Health Insurance Subsidy Reimbursement Program

The Health Insurance Premium Reimbursement Program is available to pensioners and qualified surviving spouses / domestic partners who live outside of California, or within the state but not within a City-approved medical plan service area.

Members who qualify may receive reimbursement, up to the maximum monthly health insurance subsidy allowed. Reimbursement will be made for health insurance premiums paid to a non-City approved, state-regulated health plan.

At age 65, you are required to enroll in Medicare to the fullest extent of your entitlement to continue participation in the Health Insurance Premium Reimbursement Program. If you are in a Medicare A and B health plan, you will also receive reimbursement for the Part B regular monthly premium paid upon verification of your Medicare enrollment.

IMPORTANT! If you plan to cancel your current coverage to qualify for this program, please ensure that adequate coverage is obtained prior to submitting the cancellation form. Once cancelled, re-enrollment in a City-approved health plan will be allowed only under the regular policies of each organization (e.g., relocation, open enrollment, etc.).

Who is eligible?

You are eligible for the reimbursement program if you:

What health care plans are eligible for reimbursement?
  • For residents of the United States, health insurance plans must be state- regulated. The Department will verify the eligibility of the health insurance plan.
  • Dental plan premiums, vision plan premiums and medications are not eligible reimbursements.
  • The member must be the primary subscriber to the health insurance plan.
  • Effective July 1, 2009: Medicare Part D premiums may be eligible for reimbursement up to your maximum subsidy amount.
What is the reimbursement amount?

Your reimbursement amount equals the health subsidy amount for which you are eligible.

If you are eligible for a MOU negotiated subsidy, those subsidy amounts will apply to your reimbursement amount.

For members who reside out of the United States, exchange rates for reimbursement will be based on those of the Department’s Custodial Bank effective the date premiums were paid to the health plan. Coverage for dependents is permitted as defined under the regular guidelines of the Health Insurance Subsidy for Members Program.

How do I apply for reimbursement?

To request reimbursement:

  • Complete a Retired Health Insurance Premium Reimbursement Claim Form. You may copy this form, but each claim form submitted must have an original signature and you may claim only one coverage period per claim form.
  • Submit evidence of coverage and payment of premiums, such as:
    • Evidence of coverage: statement from the company and/or a copy of a health insurance card indicating coverage for the reimbursement period requested.
    • Proof of payment: copies of cancelled checks (front and back), front of checks with copies of banks statements, credit card statements and/or a letter from the insurance company indicating receipt of monthly premiums paid.

If you are enrolled in Medicare, you must provide a photocopy of your Medicare card and your Part D insurance card (if applicable) the first time you file a claim and upon request thereafter. Please keep copies of all documents submitted, as they become part of the claim. No documents will be returned.

When will I receive reimbursement?
Coverage Period Claim Form
Received by		 Reimbursement
Sent by
January 1 – March 31 April 15 May 31
April 1 – June 30 July 15 August 31
July 1 – September 30 October 15 November 30
October 1 – December 31 January 15 February 28

Note: Claim forms received after the deadline will be processed according to the payment schedule for the following quarter. Claim forms received later than 12 months after the end of the coverage period will not be processed.