefit plan, respectively.
(d) A certificated school employee who retired on or before August 24, 1986, the effective date of Chapter 561 of the Statutes of 1986, or the surviving spouse of a certificated employee retired as of August 25, 1986, shall be permitted to enroll in any district health and dental care plan during the 1986, 1987, and 1988 enrollment periods.
(e) A certificated school employee who retires after August 24, 1986, the effective date of Chapter 561 of the Statutes of 1986, or the surviving spouse of a certificated employee retired as of August 25, 1986, shall be allowed to enroll in the coverage provided by this article within 30 days of losing active employee coverage, but if the retiree does not enroll in a district health or dental care plan during this initial enrollment period, the retiree may be denied further opportunity to do so. The enrollment period for retirees under this subdivision shall correspond to that provided to active employees, unless a district chooses to offer an additional enrollment period.
(f) This article shall permit enrollment into any district health and dental care plan only once. A retiree or spouse or surviving spouse of a certificated employee who has been previously covered under this article and who has voluntarily terminated that coverage, thereafter may be excluded from obtaining coverage under this article. This subdivision does not apply to a person who is changing plans within a district during an open enrollment period.
(g) Retirees or surviving spouses of certificated employees may be enrolled in a medical care plan pursuant to this section during periods other than those specified therein if they lose their coverage. With documentation of prior coverage, they may be allowed to enroll in a medical care plan, if they do so within 31 days of losing their other coverage.
(h) Any person described by subdivision (a) who elects, pursuant to this article, to be covered by, respectively, a health and welfare benefit plan or dental care benefit plan, may be required to pay all premiums, dues, and other charges, including any increases in the rate of premiums or dues for these persons, and all costs incurred by the district or county superintendent of schools in administering this article.
Enrollment in Medicare A shall not be a prerequisite for
enrollment in any district health plan pursuant to this article.
However, the purchase of Medicare B may be required for enrollment if
the participant qualifies to purchase it. In addition, a district
health plan may be restructured to pay benefits as if each
participant is enrolled in Medicare B as soon as the participant
qualifies to purchase Medicare B.
A health plan may condition eligibility for enrollment on the
effective assignment of any Medicare benefits for which the enrollee
would be eligible.
(a) Any health benefits plan provided by any county
superintendent of schools, school district, or community college
district pursuant to this article may contain a preexisting condition
exclusion, as follows:
(1) The coverage of any person who has a break in coverage, may, for the first three months after reenrollment, exclude any care received for a condition which is caused by, or results from, a condition existing at the time of reenrollment or for which the person received medical advice or treatment during the six-month period immediately preceding reenrollment.
(2) Coverage of any person who is confined to a hospital or his or her home for medical treatment at the time of enrollment in a health plan pursuant to this section shall exclude any benefits until the period commencing on the 15th day following the termination of that confinement.
(b) This section does not apply to any entity which provides a health benefits plan which contains a preexisting condition exclusion.
(c) This section does not apply to any changes in enrollment by a person currently enrolled in a school district's health benefits plan or due to any change in enrollment or coverage caused by the retirement of a person.
(1) The coverage of any person who has a break in coverage, may, for the first three months after reenrollment, exclude any care received for a condition which is caused by, or results from, a condition existing at the time of reenrollment or for which the person received medical advice or treatment during the six-month period immediately preceding reenrollment.
(2) Coverage of any person who is confined to a hospital or his or her home for medical treatment at the time of enrollment in a health plan pursuant to this section shall exclude any benefits until the period commencing on the 15th day following the termination of that confinement.
(b) This section does not apply to any entity which provides a health benefits plan which contains a preexisting condition exclusion.
(c) This section does not apply to any changes in enrollment by a person currently enrolled in a school district's health benefits plan or due to any change in enrollment or coverage caused by the retirement of a person.
(a) This article does not create a vested retirement right
in health and dental care benefits.
(b) The individual districts, the county office, a health plan, an entity providing or arranging a health plan, and the State Teachers' Retirement System do not have any legal duty to contact retired teachers or surviving spouses of certificated employees with regard to this article.
(b) The individual districts, the county office, a health plan, an entity providing or arranging a health plan, and the State Teachers' Retirement System do not have any legal duty to contact retired teachers or surviving spouses of certificated employees with regard to this article.
(a) Nothing in this article shall be construed as requiring
or permitting the impairment of any contract, board rule, or
regulation affecting retired certificated personnel, in existence on
the effective date of this article.
(b) Nothing in this article is intended to reduce or conflict with any benefit provided in the federal Consolidated Omnibus Budget Reconciliation Act of 1986 (Public Law 99-272).
(c) Nothing in this article mandates the provision of life insurance or vision care.
(b) Nothing in this article is intended to reduce or conflict with any benefit provided in the federal Consolidated Omnibus Budget Reconciliation Act of 1986 (Public Law 99-272).
(c) Nothing in this article mandates the provision of life insurance or vision care.
