Subchapter XXI. Health Benefits.
§ 1–621.01. Federal health benefits.
The health insurance benefit provisions of Chapter 89 of Title 5 of the United States Code are applicable to all employees of the District government first employed before October 1, 1987, except those specifically excluded by law or rule and regulation. Procedures established for administering the health benefits program with the District government shall be consistent with law and civil service rules.
§ 1–621.02. District health benefits.
The District shall provide health benefits as set forth in § 1-621.05 to all employees of the District first employed after September 30, 1987, except those specifically excluded by law or by rule.
§ 1–621.03. Definitions.
For the purposes of §§ 1-621.04 through 1-621.13, the term:
(1) “Annuitant” means:
(A) An employee first employed by the District after September 30, 1987, who has subsequently retired pursuant to any of the following:
(i) Teachers’ Retirement System (§§ 38-2001.01 to 38-2023.16);
(ii) Police and Fire Retirement System §§ 5-707 to 5-730;
(iii) Judges’ Retirement System (§§ 11-1561 to 11-1571); or
(iv) Teachers’ Insurance and Annuity Association programs; or
(B) An employee first employed by the District after September 30, 1987, who has subsequently separated pursuant to the District Retirement Benefit Program (§§ 1-626.03 to 1-626.14) after any of the following:
(i) Reaching 57 years of age and having completed 25 years of creditable District service in a correctional officer position;
(ii) Reaching 62 years of age and having completed 10 years of District government service in a position other than correctional officer; or
(iii) Becoming entitled to disability benefits under the Social Security Act.
(2) “Carrier” means a voluntary association, corporation, partnership, or other nongovernmental organization that is lawfully engaged in providing, paying for, or reimbursing the cost of health services under group insurance policies or contracts, medical or hospital service agreements, membership or subscription contracts, or similar group arrangements, in consideration of premiums or other periodic charges payable to the organization.
(2A) “Creditable District service” means all service in the employment of the District government that is creditable for purposes of the employee’s retirement.
(3) “Dependent child” includes:
(A) An adopted child; and
(B) A stepchild, foster child, or natural child of an employee or annuitant.
(4) “Employee” means an individual first employed by the District after September 30, 1987.
(5) “Health benefit plan” means a group insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar group arrangement provided by a carrier for the purpose of providing, paying for, or reimbursing expenses for health services under § 1-621.05.
(6) “Member of family” or “Family member” means:
(A) The spouse of an employee or annuitant;
(B) An unmarried dependent child under 22 years of age;
(C) An unmarried dependent child under 25 years of age who is a full-time student; and
(D) An unmarried child regardless of age who is incapable of self-support because of mental or physical disability that existed before age 22.
§ 1–621.04. Contracting authority.
The Mayor may contract with qualified carriers to provide health benefits under the laws of the District for periods of time to be determined by the Mayor. Any contract under this section shall be in accordance with the provisions of Chapter 3 of Title 2.
§ 1–621.05. Health benefit plans.
The District may contract for or approve the following health benefit plans:
(1) An Indemnity Benefit Plan: One District-wide plan offering at least 3 levels of benefits (one of which shall be deemed by the Mayor to be a standard option) under which a carrier agrees to pay certain sums of money, not in excess of the actual expenses incurred, for health benefits.
(2) Health Maintenance Organization Plans including:
(A) One or more group prepayment plans that offer health benefits, in whole or in substantial part on a prepaid basis, with professional services provided by physicians representing at least 3 major medical specialties practicing as a group in a common center or centers who receive all or a substantial part of their professional income from the prepaid funds; and
(B) An individual practice prepayment plan that offers health benefits in whole or substantial part on a prepaid basis, with professional services provided by individual physicians who agree, under rules promulgated by the Mayor, to accept the payments provided by the plan as full payment for covered services that include in-hospital services, general care provided in their offices and in the patients’ homes, out-of-hospital diagnostic procedures, and preventive care.
(3) Preferred Provider Organization Plan: An individual practice plan that offers health benefits in whole or substantial part with professional services provided by individual physicians, hospitals, and other health care providers who agree under rules promulgated by the Mayor to accept contractually reduced payments for the covered services they provide.
(4) Combined Benefit Plan: A plan that includes elements of more than 1 of the plans described in paragraphs (1), (2), and (3) of this section.
