Health And Welfare Benefits - Personnel General Provisions - CA Education

Section § 7000

This law allows retired school employees and their spouses to enroll in the same health and dental benefit plans that current employees receive. It specifies that retirees over 65 years old may be charged different rates, depending on whether they have Medicare. There are specific enrollment periods for retirees, and if a retiree does not enroll right after losing active coverage, they might miss the chance to do so later. The law also says retirees can only enroll once, and if they drop coverage, they might not be able to re-enroll. However, retirees losing other medical coverage can join a plan if they enroll within 31 days. Finally, retirees might need to pay all costs for the plans and any administration fees.

(a) Notwithstanding Article 1 (commencing with Section 53200) of Chapter 2 of Part 1 of Division 2 of Title 5 of the Government Code, a county superintendent of schools, a school district, or a community college district, which provides health and welfare benefits or dental care benefits for the benefit of its certificated employees, shall permit enrollment in, respectively, the health and welfare benefit plan or dental care benefit plan currently provided for its current certificated employees by any former certificated employee thereof who retired therefrom under any public retirement system and his or her spouse and by any surviving spouse of a former certificated employee thereof who either retired therefrom under any public retirement system or was, at the time of death, both employed thereby in a position requiring contributions to the State Teachers’ Retirement System and a member of the State Teachers’ Retirement System.

This subdivision does not apply to either the new spouse upon the remarriage of a surviving spouse of a former certificated employee or the children of a certificated or former certificated employee.

(b) A county superintendent of schools or district may develop an experience claims rating for the persons specified in subdivision (a) and may, if appropriate, require those persons to pay different rates as a class. Any plan pursuant to this article shall provide separate single and two-party rates for at least the following classes: for those under 65, for those over 65 who have Medicare A and B, and for those over 65 who do not have Medicare A.

(c) The county superintendent of schools, school district, or community college district shall annually select a one-month period during which persons described by subdivision (a) may elect to enroll in, respectively, the health and welfare benefit plan or the dental care benefit plan or change their enrollment from one to another health and welfare plan or dental care benefit plan, respectively.

(d) A certificated school employee who retired on or before August 24, 1986, the effective date of Chapter 561 of the Statutes of 1986, or the surviving spouse of a certificated employee retired as of August 25, 1986, shall be permitted to enroll in any district health and dental care plan during the 1986, 1987, and 1988 enrollment periods.

(e) A certificated school employee who retires after August 24, 1986, the effective date of Chapter 561 of the Statutes of 1986, or the surviving spouse of a certificated employee retired as of August 25, 1986, shall be allowed to enroll in the coverage provided by this article within 30 days of losing active employee coverage, but if the retiree does not enroll in a district health or dental care plan during this initial enrollment period, the retiree may be denied further opportunity to do so.

The enrollment period for retirees under this subdivision shall correspond to that provided to active employees, unless a district chooses to offer an additional enrollment period.

(f) This article shall permit enrollment into any district health and dental care plan only once. A retiree or spouse or surviving spouse of a certificated employee who has been previously covered under this article and who has voluntarily terminated that coverage, thereafter may be excluded from obtaining coverage under this article. This subdivision does not apply to a person who is changing plans within a district during an open enrollment period.

(g) Retirees or surviving spouses of certificated employees may be enrolled in a medical care plan pursuant to this section during periods other than those specified therein if they lose their coverage. With documentation of prior coverage, they may be allowed to enroll in a medical care plan, if they do so within 31 days of losing their other coverage.

(h) Any person described by subdivision (a) who elects, pursuant to this article, to be covered by, respectively, a health and welfare benefit plan or dental care benefit plan, may be required to pay all premiums, dues, and other charges, including any increases in the rate of premiums or dues for these persons, and all costs incurred by the district or county superintendent of schools in administering this article.

retired school employees health benefits dental care benefits retirement system surviving spouse experience claims rating enrollment periods Medicare coverage premium rates coverage termination change plans administration costs benefit plan enrollment

(Amended by Stats. 1990, Ch. 1372, Sec. 42.)

Section § 7000.3

This section explains that joining Medicare A isn't required to join a district health plan. However, you might need to buy Medicare B if you can. A health plan could also adjust its benefits to act as if everyone has Medicare B once they qualify. Additionally, a health plan could require you to assign any Medicare benefits you're eligible for to be able to join.

