1. Who can participate?
Eligibility in the Plan is generally open to all permanent Employees who are members of a bargaining unit represented by a participating Association, and for whom Contributions (either monthly Pooled Contributions or Lump Sum Transfers) are made to the Trust as required by the MOU.
2. Who is eligible for benefits?
There are two categories of Beneficiaries: Regular Beneficiary and Limited Beneficiary. An Employee can be eligible as both a Limited Beneficiary and a Regular Beneficiary at the same time, or for one or the other, depending on whether the Employee meets the requirements below.
a) Eligibility for Regular Beneficiaries. An Employee described in Answer No. 1 becomes a Regular Beneficiary entitled to benefits under the Plan, generally, after the Employee meets all of the following requirements:
- Earns five years of Active Service in the Trust (i.e., through five years of Pooled Contributions to the Trust or through conversion of Lump Sum Transfers equal to five years of Active Service).
- Attains age 50.
- Becomes eligible to receive retirement benefits from the retirement plan of his or her participating employer.
- Separates from employment with a participating employer.
A Regular Beneficiary is entitled to a lifetime stream of monthly benefit payments at his/her benefit level from the Pooled Account of the Trust, for reimbursement of medical expenses. See Sections 3.2 – 3.3 of the Plan for details.
b) Eligibility for Limited Beneficiaries. An Employee described in Answer No. 1 becomes a Limited Beneficiary entitled to benefits from his/her Employee Account in the Plan, generally, after the Employee meets all of the following requirements:
- Employee Account balance is positive:
- from Lump Sum Transfers (including accumulated leave payouts and San Diego Option C transfers) from the employer to the Employee Account, or
- from credit of Pooled Contributions to the Employee Account due to failure to meet the requirements for eligibility as a Regular Beneficiary, or
- from rollover of unused Pooled Account monthly benefits to the Employee Account; and
- Separation from employment with a participating employer.
A Limited Beneficiary is entitled to benefit payments from the Employee Account, for reimbursement of medical expenses, until the Employee Account balance reaches zero. See Section 3.5 of the Plan for details.
3. What happens if I separate from service before I contribute to the Trust for five years?
If an Employee does not earn the five years of Active Service necessary to become a Regular Beneficiary, that Employee is classified as a Limited Beneficiary. Instead of receiving a lifetime stream of monthly reimbursement payments, the Trust will credit to an Employee Account the amount of Pooled Contributions made to the Trust on behalf of that Employee over his/her career (without any allotment for prior investment gains and/or losses). That is, the Pooled Contributions of a Limited Beneficiary will be held in trust in his or her Employee Account, along with any Lump Sum Transfers received on his/her behalf. Investment earnings and losses and administrative expenses will be allocated to the Employee Account after the Account is established. The Limited Beneficiary may draw on that Account for the reimbursement of Covered Expenses, after separation from employment with a participating employer. There is no monthly limit on the benefits for a Limited Beneficiary, as long as all claims are for reimbursement of Covered Expenses. Benefits cease when the Account balance reaches zero.
Note that a Regular Beneficiary may also have an Employee Account, which holds Lump Sum Transfers, such as mandatory transfers of sick and/or vacation leave payout, or other negotiated lump sum contributions as allowed under the Plan (for example, San Diego City “Option C” transfers).
See Sections 2.1(b) and 3.5 of the Plan for details.
The Employee who has not earned the five years of Active Service prior to separation from service has another option: he/she may elect to convert his/her Employee Account balance from Lump Sum Transfers to Active Service Units, in order to reach the minimum five (5) years of Active Service for eligibility as a Regular Beneficiary. For purposes of meeting the Active Service Threshold for eligibility as a Regular Beneficiary, the Active Service Units required for one (1) year of Active Service are equal to the annual number of Active Service Units earned per employee through Pooled Contributions for the Employee’s Association.
4. What are the benefits?
After meeting the eligibility requirements, both Regular Beneficiaries and Limited Beneficiaries are entitled to reimbursement toward the payment of Covered Expenses, which consist of insurance premiums and medical expenses paid by the Employee after the Employee separates from service and becomes eligible for benefits under the Plan. Reimbursement payments are subject to proper and timely submission of benefit claims. The amount of the reimbursement payment is limited to the Beneficiary’s monthly benefit level (for a Regular Beneficiary), or the balance in his/her Employee Account (for a Limited Beneficiary).
Cost Sharing. Also, it is important to remember that the Plan reimburses toward the cost of Covered Expenses, but your benefit level or Employee Account may not cover the entire Covered Expense amount. If your benefit from the Plan does not cover the entire cost of your Covered Expense, you will be responsible for the balance of any Covered Expense amounts you owe in excess of your benefit.