(5) Other Health Benefit Plans: Nothing in this section shall preclude the Mayor from contracting for or approving a type of health benefit plan not specifically listed in this section.
§ 1–621.06. Types of benefits.
(a) The benefits provided under the health benefit plans shall include benefits for costs associated with care in a general hospital and for health services of a catastrophic nature and may include at a minimum the following benefits:
(1) Hospital benefits;
(2) Managed care;
(3) Office visits;
(4) Substance abuse;
(5) Well baby care;
(6) Prescription drugs;
(7) Obstetrical benefits;
(8) Mental health benefits; and
(9) Hospice care.
(b) Each contract issued under § 1-621.05 shall comply with the provisions of Chapter 31 of Title 31.
§ 1–621.07. Election of coverage.
(a) Unless an employee or annuitant affirmatively waives health insurance coverage, each employee or annuitant shall enroll in 1 of the approved health benefit plans under § 1-621.05 either as an individual or for self and family or provide evidence satisfactory to the Mayor that the employee or annuitant is covered under another health benefit plan.
(b) If an employee or annuitant has a spouse or domestic partner who is an employee or annuitant, either spouse or domestic partner but not both may enroll for self and family, or each spouse or domestic partner may enroll as an individual. An individual shall not be enrolled as an employee or annuitant and also as a member of a family.
(c) An employee or an annuitant enrolled in a health benefit plan may change coverage by an application filed within 60 days of a change in family status or as otherwise permitted by rule promulgated by the Mayor.
(d) An employee or annuitant may transfer enrollment from one health benefit plan to another health benefit plan under § 1-621.05 as permitted by rules promulgated by the Mayor.
§ 1–621.08. Employee deductions and withholdings.
(a) During each pay period in which an employee or an annuitant is enrolled under 1 of the health benefit plans there shall be withheld from the compensation of each employee and from the annuity of each annuitant or there shall be paid by each annuitant who received his or her benefits as a lump sum payment an amount equal to the cost of the selected health benefit plan less the amount of the District contribution for the employee or the annuitant. The amount withheld or paid by the employee or the annuitant, together with the District’s contribution, shall be transferred to the carrier of the health benefit plan selected by the employee or the annuitant.
(b) During each pay period in which an individual receiving disability compensation benefits pursuant to subchapter XXIII of this chapter is enrolled under 1 of the health benefit plans, there shall be withheld from those benefits an amount equal to the cost of the selected health benefit plan less the amount of the District contribution for the enrolled individual. The amount withheld from the employee or the annuitant, together with the District’s contribution, shall be transferred to the carrier of the health benefit plan selected by the individual receiving disability benefits.
§ 1–621.09. District contribution.
(a) The District’s contribution to the cost of any health benefit plan shall be an amount equal to 75% of the subscription charge of the standard option indemnity plan, except that in no event shall the District’s contribution exceed 75% of the total subscription charge of any plan or option in which the employee is enrolled. The District’s contribution shall be paid on a regular pay period basis.
(b) The Mayor shall determine the amount of the District contribution for individual and for self and family enrollments before the beginning date of each contract period.
(c) There is established the Other Post-Employment Benefits Fund (“Fund”) from which the District’s contribution for health and life insurance for annuitants shall be paid. The monies in the Fund shall not be a part of, or lapse into, the General Fund of the District or any other fund of the District and, subject to authorization in an approved budget and financial plan, any funds appropriated in the Fund shall be continually available without regard to fiscal year limitation.
(d) Every fiscal year, the Chief Financial Officer shall deposit into the Fund the amount that has been appropriated for the purpose of funding the District contribution for the health and life insurance premiums of annuitants. The Chief Financial Officer may also deposit into the Fund any balances in rate stabilization fund reserves that are refunded to the District by a health insurance carrier.
(d-1) Each fiscal year, the District shall ensure that a sufficient amount is appropriated for the Fund, as the District of Columbia payment to the Fund, which shall be equal to, or greater than, the amount calculated as provided for in § 1-621.09a, and as determined by the enrolled actuary engaged pursuant to § 1-621.09a(a).
(d-2) If at any time the balance of the Fund is not sufficient to meet all obligations against the Fund, the Fund shall have claims on the revenues of the District of Columbia to the extent necessary to meet the obligation, subject to appropriation.