As used in this article:
(a) "Certificated employee" means a member, as defined by Section 22146, of the State Teachers' Retirement System.
(b) "School district" means that district from which the member of the State Teachers' Retirement System last made contributions to the system before retirement.
(c) "Spouse" means a spouse as defined by Section 22171.
(a) "Certificated employee" means a member, as defined by Section 22146, of the State Teachers' Retirement System.
(b) "School district" means that district from which the member of the State Teachers' Retirement System last made contributions to the system before retirement.
(c) "Spouse" means a spouse as defined by Section 22171.
This article does not apply to persons receiving benefits
pursuant to the Public Employees' Medical and Hospital Care Act
(Chapter 1 (commencing with Section 22750) of Part 5 of Division 5 of
Title 2 of the Government Code) and to the employers on which their
benefits are based.
For purposes of this section, "employer" means a county
superintendent of schools, a school district, or a community college
district irrespective of whether employees may be represented by
different bargaining groups. Notwithstanding any other provision of
this part, this article does not apply to employers for those groups
of employees for whom coverage under the Public Employees' Medical
and Hospital Care Act (Part 5 (commencing with Section 22750) of
Division 5 of Title 2 of the Government Code) is provided by
contract.
(a) Any qualified organization, as defined in subdivision
(b), in cooperation with the Public Employees' Retirement System, may
develop a health benefits plan which would be available to persons
who are members of those organizations, with equal premiums for both
active and retired teachers. The plan would be available, on an
optional basis, to each school district, county board of education,
and a county superintendent of schools which becomes a contracting
agency with the Public Employees' Retirement System pursuant to
Section 22857 of the Government Code.
(b) "Qualified organization" means an exclusive representative of the certificated or classified employees, as defined by Section 3540.1 of the Government Code, or any organization with a membership of at least 1,000 members who are retirees of the State Teachers' Retirement System, or any organization with a membership of at least 1,000 members who are faculty members in the California Community Colleges.
(c) This section shall not apply to any contracting agency unless and until the agency elects to be subject to this section pursuant to Section 22857 of the Government Code.
(b) "Qualified organization" means an exclusive representative of the certificated or classified employees, as defined by Section 3540.1 of the Government Code, or any organization with a membership of at least 1,000 members who are retirees of the State Teachers' Retirement System, or any organization with a membership of at least 1,000 members who are faculty members in the California Community Colleges.
(c) This section shall not apply to any contracting agency unless and until the agency elects to be subject to this section pursuant to Section 22857 of the Government Code.
(a) Notwithstanding any other provision of law, a member of
the Defined Benefit Program of the State Teachers' Retirement Plan
who is disabled as a result of an injury that is a direct consequence
of a violent act perpetrated on his or her person while performing
duties in the scope of employment, and the employment is creditable
under the provisions of the Teachers' Retirement Law (Part 13
(commencing with Section 22000)), may, upon qualifying for a
disability under Section 24001 and while receiving an allowance under
Section 24002, continue in the district's health care plan and
dental care plan by paying all of the employer's and employee's
premiums and all of the related administrative costs of the employer.
(b) Notwithstanding any other provision of law, a school member as defined in Section 20370 of the Government Code, or a local police officer as defined in Section 20430 of the Government Code, who is disabled as a result of an injury that is a direct consequence of a violent act perpetrated on his or her person while performing duties in the scope of employment, and the employment is creditable under the Public Employees' Retirement Law (Part 3 (commencing with Section 20000) of Division 5 of Title 2 of the Government Code), may, upon qualifying for a disability and while receiving an allowance under Chapter 12 (commencing with Section 21060) of Part 3 of Division 5 of Title 2 of the Government Code, continue in the employer's health care plan and dental care plan by paying all of the employer's and employee's premiums and all of the related administrative costs of the employer.
(c) Subdivisions (a) and (b) do not apply to any member who is employed by a school district that contracts with the Public Employees' Retirement System for health care coverage under the Public Employees' Medical and Health Care Act, (Part 5 (commencing with Section 22750) of Division 5 of Title 2 of the Government Code).
(b) Notwithstanding any other provision of law, a school member as defined in Section 20370 of the Government Code, or a local police officer as defined in Section 20430 of the Government Code, who is disabled as a result of an injury that is a direct consequence of a violent act perpetrated on his or her person while performing duties in the scope of employment, and the employment is creditable under the Public Employees' Retirement Law (Part 3 (commencing with Section 20000) of Division 5 of Title 2 of the Government Code), may, upon qualifying for a disability and while receiving an allowance under Chapter 12 (commencing with Section 21060) of Part 3 of Division 5 of Title 2 of the Government Code, continue in the employer's health care plan and dental care plan by paying all of the employer's and employee's premiums and all of the related administrative costs of the employer.
(c) Subdivisions (a) and (b) do not apply to any member who is employed by a school district that contracts with the Public Employees' Retirement System for health care coverage under the Public Employees' Medical and Health Care Act, (Part 5 (commencing with Section 22750) of Division 5 of Title 2 of the Government Code).
