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Actuarial Valuation of Other Post - Employment Benefit Programs as of <br />April 1, 2012 for the City of Sample City <br />JM <br />Table 3A <br />Summary of Retiree Benefit Provisions <br />OPEB provided: The City has indicated that the only OPEB provided is medical coverage. <br />Access to coverage: Medical coverage is currently provided through CalPERS as <br />permitted under the Public Employees' Medical and Hospital and Care Act (PEMHCA). <br />➢ This coverage requires the employee to satisfy the requirements for retirement under <br />CaIPERS, which requires attainment of age 50 with 5 years of State or public <br />agency service or approved disability retirement. <br />> If an eligible employee is not already enrolled in the medical plan, he or she may <br />enroll within 60 days of retirement or during any future open enrollment period. <br />A Coverage may be continued at the retiree's option for his or her lifetime. A surviving <br />spouse and other eligible dependents may also continue coverage. <br />> The employee must commence his or her retirement warrant within 120 days of <br />terminating employment with the City to be eligible to continue medical coverage <br />through the City and be entitled to the employer subsidy described below. <br />Benefits provided: As a PEMHCA employer, the City is obligated to contribute toward the <br />cost of retiree medical coverage for the retiree's lifetime or until coverage is discontinued. <br />Benefits continue to dependents so long as they remain eligible for coverage. The City's <br />contribution toward the cost of medical plan premiums for active and retired employees and <br />their dependents are defined by two resolutions with CalPERS, which apply based on <br />employment group: <br />For active and retired employees in the City Management group, the City contributes <br />100% of the medical plan premium for the employee and any covered dependents. <br />o For active and retired employees in all other employment groups, the City <br />contributes toward medical plan premiums not to exceed the monthly maximum <br />amounts shown in the table below: <br />Employee only <br />Employee + 11 <br />Family <br />$ 279.25 <br />1 $ 555,49 <br />1 $ 726.04 <br />Current premium rates: The 2012 CalPERS monthly medical plan rates in the Los <br />Angeles Area rate group are shown in the table below. If different rates apply where the <br />member resides outside of this area, those rates are reflected in the valuation, but are not <br />shown below. <br />Los An eles Area 2012 Health Plan Rates <br />Actives <br />and Pre -M Retirees <br />11 Medicare 'Eli <br />ible <br />Plan <br />Ee Only <br />Ee & 1 <br />Ee & 2 +' _ <br />Ee Only <br />Ee & 1 <br />Ee & 2+ <br />Blue Shield HMO <br />$510.72 <br />$1,021.44 <br />$1,327.87 <br />$337.99 <br />$675.98 <br />$982.41 <br />Blue Shield NetValue HMO <br />439.25 <br />878.50 <br />1142.05 <br />337.99 <br />675.98 <br />939.53 <br />Kaiser HMO <br />465.63 <br />931.26 <br />1210.64 <br />277.81 <br />555.62 <br />835.00 <br />PERS Choice PPO <br />505.63 <br />1011.26 <br />1314.64 <br />383.44 <br />766.88 <br />1070.26 <br />PERS Select PPO <br />429.22 <br />858.44 <br />1115.97 <br />383.44 <br />766.88 <br />1024.41 <br />PERS Care PPO <br />906.39 <br />1812.78 <br />2356.61 <br />432.43 <br />864.86 <br />1408.69 <br />PORAC Association Plan <br />556.00 <br />1041.00 <br />1323.00 <br />418.00 <br />833,00 <br />1115.00 <br />Note that the additional CalPERS administration fee is not included in this valuation. <br />B ckmore A6 <br />