(d-3) All expenses incurred by the Chief Financial Officer in administering the Fund, including hiring staff for the Office of the Chief Financial Officer, shall be paid out of the Fund, subject to appropriation. The budget prepared and submitted by the Mayor pursuant to § 1-204.42 shall include recommended expenditures at a reasonable level for the forthcoming fiscal year for the administrative expenses of the Fund. The budget enacted pursuant to § 1-204.46 may designate the portion of the Fund to be allocated for the administrative expenses of the Fund; provided, that it shall not specify the specific manner in which, or the specific purposes for which, the Chief Financial Officer may expend such portion of the Fund.
(e) Notwithstanding the other provisions of this chapter, the Mayor may issue rules to establish vesting requirements for the provision of other post-employment benefits to annuitants. Any proposed rules promulgated by the Mayor shall be submitted to the Council for a 60-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess. If the Council does not approve or disapprove the proposed rules within the 60-day period, by resolution, the proposed rules shall be deemed disapproved.
(f) In the case of an annuitant who has separated pursuant to the District Retirement Benefit Program, no contribution shall be made by the District until the annuitant attains 62 years of age. The annuitant shall pay 100% of the cost of any health benefit plan selected by the annuitant until the annuitant attains age 62. Upon attaining 62 years of age, the District shall pay a portion of the cost of any health benefit plan selected by the annuitant in accordance with subsections (h)(1) or (2) of this section.
(g) In the case of an annuitant who retired pursuant to the Teachers’ Retirement System, or the Judges’ Retirement System or the Teachers’ Insurance and Annuity Association programs, the District shall pay the portion of the cost of any health benefit plan selected by the annuitant in accordance with subsection (h) of this section.
(h) The District contribution to post-employment health benefits for an annuitant described in subsection (g) of this section (and following the annuitant’s death, the annuitant’s eligible family members) shall be determined as follows:
(1) For annuitants who retire with at least 10 years of creditable District service, but less than 30 years of creditable District service, the District contribution to the cost of a health benefit plan selected by the annuitant shall be an amount equal to 25% of the cost of the selected health benefit plan (as secondary to Medicare) and 20% for the covered family member of the annuitant, plus an additional 2.5% for each year of creditable District service over 10 years; provided, that the District contribution shall not exceed 75% of the cost of the selected health benefits plan and 60% for the covered family member of the annuitant. The annuitant and family member shall contribute the applicable balance of the cost of the selected health benefit plan.
(2) For annuitants with 30 or more years of creditable District service, the District contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 60% of the cost of the selected health benefit plan and the covered family member shall contribute 40% of the cost of the selected health benefit plan.
(3) For annuitants who are injured or killed in the line of duty, the District’s contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the family member shall contribute 25% of the cost of the selected health benefit plan. This paragraph shall apply as of October 1, 2009.
(i) In the case of an annuitant who retired pursuant to the Police and Fire Retirement System, the District shall pay the portion of the cost of any health benefit plan selected by the annuitant in accordance with subsection (j) of this section.
(j) The District contribution to post-employment health benefits for an annuitant described in subsection (i) of this section (and following the annuitant’s death, the annuitant’s eligible family members) shall be determined as follows:
(1) For annuitants hired before November 10, 1996, who retire with at least 5 years of creditable District service, the District contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 60% of the cost of the selected health benefit plan and the covered family member shall contribute 40% of the cost of the selected health benefit plan.
(2) For annuitants hired on or after November 10, 1996, with at least 10 years of creditable District service, but less than 25 years of creditable District service, the District contribution to the cost of a health benefit plan selected by the annuitant shall be an amount equal to 30% of the cost of the selected health benefit plan (as secondary to Medicare) for the annuitant, plus an additional 3% for each year of creditable District service over 10 years, and 25% for the covered family member of the annuitant, plus an additional 3% for each year of creditable District service over 10 years; provided, that the District contribution shall not exceed 75% of the cost of the selected health benefits plan for the annuitant and 60% of the cost of the selected health benefits plan for the covered family member of the annuitant. The annuitant and family member shall contribute the applicable balance of the cost of the selected health benefit plan.
(k) In the case of an individual who would otherwise be subject to the Police and Fire Retirement System upon retirement but who is killed in the line of duty and in the case of an individual who retires under the Police and Fire Retirement System due to an injury that occurred in the line of duty, the District shall pay the portion of the cost of any health benefit plan selected by the individual or the individual family member in accordance with subsection (l) of this section.
