Applying for Health Insurance Premium Reimbursement


The Health Insurance Premium Reimbursement Program is available to pensioners and Qualified Surviving Spouses/Domestic Partners who meet LAFPP health insurance subsidy eligibility requirements and are not enrolled in a Board-approved health plan.

For more information, visit Health Insurance Premium Reimbursement (HIPR).

How do I apply for reimbursement?

  • Complete and sign a Retired Health Insurance Premium Reimbursement Claim Form for each period of coverage to be reimbursed.
  • Submit proof of premium coverage and payment of premiums, such as:
    • Proof of coverage: statement/premium bill 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), 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 Within

Claim Forms Received By

Reimbursement Issued

January 1 – March 31


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.


If you have, please contact the Medical and Dental Benefits Section at (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.


Retired Health Insurance Premium Reimbursement Claim Form