5. What type of medical expenses will be reimbursed by the Plan?
The following medical expenses are considered “Covered Expenses” and will be reimbursed by the Plan:
- Premium or contribution payments for coverage under health, dental, or visions insurance plans, for types of medical expenses excludible from gross income under Internal Revenue Service Code (“Code”) Section 105(b). See Details in IRS Publication https://www.irs.gov/pub/irs-pdf/p502.pdf
- Medical expenses excludable from gross income under Code Section 213(d), i.e., costs for diagnosis, cure, mitigation, treatment, or prevention of disease or injury, including insulin but excluding all other non-prescribed drugs.
- Premium payment for long-term care insurance qualified under Code Section 7702B.
See Plan Section 1.9 for a full definition of “Covered Expenses”.
6. How is my monthly benefit level from the Pooled Account calculated?
A Regular Beneficiary’s monthly benefit level from the Pooled Account is determined by the number of Active Service Units he/she has accrued in this Plan and the Unit Multiplier in effect when Pooled Contributions cease on behalf of that Employee.
- An Employee earns Active Service Units for each month of Active Service in the Plan. Each monthly Pooled Contribution of $25 is equal to one Active Service Unit.
- The Unit Multiplier is a factor determined by the Trustees, with actuarial advice.
After separation from employment, the Trust Office will calculate your monthly benefit level by the following methodology (as further described in Plan Section 3.3, and illustrated in Appendix A of the Plan):
- Determine the total number of Active Service Units
- Multiply the total number of Active Service Units by the Unit Multiplier
From time to time, the Trustees will determine the Unit Multiplier, as defined in Plan Section 1.22, with the assistance of professional actuarial advice. You may contact the Trust Office to find out the current Unit Multiplier.
7. What is my Pooled Account monthly benefit level?
A Regular Beneficiary’s monthly benefit level is calculated by the methodology described above in No. 6. As such, each Regular Beneficiary’s monthly benefit level will be affected by the number of Active Service Units earned by the employee over his or her career. An Employee earns one Active Service Unit for each $25 monthly Pooled Contribution made to the Trust on his/her behalf.
The monthly Pooled Contribution rate is negotiated by the Employee’s bargaining unit. For example, a monthly Pooled Contribution rate of $150 will provide six Active Service Units per month to each Employee in that bargaining unit; and a monthly Pooled Contribution rate of $200 will provide eight Active Service Units per month. Thus, Regular Beneficiaries from different bargaining groups will have different Pooled Account monthly benefit levels, depending upon what Pooled Contribution rate their bargaining groups selected and negotiated.
Conversion of Employee Account funds to Active Service Units. An Employee may also transfer lump sum amounts of $3000.00 or more from his/her Employee Account into the Pooled Account to earn Active Service Units in the Plan. The Employee must request these transfers in writing to the Trust Office (on a form supplied by the Trust) and may make only one transfer request per calendar year. The lump sum amount transferred from the Employee Account to the Pooled Account is converted to Active Service Units at separation from employment on an actuarially equivalent basis, using the “Active Service Unit Conversion Table,” attached to the Plan as Appendix B. When you review the Conversion Table in Appendix B, you will note that the conversion rate may be more or less than the regular monthly Pooled Contribution rate of $25 per Active Service Unit. The rates in Appendix B were actuarially calculated to be equivalent to monthly Pooled Contributions. The rates are higher or lower based upon the time that the funds will be invested in the Pooled Account prior to retirement. Examples of conversions of lump sum transfers to Active Service Units are also available for your reference in Appendix C to the Plan. These examples illustrate the cost of conversion of Employee Account funds to Active Services Units in different circumstances. If you need a copy of Appendix B or C, please contact the Trust Office.
Adjustments to benefit level. The Trustees reserve the right and power to adjust the Unit Multiplier or the benefit levels up or down. Such adjustments, or termination of benefits, may apply to some or all current as well as future Beneficiaries. This could occur, generally, after the Trustees conduct a periodic review of the investment and demographic experience of the Trust. That is, if the investment returns or the demographic experience (e.g., life span, retirement age, etc.) are significantly different than projected, then the Unit Multiplier or benefit levels could be adjusted (up or down).
8. What will the benefit level be for my spouse and children in the event of my death?
Pooled Account Monthly Benefit Level. The Pooled Account monthly benefit level for a Surviving Spouse is equal to 50% of the benefit level of the deceased Eligible Retiree. If there is no Surviving Spouse, the Pooled Account monthly benefit level for surviving Children will be 75% of the benefit level for the deceased Eligible Retiree (to be divided equally among the Children).
Benefits for a Surviving Spouse continue until Death. Benefits for a surviving Child cease upon loss of Child status under the plan, i.e., on the Child’s 26th birthday, or upon the Child’s death.