(l) For an individual covered by subsection (k) of this section, the District’s contribution to the cost of the selected health benefits plan of the individual shall be an amount equal to 75% of the cost of the selected health benefit plan and the individual shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of the individual, the District contribution to the cost of the selected health benefit plan of the family member shall be an amount equal to 75% of the cost of the selected health benefit plan and the family member shall contribute 25% of the cost of the selected health benefit plan.
(m) An individual described in subsection (k) of this section shall be considered an annuitant for the purposes of this section.
§ 1–621.09a. Calculation of District of Columbia payment to Other Post-Employment Benefits Fund.
(a)(1) As specified in paragraph (2) of this subsection, the Chief Financial Officer shall engage an enrolled actuary, to be paid for out of the Fund, to make the following determinations as of a specified date on the basis of the entry age normal funding method and in accordance with generally accepted actuarial principles and practices with respect to the Fund:
(A) The normal cost, determined as a level percentage of covered annual payroll;
(B) The unfunded accrued liability payment; which, for the purposes of this section, means the level amount or the level percentage of covered annual payroll that, when contributed annually to the Fund for a period of not greater than 30 years, would be sufficient to fund the liability for benefits accrued by participants as of the valuation date (“accrued liability”) in excess of the current value of assets of the Fund (“unfunded accrued liability”);
(C) The current value of the assets in the Fund;
(D) The estimated covered annual payroll; and
(E) Such additional information as the Chief Financial Officer may need to make the determinations specified in paragraph (4) of this subsection and in subsection (b) of this section.
(2) Unless the actuary engaged by the Chief Financial Officer pursuant to paragraph (1) of this subsection determines that a more frequent valuation is necessary to support the actuary’s opinion, the actuary shall make the determinations described in paragraph (1) of this subsection upon the request of the Chief Financial Officer and at least once every year.
(3)(A) On the basis of the most recent determinations made under paragraph (1) of this subsection, the enrolled actuary shall certify to the Chief Financial Officer each year, at a time specified by the Chief Financial Officer, the following information for the next fiscal year with respect to the Fund:
(i) The normal cost;
(ii) The present value of future benefits payable from the Fund for covered employees as of the valuation date;
(iii) The unfunded accrued liability payment;
(iv) The current value of assets as of the valuation date; and
(v) The value of assets used in developing the amortization of unfunded accrued liability payment.
(B) In calculating the District’s annual required contribution to the Fund, a closed amortization period of 30 years or less shall be used.
(4) On the basis of the most recent certification submitted by the enrolled actuary under paragraph (3) of this subsection, the Chief Financial Officer shall certify the sum of the normal cost and the unfunded accrued liability payment (“amount of the District payment”) for the next fiscal year for the Fund.
(b)(1) On the basis of the most recent determinations made under subsection (a)(4) of this section, the Chief Financial Officer shall, by March 1st of each year, certify to the Mayor and the Council the amount of the District contribution to the Fund.
(2) The Mayor, in preparing each annual budget for the District of Columbia pursuant to § 1-204.42, and the Council, in adopting each annual budget in accordance with § 1-204.46, shall, for the Fund, include in the budget no less than the amount of the District payment for the Fund certified by the Chief Financial Officer under paragraph (1) of this subsection. The Mayor and the Council may comment and make recommendations concerning any such amount certified by the Chief Financial Officer.
(c)(1) Before the enactment of any law, resolution, regulation, rule, or agreement producing any change in health and life insurance benefits for annuitants, the Mayor shall notify the Chief Financial Officer, who in turn shall engage an enrolled actuary to estimate the effect of that change in benefits over the next 5 fiscal years on the:
(A) Accrued liability of the Fund;
(B) Unfunded accrued liability of the Fund;
(C) Unfunded accrued liability payment with respect to the Fund;
(D) Normal cost with respect to the Fund; and
(E) The District’s annual required contribution to the Fund.
(2) The Mayor shall transmit the estimates of the actuary to the Chief Financial Officer and the Council, and the change in benefits shall not become effective until the end of a 30-day period of review, which shall begin on the date of the Mayor’s transmittal.
§ 1–621.09b. Actuarial statement and opinion.