Enrollment in Medicare A shall not be a prerequisite for enrollment in any district health plan pursuant to this article. However, the purchase of Medicare B may be required for enrollment if the participant qualifies to purchase it. In addition, a district health plan may be restructured to pay benefits as if each participant is enrolled in Medicare B as soon as the participant qualifies to purchase Medicare B.

A health plan may condition eligibility for enrollment on the effective assignment of any Medicare benefits for which the enrollee would be eligible.

Medicare A district health plan Medicare B purchase participant qualification enrollment eligibility benefit assignment health plan restructuring effective assignment Medicare benefits

(Added by Stats. 1986, Ch. 561, Sec. 3. Effective August 25, 1986.)

Section § 7000.5

This law allows health plans provided by schools or community colleges in California to have exclusions for preexisting conditions under certain circumstances. If someone had a lapse in coverage, the plan may not cover health issues related to preexisting conditions for the first three months after they rejoin. For people in the hospital or receiving home care when they enroll, coverage won't start until 15 days after their treatment ends. This rule doesn't impact those who are already in a plan and just changing their plan or retiring.

(a) Any health benefits plan provided by any county superintendent of schools, school district, or community college district pursuant to this article may contain a preexisting condition exclusion, as follows:

(1) The coverage of any person who has a break in coverage, may, for the first three months after reenrollment, exclude any care received for a condition which is caused by, or results from, a condition existing at the time of reenrollment or for which the person received medical advice or treatment during the six-month period immediately preceding reenrollment.

(2) Coverage of any person who is confined to a hospital or his or her home for medical treatment at the time of enrollment in a health plan pursuant to this section shall exclude any benefits until the period commencing on the 15th day following the termination of that confinement.

(b) This section does not apply to any entity which provides a health benefits plan which contains a preexisting condition exclusion.

(c) This section does not apply to any changes in enrollment by a person currently enrolled in a school district’s health benefits plan or due to any change in enrollment or coverage caused by the retirement of a person.

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(Added by Stats. 1986, Ch. 561, Sec. 4. Effective August 25, 1986.)

Section § 7002.5

This law section clarifies that it does not guarantee retired teachers or their surviving spouses any rights to health and dental benefits. Additionally, it states that neither school districts, the county office, health plan providers, nor the State Teachers' Retirement System are required to inform retired teachers or spouses about anything related to this law.

(a) This article does not create a vested retirement right in health and dental care benefits.

(b) The individual districts, the county office, a health plan, an entity providing or arranging a health plan, and the State Teachers’ Retirement System do not have any legal duty to contact retired teachers or surviving spouses of certificated employees with regard to this article.

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(Amended by Stats. 2006, Ch. 538, Sec. 86. Effective January 1, 2007.)

Section § 7003

This section outlines that nothing in this article is meant to interfere with existing contracts or rules related to retired certificated staff, as they were when this article took effect. It also clarifies that it does not aim to limit or contradict any benefits from a well-known federal law, COBRA, and does not require offering life insurance or vision care.

(a) Nothing in this article shall be construed as requiring or permitting the impairment of any contract, board rule, or regulation affecting retired certificated personnel, in existence on the effective date of this article.

(b) Nothing in this article is intended to reduce or conflict with any benefit provided in the federal Consolidated Omnibus Budget Reconciliation Act of 1986 (Public Law 99-272).

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(Amended by Stats. 1986, Ch. 561, Sec. 7. Effective August 25, 1986.)

Section § 7004

This section defines specific terms used in the article. 'Certificated employee' refers to a member of the State Teachers' Retirement System. 'School district' is the district where the member last paid contributions before retiring. 'Spouse' is defined as per another section, Section 22171.

As used in this article:

(a) “Certificated employee” means a member, as defined by Section 22146, of the State Teachers’ Retirement System.

(b) “School district” means that district from which the member of the State Teachers’ Retirement System last made contributions to the system before retirement.

certificated employee State Teachers' Retirement System retirement contributions school district Section 22146 Section 22171 teacher retirement retirement system member education code definitions

(Amended by Stats. 2004, Ch. 896, Sec. 5. Effective September 29, 2004.)

Section § 7005

This law section clarifies that it doesn't apply to people who get health benefits under a specific government health plan or their employers. It defines 'employer' as school-related organizations like school districts, even if employees belong to different unions. Essentially, if an employer provides health benefits through a certain government plan, this particular article doesn't apply to them.