Employee Account. If the Employee had an Employee Account upon death with a positive balance, then the Surviving Spouse or Domestic Partner may be reimbursed for Covered Expenses from that Account, to the extent there is a positive balance in the decedent’s Employee Account. Benefits to the Surviving Spouse or Domestic Partner cease when the Account balance reaches zero, or upon the Surviving Spouse or Domestic Partner’s death. If there is no Surviving Spouse or Domestic Partner, then the surviving Children may be reimbursed for Covered Expenses from the Employee Account until the account balance reaches zero, the Child loses Child status under the Plan, or the Child dies, whichever occurs first.
9. What is the definition of a Surviving Spouse?
A Surviving Spouse is the lawful spouse of an Eligible Retiree, who has been the spouse of the Eligible Retiree for at least twelve (12) months on the date of death of the Eligible Retiree. Such a spouse of an Employee or former Employee, who satisfied all the eligibility requirements except that he/she died before age 50 and/or before separation from employment, is also a Surviving Spouse eligible for benefits. Please note that the Trust grants the same rights and benefits to same-sex spouses as it does to opposite sex spouses. If you have entered into a same-sex marriage, please notify the Trust Office.
10. How do I submit my claims for benefits? And what are the appeal procedures for denied claims?
To present a claim for benefits under this Plan, the Employee or Surviving Spouse or Child must submit a written claim, on a form approved by the Trustees, with proof of payment of the Covered Expense. Claims must be submitted within 90 days, after the end of the calendar year, to the Trust Office at:
Southern California Firefighter Benefit Trust
C/O Benefit Programs Administration
1200 Wilshire Blvd, 5th Floor
Los Angeles, CA 90017-1906
Phone: 213-406-2370
Toll Free 844-353-7839
Fax: 562-463-5894
Or through the Website: www.firefightertrust.org
Any individual whose claim is denied or who receives an adverse determination related to the Plan may appeal to the Board of Trustees to conduct a hearing in the matter. The request for hearing must be in writing and submitted to the Trust Office (contact information above) within 181 calendar days after receipt of the notification of denial of benefits or adverse determination.
Details for claim submission and appeal of claim denial are set forth in Article III, Section 3.6 and Article IV of the Plan. Note that the appeal procedures apply to any complaint that you may have regarding the Plan, i.e., not just a claim denial.
11. What is the Plan Year?
The Plan year runs from March 1 to February 28.
12. What should I do if I change my address, spouse, or add children?
It is the Participant’s responsibility to notify the Trust Office of any change in mailing address, spouse or children. Note that it is important to keep this type of information updated with the Trust Office so that notices related to the Plan and benefit payments may be sent to you and/or your Beneficiaries. Failure to notify the Trust Office of such changes may result in the loss or delay of benefits under this Plan. Please update the Trust Office with any changes to your address or Beneficiaries by contacting the following
Southern California Fire Fighters’ Benefit Trust
C/O Benefit Programs Administration
1200 Wilshire Blvd, 5th Floor
Los Angeles, CA 90017-1906
Phone: 213-406-2370
Toll Free 844-353-7839
Fax: 562-463-5894
13. What are the circumstances that may result in ineligibility or denial of benefits; or amendment or termination of the Plan?
Circumstances which may result in disqualification, ineligibility, denial, or the loss of benefits include failure by the Employee or employer to make required Contributions, failure to properly submit expense receipts, failure to meet the eligibility requirements, death, or termination of the Plan. Also, note the following events will cause termination of benefits:
- An Eligible Employees monthly benefits from the Pooled Account under this Plan will terminate upon his/her death, or if he/she returns to employment with a participating employer. Limited Employee Account benefits under this Plan will terminate when the Employee Account balance reaches zero, upon the Eligible Employee’s death, or if he/she returns to employment with a participating employer. Provided, however, that benefit payments will resume when the Eligible Employee ceases employment with the Participating Employer.
- A Surviving Spouse’s monthly benefits from the Pooled Account under this Plan will terminate upon his/her death. Employee Account benefits under this Plan will terminate when the Employee Account balance reaches zero or upon the Surviving Spouse’s death.
- A Surviving Child’s benefits from the Pooled Account will terminate upon death of the Child or the loss of Child status under this Plan, i.e., on the Child’s 26th birthday. Employee Account benefits under this Plan will terminate when the Employee Account balance reaches zero, upon loss of Child status, or upon the Child’s death.
Benefit coverage and benefit amounts may be modified or terminated pursuant to Article VI of the Plan and such changes may apply to current and/or future Beneficiaries. In the event of the termination of the Plan, assets of the Plan which remain after payment of expenses associated with termination will be allocated and distributed to the Beneficiaries in accordance with Section 501(c)(9) of the Internal Revenue Code.