(a) As a part of the actuarial report presented to the Chief Financial Officer, the actuary shall prepare an actuarial statement. The statement shall contain:
(1) The dates of the fiscal year and the most recent actuarial valuation;
(2) The total amount of the contributions made by participants and the total amount of all other contributions, including the District payment, received for the fiscal year and for each preceding fiscal year for which the information was not previously reported;
(3) The number of participants, whether or not retired, and beneficiaries receiving benefits covered as of the last day of the fiscal year;
(4) The following information as of the date of the most recent actuarial valuation and, if available and sufficiently comparable so as not to be misleading, for at least the 2 preceding actuarial valuations:
(A) The aggregate annual compensation of participants;
(B) The actuarial value of assets of the Fund;
(C) The actuarial accrued liability, if applicable;
(D) The difference between the actuarial value of assets of the system and actuarial accrued liability, if applicable;
(E) The actuarial value of assets of the system expressed as a percentage of actuarial accrued liability, if applicable;
(F) The difference between the actuarial liability expressed as a percentage of the aggregate annual compensation of participants, if applicable; and
(G) The actuarial assumptions and methods used in determining the information described in this paragraph and other factors that significantly affect the information described in this paragraph; and
(5) Other information necessary to disclose fully and fairly the actuarial condition of the Fund.
(b)(1) The actuarial report shall also contain an opinion of the enrolled actuary on the actuarial statement attesting that:
(A) To the best of the actuary’s knowledge the statement is complete and accurate;
(B) Each assumption and method used in preparing the statement is reasonable, and the assumptions and methods in the aggregate are reasonable, taking into account (but not limited to) the experience of the benefits system; and
(C) The assumptions and methods in combination offer the actuary’s best estimate of anticipated experience.
(2) In formulating an opinion, the actuary may rely on the correctness of any accounting matter as to which any qualified public accountant has expressed an opinion, if the actuary so indicates.
(c) The actuarial statement and opinion required by this section shall be included as part of the annual report required pursuant to § 1-621.09f(a)(1).
(d) For the purposes of §§ 1-621.09b through 1-621.09e, the term “benefits system” means the District’s system for funding and administering other post-employment benefits to annuitants.
§ 1–621.09c. Information about the other post-employment benefits system.
Upon request by the Chief Financial Officer, the Mayor and the head of any District agency or instrumentality shall furnish to the Chief Financial Officer information with respect to the benefits system to which this subchapter applies as the Chief Financial Officer considers necessary to enable it to carry out its responsibilities under this subchapter and to enable the enrolled actuary engaged pursuant to § 1-621.09(a) to carry out its responsibilities under this subchapter.
§ 1–621.09d. Preparation of studies; enrolled actuary.
The Chief Financial Officer shall:
(1) Direct the enrolled actuary engaged pursuant to § 1-621.09a to:
(A) From time to time, prepare an experiential study for the Fund;
(B) Each fiscal year, prepare an asset allocation study for the Fund, and:
(C) Prepare such other analyses as are best practice for other post- employment benefits funds or the District of Columbia Retirement Board; and
(2) Rebid the contract for the enrolled actuary no less frequently than every 5 years.
§ 1–621.09e. Annual audit.
(a) The Office of the Chief Financial Officer shall engage an independent qualified public accountant to conduct an annual audit of the Fund in accordance with generally accepted auditing standards. The annual audit of the Fund shall be conducted by a contracted auditor as part of the Comprehensive Annual Financial Report. The cost of the financial statement preparation shall be paid for out of the Fund. The examination shall involve such tests of the books and records of the Fund as are considered necessary by the accountant. The independent qualified public accountant shall also offer an opinion as to whether the separate schedules required by subsection (b) of this section and the summary material required under section § 1-621.09a present fairly, in all material respects, the information contained therein when considered in conjunction with the financial statements taken as a whole. The opinion by the independent qualified public accountant shall be made a part of the annual report required pursuant to § 1-621.09f. In offering the opinion, the accountant may rely on the correctness of any actuarial matter certified to by an enrolled actuary if the accountant so states this reliance.
