Health Insurance Premium Reimbursement Program

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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 provided by:

Members who qualify may receive reimbursement, up to the maximum monthly health insurance subsidy for which they are eligible. Reimbursement will be issued directly to the member, on a quarterly basis, for health insurance premiums paid to a non-Board 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 basic 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 Board-approved health plan will be allowed only under the regular policies of each organization (e.g., relocation, open enrollment, etc.)

Am I eligible?

You are eligible to participate in the reimbursement program if you:

  • Have at least 10 years of service as a sworn fire or police pension member, or are the qualified survivor of the deceased member who had at least 10 years of service.
  • Meet the minimum age requirement in place on the effective date of retirement or are a Qualified Surviving Spouse/Domestic Partner of the deceased pensioner who would have met the minimum age requirement.
  • Are a Tier 6 retiree with a service-connected disability and less than 10 years of service.

What health care plans are eligible for reimbursement?

  • State-regulated health insurance plans offered within the United States and verified by LAFPP.
  • Medicare Parts A, B & D premiums up to your maximum Medicare subsidy amount.
  • Dental plan premiums and vision plan premiums are not eligible reimbursements.

What is the reimbursement amount?

  • You can be reimbursed up to the maximum health subsidy amount for which you are eligible.

    If you reside outside of the United States, reimbursement will be based on the Department’s Custodial Bank exchange rates in effect on the date(s) the premium(s) 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.

Retirees enrolled in a Medicare Plan, can be eligible for additional subsidy if:

  1. Their eligible dependent(s) is enrolled in the member’s own Medicare health plan, or
  2. Their eligible dependent(s) is enrolled in a health insurance plan that is issued by the same provider as the member’s plan (e.g., Anthem Blue Cross, Kaiser, AARP, etc.).

How does HIPR affect my federal tax credit or subsidy?

If you receive reimbursement of premiums from LAFPP for a health insurance plan you purchase through a state or federal health insurance exchange, you may NOT also claim a federal tax credit or subsidy. For any month that LAFPP reimburses your health insurance premiums, you are considered to be in an employer health plan and thus ineligible for federal tax credits toward your insurance premiums. Members who are eligible to claim a federal subsidy for a health insurance plan from one of the state or federal health insurance exchanges are encouraged to compare this federal subsidy to their reimbursement eligibility from Fire and Police Pensions. Please contact the Medical and Dental Benefits Section at (213) 279-3115 or (844) 885-2377 if you have questions regarding HIPR and health insurance offered on one of the federal or state health insurance exchanges.

How do I apply for reimbursement?

When will I receive reimbursement?

Coverage Period Within

Claim Forms Received By

Reimbursement Issued

January 1 – March 31

NO LATER THAN 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.

Questions?

If you have, please contact the Medical and Dental Benefits Section at (213) 279-3115 or toll-free at (844) 88-LAFPP (52377).

REFERENCED DOCUMENTS: 

Retired Health Insurance Premium Reimbursement Claim Form