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Health Insurance Subsidy for Members

    Health Insurance Subsidy for Members

    You qualify for a health insurance subsidy if you meet the following requirements:

    • You must be enrolled in a Board-approved health plan. One offered by:
    • You must be 55 years of age or older; and
    • Receiving a pension (Retired/Exit DROP); and
    • You must have at least 10 years of service (YOS).
    • Qualification for a health subsidy is different for a Tier 6 member who retired on a service-connected disability pension.  

    At age 65, you are required to enroll in Medicare to the fullest extent of your entitlement to continue your participation in the Health Subsidy Program. Qualified survivors (e.g., spouse/domestic partner, dependent child) must also be enrolled in Medicare to the full extent of their eligibility at age 65 in order to maintain eligibility for the Health Subsidy Program. Members who become eligible for Medicare before turning age 65 must contact the Medical and Dental Benefits Section at (213) 279-3115 or by sending an email to: [email protected]

    WHAT IS THE SUBSIDY AMOUNT?

    YOUR MONTHLY SUBSIDY DEPENDS ON WHETHER YOU ARE ENROLLED IN MEDICARE. 

    If you are (1) under age 65 and not enrolled in Medicare or, (2) at least age 65 and enrolled in Medicare Part B only, monthly subsidy maximums are calculated as follows:

    FORMULA: YOS x 4% x Maximum Subsidy Amount = Monthly Subsidy

    Members with an unfrozen subsidy: Members who either (1) entered DROP or retired prior to July 15, 2011 or, (2) chose to opt-in during the designated period are subject to the updated monthly subsidy maximum effective July 1st. 

    If for example, you have 20 years of service and the maximum subsidy amount is $2,046.97, then the amount of subsidy you will receive toward your health premium is $1,637.58 (20 YOS x 4% x $2,046.97 = $1,637.58).

    Note: Amounts shown above are for illustration purposes only. Please click here to view the current subsidy.

    Members with a frozen subsidy: Members who chose not to opt-in during the designated period and entered DROP or retired on July 15, 2011 and later are frozen at the monthly subsidy maximum of $1,097.41, the rate effective July 1, 2011.

    If for example, you have 20 years of service, $877.93 is your monthly subsidy, which would be applied toward your health premium. (20 YOS x 4% x $1,097.41 = $877.93)

    At age 65, if you do not qualify for Medicare Part A, the above formula will be used to calculate your subsidy amount and, additionally, you will not be reimbursed for the cost of the standard Part B premium.


    IF YOU ARE ENROLLED IN MEDICARE PARTS A AND B, SUBSIDY FORMULAS ARE PLAN-SPECIFIC AND YOU ARE REIMBURSED THE COST OF THE STANDARD PART B PREMIUM. 

    If you are enrolled in Medicare Parts A and B, the following monthly subsidy maximums apply:

    Members with an UNFROZEN subsidy: Members who either (1) entered DROP or retired prior to July 15, 2011 or (2) chose to opt in during the designated period are subject to the updated monthly subsidy maximum effective January 1st.*

    Please click here to view the current subsidy.

    Members with a FROZEN subsidy: Members who chose not to opt in during the designated period and entered DROP or retired on July 15, 2011 and later are frozen at the monthly subsidy maximum of $480.41, the rate effective July 1, 2011.*

    *Please note that this is the maximum single-party subsidy; Members enrolled in a Medicare plan with covered dependents may qualify for a higher amount.

    If the plan premium is higher than your eligible subsidy, the difference will be taken in the form of a deduction from your monthly pension payment. If your eligible subsidy exceeds your plan premium, the unapplied subsidy amount is forfeited.

    HOW DO I ENROLL?

    Any eligible retiree or qualified surviving spouse/ domestic partner enrolled in a Board-approved health plan will automatically receive this benefit.

    However, it is recommended that members contact the Association that is administering their active health plan approximately one year before retirement or exiting from DROP to inquire about any special enrollment requirements prior to making the transition to the Association’s retiree health plan. 

    Members must contact the Association administering their active health plan after their retirement or DROP exit date is finalized in order to complete the required paperwork to make the transition to the Association’s retiree health plan.

    Members may also access their eligible subsidy benefit by participating in the Health Insurance Premium Reimbursement Program.

    WHERE CAN I GET MORE INFORMATION?

    If you have any questions, please contact the Medical and Dental Benefits Section by calling (213) 279-3115 or toll-free at (844) 88-LAFPP, Monday-Friday from 7:30 a.m. to 4:30 p.m. (PDT), excluding weekends and City Holidays. You can also reach us by email at [email protected].