(b)(1) The financial statement shall contain a statement of assets and liabilities, and a statement of changes in net assets available for benefits under the benefits system, which shall include details of revenues and expenses and other changes aggregated by general source and application. In the notes to financial statements, disclosures concerning the following items shall be considered by the accountant:
(A) A description of the benefits system, including any significant changes in the system made during the period and the impact of the changes on benefits;
(B) The funding policy (including the policy with respect to prior service cost), and any changes in the policy during the year;
(C) A description of any significant changes in benefits made during the period;
(D) A description of material lease commitments, other commitments, and contingent liabilities;
(E) A description of agreements and transactions with persons known to be parties in interest; and
(F) Any other matters necessary to fully and fairly present the financial statements of the Fund.
(2) The statement required under paragraph (1) of this subsection shall have attached the following information in separate schedules:
(A) A statement of the assets and liabilities of the Fund, aggregated by categories and valued at their current value, and the same data displayed in comparative form for the end of the previous fiscal year;
(B) A statement of receipts in and disbursements from the Fund during the preceding 12-month period, aggregated by general source and application;
(C) A schedule of all assets held for investment purposes, aggregated and identified by issuer, borrower, or lessor, or similar party to the transaction (including a notation as to whether the party is known to be a party in interest), maturity date, rate of interest, collateral, par or maturity value, cost, and current value;
(D) A schedule of each transaction involving a person known to be a party in interest, the identity of the party in interest and the party of interest’s relationship, or that of any other party in interest, to the Fund, and:
(i) A description of each asset to which the transaction relates;
(ii) The purchase or selling price if a sale or purchase, the rental rate if a lease, or the interest rate and maturity date if a loan;
(iii) Expenses incurred in connection with the transaction; and
(iv) The cost of the asset, the current value of the asset, and the net gain or loss on each transaction;
(E) A schedule of all loans or fixed-income obligations that were in default as of the close of the fiscal year or were classified during the year as uncollectible and the following information with respect to each loan on the schedule (including a notation as to whether parties involved are known to be parties in interest):
(i) The original principal amount of the loan;
(ii) The amount of principal and interest received during the reporting year;
(iii) The unpaid balance;
(iv) The identity and address of the obligor;
(v) A detailed description of the loan (including date of making and maturity, interest rate, the type and value of collateral, and other material terms); and
(vi) The amount of principal and interest overdue (if any) and an explanation thereof;
(F) A list of all leases that were in default or were classified during the year as uncollectible, and the following information with respect to each lease on the list (including a notation as to whether parties involved are known to be parties in interest):
(i) The type of property leased (and, if fixed assets such as land, buildings, and leaseholds, then the location of the property);
(ii) The identity of the lessor or lessee from or to whom the Fund is leasing;
(iii) The relationship of the lessors and lessees, if any, to the Fund, the government of the District of Columbia, any employee organization, or any other party in interest;
(iv) The terms of the lease regarding rent, taxes, insurance, repairs, expenses, and renewal options;
(v) The date the leased property was purchased and its cost;
(vi) The date the property was leased and its approximate value at that date;
(vii) The gross rental receipts during the reporting period;
(viii) Expenses paid for the leased property during the reporting period;
(ix) The net receipts from the lease;
(x) The amounts in arrears; and
(xi) A statement as to what steps have been taken to collect amounts due or otherwise remedy the default;
(G) The most recent annual statement of assets and liabilities of any common or collective trust maintained by a bank or similar institution in which some or all the assets of the Fund are held, of any separate account maintained by an insurance carrier in which some or all of the assets of the Fund are held, and of any separate trust maintained by a bank as trustee in which some or all of the assets of the Fund are held, and for each separate account or a separate trust, such other information as may be required by the Chief Financial Officer to comply with this subsection; and
(H) A schedule of each reportable transaction, the name of each party to the transaction (except that, for an acquisition or sale of a security on the market, the report need not identify the person from whom the security was acquired or to whom it was sold), and:
(i) A description of each asset to which the transaction applies;
(ii) The purchase or selling price if a sale or purchase, the rental rate if a lease, or the interest rate and maturity date if a loan;
(iii) Expenses incurred in connection with the transaction; and
(iv) The cost of the asset, the current value of the asset, and the net gain or loss on each transaction.
