NEW BILL, SB 1088, EXPANDS COVERAGE IN CALIFORNIA FOR DEPENDENTS UP TO AGE 26: TIMELINE OF EVENTS
The Affordable Care Act (ACA), also known as healthcare reform, requires that health plans offer coverage for dependent children up to their 26th birthday. Because the LACERA group health plan is a retiree-only plan, certain ACA provisions did not apply, including offering coverage for dependent children up to age 26.
Recently, the California Senate voted to align a California law, SB 1088, with the ACA provisions offering coverage for dependents up to age 26. The purpose of SB 1088 is to prohibit the limiting age from being less than 26, for adult dependents covered by healthcare service plan contracts and health insurance policies, with respect to plan or policy years beginning on or after September 23, 2010. Based on our understanding of the law, this bill creates a mandate on insurance carriers to increase the limiting age for dependents to 26. We understand also that the mandate is not on plan sponsors or public entities; the mandate is on the carriers.
SB 1088 exempted retiree-only plans, such as LACERA's, until July 1, 2014. Prior to the expiration of LACERA's exemption, existing plan contracts covered dependents up to age 19 or, if the dependent was a full-time student and unmarried, age 23.
As the plan sponsor, the County of Los Angeles determined on March 9, 2015 that a retiree's child, up to age 26, will be considered a dependent for the purpose of paying the retiree healthcare subsidy. This limit is extended to the natural children, legally adopted children, or stepchildren of the retiree or the retiree's spouse or domestic partner, regardless of a dependent child's marital or student status.
You can read SB 1088 here. For information on eligibility, reinstating dependent children, and the enrollment process, see Eligible Dependent Child Age Limit Increased to Age 26. (4-2-15)
PENSION PROTECTION ACT OF 2006 (PPA)
The Pension Protection Act of 2006 (PPA), signed into law by President Bush on August 17, permits eligible retired Public Safety Officers (PSO) to exclude up to $3,000 of distributions from their LACERA retirement plan for direct payment of healthcare premiums. These excluded distributions shall be used by LACERA for direct payment of qualified accident or health and/or long-term care insurance premiums for the public safety officer, his or her spouse, and/or dependents. This Internal Revenue Service (IRS) tax benefit became effective January 1, 2007.
Please review the PPA FAQs for supplemental details on eligibility requirements.
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), eligible PSOs who wish to have LACERA make direct payments to their LACERA-sponsored MetLife long-term care plans must contact the carriers directly to authorize the necessary payment agreement. LACERA does not administer the long-term care program and cannot initiate direct payments on premiums for these plans until the policyholder contacts the carrier and establishes a direct payment arrangement. For information call MetLife at 800-207-9883. (2-6-07)
For additional information, click here.
WHAT IS MEDICARE PART D?
- Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) signed into law by President Bush in December 2003.
- This landmark legislation provides seniors and individuals with disabilities with a prescription drug benefit called Medicare Part D, more choices, and better benefits under Medicare.
- No action required by Medicare-eligible members/dependents enrolled in a LACERA-administered medical plan. All LACERA-administered medical plans are creditable, meaning the prescription drug coverage provided is at least as good, if not better, than individual Medicare Part D coverage.
- Enrolling in an individual Medicare Part D prescription drug program may jeopardize the member’s LACERA-administered medical plan. In addition, enrolling in Part D may cause a delay in reinstating the LACERA-administered medical plan, should the member decide to switch back. (2-27-07)
AB 205 - RETIREE HEALTHCARE BENEFITS FOR DOMESTIC PARTNERS
AB 205 gives domestic partners most of the legal rights, protections, and benefits accorded to married persons. It also gives them the same responsibilities, obligations, and legal duties under the law. These rights and responsibilities extend to community property, parenting responsibility, child support, access to divorce court, access to family benefits at work, and mutual responsibility for debt.
To qualify as domestic partners under AB 205, the persons must meet the requirements of the Family Code. In addition, termination of the partnership may be handled through the courts or, if certain conditions are met, by filing a Notice of Termination of Domestic Partnership with the California Secretary of State. Registered domestic partners will be subject to these rights and responsibilities effective January 1, 2005.
The new law implemented by the Board of Supervisors provides that a person who qualifies as a domestic partner under the Family Code is eligible for the same survivor benefits as a spouse. The qualifications include:
- The partnership is registered with the California Secretary of State.
- Both persons have a common residence.
- Neither person is married or a member of another domestic partnership that has not been terminated.
- Both persons are at least 18 years of age.
- Either of the following:
- Both persons are members of the same sex.
- If of the opposite sex, one or both of the persons are over the age of 62.
- Both persons are capable of consenting to the domestic partnership. (5-24-06)
CALIFORNIA AB 88 COVERAGE CHANGES
This mental health parity law requires health plans to provide coverage for "severe mental illnesses" and "serious emotional disturbances of a child."
All LACERA-administered healthcare plans have adjusted their mental health benefits to comply with the law as of July 1, 2000. Anyone enrolled in a California health plan will no longer have annual day or visit maximums for certain mental illnesses.
There are ten conditions listed in the new law as severe mental illnesses.
- Schizoaffective disorder
- Bipolar disorder (manic-depressive illness)
- Major depressive disorders
- Panic disorder
- Obsessive-compulsive disorder
- Pervasive developmental disorder or autism
- Anorexia nervosa
- Bulimia nervosa
- Substance Abuse Parity and Addiction
Mental Health and Substance Abuse Parity and Addiction Equity Act of 2008
Effective July 1, 2010, LACERA will implement the Mental Health and Substance Abuse Parity and Addiction Equity Act of 2008. This act requires coverage for mental, nervous, and substance abuse treatment to be consistent with coverage for all other medical services.