California Code of Regulations › Title 2 - Administration › Division 1 - Administrative Personnel › Chapter 2 - Board of Administration of Public Employees' Retirement System › Subchapter 3 - Public Employees' Medical and Hospital Care Act Regulations › Article 1 - Definitions, Coverage, Enrollment, Conversion, Minimum Standards, Alternative Benefit Plans, Contributions, Contingency Reserve Fund, Contracting Agency Participation and Medicare Part B › Section 599.516 - Payment of Surcharges for Late Enrollment in Medicare Part B

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) As used in this
					 section and Government Code section
					 22831(b):
(1) "Surcharge for late enrollment in Part B
					 of Medicare" means the Part B penalties for late enrollment, exclusive of the
					 Part B premium and interest or penalties for the late payment of premiums. At
					 the discretion of the Board, Part B penalties may be paid directly to the
					 Medicare program or annuitants may be reimbursed for the costs of their Part B
					 penalties.
(2) "Annuitants" means
					 annuitants and their family members.
(3) "Medicare eligible annuitants" means
					 those annuitants and their family members who (a) are enrolled in a basic
					 health benefits plan, (b) are eligible for Part A of Medicare without cost, (c)
					 turned 65 between January 1, 1985 and June 30, 2005, and (d) have not
					 previously enrolled in Part B of Medicare.
(4) "Adverse selection" means that the costs
					 of covering Medicare eligible annuitants in a particular basic plan results in
					 higher premiums for all members of that plan.
(5) "Less costly" means one of the following:
(A) The reduction in a carrier's basic plan
					 premium and resulting savings from moving a Medicare eligible annuitant into
					 the carrier's Medicare plan are greater than an amount equal to the costs of
					 that annuitant's Part B penalties and the employer's mandatory contribution for
					 enrollment in the carrier's Medicare plan. For purposes of this section, the
					 employer's mandatory contribution shall include all amounts that the employer
					 would be required to pay pursuant to Government Code section
					 22879.
(B) In the case of a self-funded plan
					 administered by the Board, the costs of medical and pharmaceutical claims paid
					 from the Health Care Fund on behalf of a Medicare-eligible annuitant have been,
					 and are projected to be, an amount greater than the Part B penalties for that
					 annuitant and the claim costs that would be paid by the Health Care Fund if the
					 annuitant were enrolled in the plan's Medicare supplement.
(6) "Defined class of Medicare eligible
					 annuitants" means a specific category or group of Medicare eligible annuitants
					 identified or established at the discretion of the Board.
(7) "Determination" means an evaluation and
					 decision made by the Board pursuant to these regulations and Section
					 22831(b) as to
					 whether (a) adverse selection due to the enrollment of Medicare eligible
					 annuitants has impacted a basic health benefits plan contracted for or approved
					 by the Board and (b) the payment of the Part B penalties for the Medicare
					 eligible annuitant(s) enrolled in that basic plan and their enrollment in a
					 Medicare health benefits plan would be less costly than continued enrollment in
					 the basic plan. An affirmative determination shall be referred to as a
					 determination of cost savings.
(8)
					 "CMS" means the Centers for Medicare and Medicaid Services, the federal agency
					 which administers the Medicare program.