(3) For the purposes of paragraph (2)(H) of this subsection, the term “reportable transaction” means a transaction to which the Fund is a party and which is:
(A) A transaction involving an amount in excess of 5% (or other percentage that may be established from time to time by the United State Department of Labor for “reportable transactions”) of the current value of the assets of the Fund;
(B) Any transaction (other than a transaction respecting a security) that is part of a series of transactions with or in conjunction with a person in a fiscal year, if the aggregate amount of the transactions exceeds 5% (or other percentage that may be established from time to time by the United States Department of Labor for reportable transactions) of the current value of the assets of the Fund;
(C) A transaction that is part of a series of transactions respecting one or more securities of the same issuer, if the aggregate amount of the transactions in the fiscal year exceeds 5% (or other percentage that may be established from time to time by the United States Department of Labor for reportable transactions) of the current value of the assets of the Fund; or
(D) A transaction with, or in conjunction with, a person respecting a security, if any other transaction with or in conjunction with the person in the fiscal year respecting a security is required to be reported by reason of subparagraph (A) of this paragraph.
§ 1–621.09f. Annual report; prohibition on reprogramming.
(a)(1) By April 1st of each year, the Office of the Chief Financial Officer shall publish an annual report regarding the Fund.
(2) The annual report published pursuant to this subsection shall include:
(A) Along with the assumptions for the Fund used by the enrolled actuary pursuant to § 1-621.09b, a side-by-side comparison with the assumptions currently used by the District of Columbia Retirement Board;
(B) A side-by-side comparison of the Fund’s asset allocation and the District of Columbia Retirement Board’s asset allocation for the prior fiscal year;
(C) The most recent recommendations transmitted by the Other Post- Employment Benefits Fund Advisory Committee pursuant to § 1-621.53; and
(D) A description of actions taken by the Chief Financial Officer in response to the recommendations described in paragraph (2)(C) of this subsection, including an explanation of why no action was taken on a recommendation, if applicable.
(b)(1) Notwithstanding § 47-363(b)-(d), upon receipt of a reprogramming request of monies in the Fund, the Chairman of the Council shall cause a notice of the request to be published in the District of Columbia Register, together with a statement that the request shall be deemed disapproved 10 days from the date of publication in the District of Columbia Register, unless a proposed approval resolution is filed before that time by a Councilmember, and that if a proposed approval resolution is filed, the request shall be deemed disapproved 30 days (excluding weekends, holidays, and days of Council recess) from the date of the receipt of the reprogramming request, unless before the end of the 30-day review period the Council adopts a resolution of disapproval or approval.
(2) The publication of a notice of a reprogramming request shall satisfy the public notice requirements of this section and the rules of the Council and no further notice shall be necessary for the Council to adopt a resolution affecting the request.
(3) The Council shall consider the reprogramming request according to its rules. No reprogramming request may be submitted to the Chairman of the Council under this subsection during such time as the Council is on recess, according to its rules, nor shall any time period provided in this subsection or in the Council’s rules with respect to the request continue to run during such time as the Council is on recess.
(4)(A) If no proposed approval resolution of a reprogramming request is filed with the Secretary to the Council (“Secretary”) within 10 days of the publication of the request from the Mayor in the District of Columbia Register, the request shall be deemed disapproved.
(B) If a proposed approval resolution is filed with the Secretary to the Council within 10 days of publication of the reprogramming request from the Mayor in the District of Columbia Register, the Council may approve or disapprove the reprogramming request by resolution within 30 days (excluding weekends, holidays, and days of Council recess) of the receipt of the request from the Mayor. If the Council neither affirmatively approves or disapproves the request within 30 days (excluding weekends, holidays, and days of Council recess) of the receipt of the request, the request shall be deemed disapproved.
(5) At any time before final action by the Council on a reprogramming request, including deemed disapproval, the Mayor may withdraw the reprogramming request.
§ 1–621.10. Information to employees.
(a) The Mayor shall make available to each employee information as may be necessary to enable the employee to exercise an informed choice among the types of health benefit plans offered.
(b) The Mayor shall make available to each employee and annuitant enrolled in a health benefit plan a written statement or summary of:
(1) The services or benefits, including maximums, limitations, and exclusions, to which the employee, annuitant, or member of the family of the employee or annuitant are entitled;
(2) The procedures for obtaining benefits; and
(3) The principal provisions of the health benefit plan affecting the employee, annuitant, or member of the family of the employee or annuitant.
§ 1–621.11. Coverage of restored employees.
An employee enrolled in a health benefit plan under § 1-621.02 who is removed or suspended without pay and later reinstated or restored to duty on the ground that the removal or suspension was unwarranted or unjustified may, at the employee’s option, enroll as a new employee or have the employee’s coverage restored, with appropriate adjustments made in contributions and claims, to the same extent and effect as though the removal or suspension had not taken place.