This article does not apply to persons receiving benefits pursuant to the Public Employees’ Medical and Hospital Care Act (Chapter 1 (commencing with Section 22750) of Part 5 of Division 5 of Title 2 of the Government Code) and to the employers on which their benefits are based.

For purposes of this section, “employer” means a county superintendent of schools, a school district, or a community college district irrespective of whether employees may be represented by different bargaining groups. Notwithstanding any other provision of this part, this article does not apply to employers for those groups of employees for whom coverage under the Public Employees’ Medical and Hospital Care Act (Part 5 (commencing with Section 22750) of Division 5 of Title 2 of the Government Code) is provided by contract.

Public Employees’ Medical and Hospital Care Act health benefits exclusion county superintendent of schools school district employers community college district employers bargaining groups contract health coverage employee representation government health plan coverage health benefits contract exclusions

(Amended by Stats. 2004, Ch. 69, Sec. 1. Effective June 24, 2004.)

Section § 7007

This section allows certain organizations to create a health benefits plan for both active and retired teachers, with equal premiums. These organizations must either represent school employees, retirees of the State Teachers’ Retirement System, or have at least 1,000 community college faculty members. Participation in the plan by school districts or educational entities is optional and requires them to work with the Public Employees’ Retirement System under specified conditions.

(a) Any qualified organization, as defined in subdivision (b), in cooperation with the Public Employees’ Retirement System, may develop a health benefits plan which would be available to persons who are members of those organizations, with equal premiums for both active and retired teachers. The plan would be available, on an optional basis, to each school district, county board of education, and a county superintendent of schools which becomes a contracting agency with the Public Employees’ Retirement System pursuant to Section 22857 of the Government Code.

(b) “Qualified organization” means an exclusive representative of the certificated or classified employees, as defined by Section 3540.1 of the Government Code, or any organization with a membership of at least 1,000 members who are retirees of the State Teachers’ Retirement System, or any organization with a membership of at least 1,000 members who are faculty members in the California Community Colleges.

(c) This section shall not apply to any contracting agency unless and until the agency elects to be subject to this section pursuant to Section 22857 of the Government Code.

health benefits plan active and retired teachers equal premiums qualified organization State Teachers’ Retirement System retirees faculty members California Community Colleges school districts Public Employees’ Retirement System contracting agency exclusive representative certificated employees classified employees optional basis Government Code Section 22857

(Amended by Stats. 2004, Ch. 896, Sec. 6. Effective September 29, 2004.)

Section § 7008

If you’re a teacher or school employee part of California's retirement programs and get hurt due to an attack while working, you might still be able to stay on your employer's healthcare and dental plans. To do this, you have to pay both your own and your employer’s share of the costs and any administration fees. This doesn't apply if your school district uses a specific state program for healthcare coverage.

(a) Notwithstanding any other provision of law, a member of the Defined Benefit Program of the State Teachers’ Retirement Plan who is disabled as a result of an injury that is a direct consequence of a violent act perpetrated on his or her person while performing duties in the scope of employment, and the employment is creditable under the provisions of the Teachers’ Retirement Law (Part 13 (commencing with Section 22000)), may, upon qualifying for a disability under Section 24001 and while receiving an allowance under Section 24002, continue in the district’s health care plan and dental care plan by paying all of the employer’s and employee’s premiums and all of the related administrative costs of the employer.

(b) Notwithstanding any other provision of law, a school member as defined in Section 20370 of the Government Code, or a local police officer as defined in Section 20430 of the Government Code, who is disabled as a result of an injury that is a direct consequence of a violent act perpetrated on his or her person while performing duties in the scope of employment, and the employment is creditable under the Public Employees’ Retirement Law (Part 3 (commencing with Section 20000) of Division 5 of Title 2 of the Government Code), may, upon qualifying for a disability and while receiving an allowance under Chapter 12 (commencing with Section 21060) of Part 3 of Division 5 of Title 2 of the Government Code, continue in the employer’s health care plan and dental care plan by paying all of the employer’s and employee’s premiums and all of the related administrative costs of the employer.

(c) Subdivisions (a) and (b) do not apply to any member who is employed by a school district that contracts with the Public Employees’ Retirement System for health care coverage under the Public Employees’ Medical and Health Care Act, (Part 5 (commencing with Section 22750) of Division 5 of Title 2 of the Government Code).

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(Amended by Stats. 2004, Ch. 69, Sec. 2. Effective June 24, 2004.)