Health Insurance Subsidy For Qualified Surviving Spouses / Domestic Partners

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Qualified Surviving Spouse / Domestic Partner may continue their existing health coverage and may also qualify for a health insurance subsidy.

At age 65, you are required to enroll in Medicare to the fullest extent of your entitlement to continue participation in the Health Subsidy Program. Members who become eligible for Medicare before turning age 65 must contact the Medical and Dental Benefits Section.

Dependents of the Qualified Surviving Spouse / Domestic Partner are not entitled to a health subsidy but may be covered under the survivor’s plan.

Who is eligible?

If you are currently receiving a Qualified Surviving Spouse / Domestic Partner pension, 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:

Los Angeles Fire and Police Pensions (LAFPP)

Los Angeles Firemen’s Relief Association (LAFRA)

Los Angeles Police Relief Association (LAPRA)

United Firefighters of Los Angeles City (UFLAC)

  • The Retired Member must have had at least 10 years of service.
  • The Retired Member must have been receiving or been eligible to receive a health insurance subsidy at the time of his or her death, or you will become eligible when your sworn member spouse/domestic partner would have been 55 years old.

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: The retiree’s Years of Service (YOS) x 4% x Maximum Subsidy Amount* = Monthly Subsidy

UNFROZEN SUBSIDY:  If the retiree either (1) entered DROP or retired prior to July 15, 2011 or (2) chose to opt in during the designated period, the qualified survivor is entitled to a monthly subsidy maximum of $853.39, effective January 1, 2019.

  • Example: If the retiree had 20 years of service with a retirement date prior to July 15, 2011, $682.71 is your monthly subsidy, which would be applied towards your health premium. (20 YOS x 4% x $826.43 = $682.71)

*The Maximum Subsidy Amount is based on the retiree’s DROP entry or retirement date.

FROZEN SUBSIDY:  If the retiree either entered DROP or retired on July 15, 2011 or later and chose not to opt in during the designated period, the qualified survivor is entitled to a monthly subsidy maximum of $595.60, the rate effective July 1, 2011.

If you are enrolled in Medicare Parts A and B, subsidy formulas are plan-specific and you are reimbursed the basic Part B premium.  At age 65, if you do not qualify for Medicare Part A (all pensioners will qualify for Medicare Part B), the above formula will be used to calculate your subsidy amount and, additionally, you will not be reimbursed the basic Part B premium.  If you are enrolled in Medicare Parts A and B, the following monthly subsidy maximums are as follows:

UNFROZEN SUBSIDY:  If the retiree either (1) entered DROP or retired prior to July 15, 2011 or (2) chose to opt in during the designated period, the qualified survivor is subject to the updated monthly subsidy maximum of $542.51, effective January 1, 2019.* 

FROZEN SUBSIDY:  If the retiree did not choose to opt in during the designated period and entered DROP or retired on July 15, 2011 and later, the qualified survivor is frozen at the monthly subsidy maximum of $480.41, the rate effective July 1, 2011.* 

*If the retiree had 20 to 25 years of service, the qualified survivor is eligible for 100% of the monthly subsidy maximum as stated.  If the retiree had 15 to 19 years of service, the qualified survivor is eligible for 90% of the monthly subsidy maximum as stated.  If the retiree had 10 to 14 years of service, the qualified survivor is eligible for 75% of the monthly subsidy maximum as stated.

While you may cover dependents under your plan, please note that the subsidy may only be applied to the cost of the single-party coverage.  If the single-party plan premium is higher than your eligible subsidy, the difference (including the premium for dependent coverage, if applicable) will be taken in the form of a deduction on your monthly pension payment.  If your eligible subsidy exceeds the single-party plan premium, the unapplied subsidy amount is forfeited and any premium for dependent coverage will be taken in the form of a deduction on your monthly pension payment.

How do I enroll?

It is not necessary to apply for this benefit. Any eligible retiree or Qualified Surviving Spouse/Domestic Partner enrolled in a Board-approved health plan will automatically receive this benefit.

Questions?

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