§ 1–621.12. Evaluations; reports; audits.
(a) The Mayor shall make periodic evaluations of the operation and administration of the health benefit plans provided under § 1-621.05.
(b) Each contract entered into under § 1-621.04 shall require the carrier to:
(1) Furnish reasonable reports as the Mayor determines necessary to enable the District to carry out its functions under this subchapter; and
(2) Permit the Mayor to examine records of the carriers as may be necessary to carry out the purposes of this subchapter.
§ 1–621.13. Rules; eligibility.
(a) In order to ensure proper implementation of the health benefit plans under § 1-621.05 by October 1, 1987, the Mayor may issue temporary rules regarding the health benefit plans that shall not be subject to Council review. These temporary rules shall remain in effect only until the proposed rules have been approved or been deemed approved by the Council in accordance with subsection (b) of this section.
(b) The Mayor shall, pursuant to subchapter I of Chapter 5 of Title 2, issue proposed rules to implement the provisions of this subchapter. The proposed rules shall be submitted to the Council for a 45-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess. If the Council does not approve or disapprove the proposed rules, in whole or in part, by resolution within this 45-day review period, the proposed rules shall be deemed approved.
(c) The proposed rules submitted pursuant to subsection (a) of this section shall prescribe the time, manner, and conditions under which employees and annuitants are eligible for coverage. The proposed rules may exclude employees on the basis of the nature and type of employment or conditions of employment such as short-term appointment, seasonal employment, intermittent or part-time employment, or employment of a similar nature, but shall not exclude an employee or group of employees solely on the basis of the hazardous nature of employment.
(d) The Mayor, pursuant to subchapter I of Chapter 5 of Title 2, [§ 2-501 et seq.], may issue rules to implement the provisions of this chapter, including rules related to post-employment health benefits coverage, including structuring coverage so that it is secondary to other coverage (including Medicare).
§ 1–621.14. Continued health benefits coverage.
A District government employee who is separated from service, or an employee’s dependent who ceases to be a dependent, may be eligible for extended health benefit coverage in accordance with rules issued by the Mayor. The rules shall be as consistent as possible with federal regulations governing extended health benefits for District government employees enrolled in the Federal Employee Health Benefits Plan.
§ 1–621.15. Reimbursement of excess premium costs. [Expired]
Expired.
§ 1–621.16. Information about post-employment benefit plans. [Repealed]
Repealed.
§ 1–621.17. Post-employment benefits.
(a) An annuitant may be eligible for the post-employment health benefits as set forth in § 1-621.05.
(b) To be eligible for post-employment health benefits, the annuitant must:
(1) Retire with at least:
(A) 10 years of creditable District service if the annuitant retired under the District Retirement Benefit Program, the Teachers’ Retirement System, the Judges’ Retirement System, or the Teachers’ Insurance and Annuity Association programs; or
(B) 10 years of creditable District service if the annuitant retired under the Police and Fire Retirement System and the annuitant was hired on or after November 10, 1996; or
(C) 5 years of creditable District service if the annuitant retired under the Police and Fire Retirement System and the annuitant was hired before November 10, 1996;
(2) Be enrolled in a health benefit plan under § 1-621.05 at the time of retirement;
(3) Have been continuously enrolled in a health benefit plan under § 1-621.05 for a period of at least 5 years preceding the annuitant’s retirement date; and
(4) Remain continuously covered under a health benefit plan under § 1-621.05.
(b-1) In addition to annuitants eligible under this section for the post-employment health benefits as set forth in § 1-621.05, individuals described in § 1-621.09(k) shall also be eligible for such benefits and those individuals shall be considered annuitants for the purposes of this section.
(c) If an annuitant’s coverage in a health benefit plan under § 1-621.05 ends, for any reason, the annuitant shall cease to be eligible for post-employment health benefits and shall not re-enroll, as an annuitant, in a health benefit plan under § 1-621.05.
(d) Upon the death of an annuitant who is enrolled in a health benefit plan under § 1-621.05 with family coverage, the annuitant’s surviving spouse and dependent children who are covered under the health benefit plan at the time of death may continue enrollment in a health benefit plan under § 1-621.05.
