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Home My WebLink AboutCity Council Resolution 03-068 Attachment A Return to: California Public Employees' Retirement System Actuarial and Employer Services Division Public Agency Contract Services P.O. Box 942709 Sacramento, CA 94229-2709 TRANSFER REQUEST RESOLUTION 03-068 WHEREAS, the City of Saratoga hereinafter designated as "Public Agency", established a "deemed" retirement system pursuant to Section 218(d)(6) of the Federal Social Security Act composed of positions of members of the California Public Employees Retirement System, desiring "Medicare-Only" coverage under the Health Insurance system established by said Act as amended; and WHEREAS, Section 218 (d)(6)(F) of the Social Security Act and Section 22155 of the California Government Code permits the transfer of positions of members not otherwise included, and members as defined in Section 22015 of the Government Code, to the deemed retirement system so established upon the filing of a request by the member with the State; and WHEREAS, State and Federal law and regulations require, as a condition of such coverage, that Public Agency take action set forth herein; NOW, THEREFORE, BE IT RESOLVED, that the Board of Administration, California Public Employees' Retirement System, be and hereby is requested to execute a modification to the California State Social Security Agreement to effect the transfer of members, including members as defined in Section 22015 of the Government Code, who so request on a timely and valid basis, to the "deemed" retirement system established pursuant to Section 218(d)(6) of the Federal Social PERS-MED40T (1/99) .). TRANSFER RESOLUTION (MEDICARE) Securi~y Act composed of members of the California Public Employees Retirement System desiring coverage under the Health Insurance system established by said Act as amended; and ßE IT FURTHER RESOLVED, that the said modification contain the same terms, conditions, and effective date of coverage with respect to services performed in positio~s covered by the California Public Employees Retirement System with respect to the ::;aid members who so request on or before December 22, 2003 . and BE IT FURTHER RESOLVED, that Lori Burns, Human Resource Analyót is hereby designated and appointed to give notice to members of their transfer rights includir:g members as defined in Section 22015 of the California Government Code and to furni~h transfer request forms. Presiding Officer Offi'S ~:'. opL~~~~~~ PERS-MED-40T (1/99) -2- TRANSFER RESOLUTION (Ml'mr ^ DP' of the G\--( LCÙ"(\ \~ (\ 1::o"lC( C), ~ Dô(\c. (Name) (Title) Oç ~G\ íG:\-o Cj CA. , State of I, California, do hereby certify the foregoing to be a full, true, and correct copy of Resolution No. ù'ò adopted by the ~lC\~-CX2:P-- G ~I COJ:ìCì \ of the t \ \--( 0\ 50. (0. \-0 YJ 0. at the regular/special meeting held on the c::JVV\ day of ~c.J.x:::m De (" ,2003, as the same appears of record in my office. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said \ 2-\1ì day of ~e (Yì 'œr , at my office this ,2aD. Title fIJ\ e lft~CQQS(j PERS-MED-40T (1199) -3· TRANSFER RESOLUTION (MEDICARF) Attachment B STATEMENT OF INFORMATION Medicare Coverage The proposed coverage is provided in addition to the California Public Employees' Retirement System. This coverage will not affect the existing Retirement System. The Medicare program with its benefits and its costs will be a separate system in addition to the Agency's retirement system. Medicare coveraqe. Medicare is a health insurance program for people age 65 or older. The Medicare program is provided for in Section 218(n) of the Social Security Act It is administered by the Health Care Financing Administration. We suggest you obtain the booklet, Medicare (Publication No. 05-10043)--Aguide to the Medicare program. A copy of the Medicare Handbook, published by the Health Care Financing Administration, is available to Medicare beneficiaries when they become eligible for the coverage. These booklets and other publications can be obtained free of charge at any Social Security Office or by calling the toll-free number, 1-800-772-1213. The present employer and employee contribution rates for the Medicare program is 1.45% each, (total 2.9%) of the employee wages. The contribution rate will remain constant through 1999. Beginning in 1994 there is no maximum wage amount for Medicare and the 1.45% applies to total wages. If the coverage procedures are completed, both employer and employee contributions will be due for m! wages paid for services performed on and after the date coverage is effective. PERS·MED·67DR STATEMENT OF JNFORMATION Employees Eligible to Choose Medicare as of October 3, 2003 Camekie, Diane Healy, Marilyn Heinrichs, Kim Pisani, Joan Tkach, Jaye Torres, Richard Vega, Joe Attachment C Attachment D NOTICE OF RIGHT TO TRANSFER Medicare Coverage NOTICE IS HEREBY GIVEN to all persons in employment with the City of Saratoga in positions covered by the California Public Employees' Retirement System, who were members of such System (or eligible to elect membership therein) and who elected not to be covered under Medicare: A division of the said System with respect to employees of the City of Saratoga was made on March 21, 2002 pursuant to the provisions of Section 22150 of the California Government Code, Section 218(d) of the Social Security Act, and rules and regulations relating thereto, at which time each eligible member of the said System was permitted to elect whether he wishes to be covered by the Health Insurance program, herein referred to as the Medicare program, provided for under section 218(n) of the Social Security Act with respect to services performed for the City of Saratoga. As a member in the group composed of positions of members who elected not to be covered under Medicare, you are eligible to elect Medicare-only coverage by transfer to the group of retirement system members covered by the Health Insurance program, if you so wish. In order for you to transfer, it will be necessary for you to file a written request to transfer on or before December 22, 2003 with the Board of Administration, càlifornia PubliE E{ñpfOyees'RetiremerírS}i~tem, P.O. Box 942709, Sacramento, CA 94229-2709. A transfer request form is attached to this notice. If you elect to transfer to the group of members covered by Medicare, the effect on your status under Medicare and the present retirement system will be substantially the same as if you had elected to be covered under Medicare at the time the opportunity to do so was first presented to members of the retirement system. Lori Burns, Human Resc-urce Analyst Local Division Officer November 20, 2003 , ,_. -., Notice Date PERS-MED-67T (1/99) NOTICE OF RIGHT TO TRANSFER (Medicare) Attachment E CITY OF SARATOGA MEDICARE COVERAGE REQUEST FOR TRANSFER FORM As an employee of the City of Saratoga and a member of the California Public Employees' Retirement System on November 18, 2002 in the group not covered under the Health Insurance program (hereinafter referred to as "Medicare") provided for by section 218(n) of the Social Security Act, I hereby request Medicare coverage by transfer to the group covered under Medicare. Medicare coveraqe will be effective November 1. 2002. You and your Employer will be required to pay any retroactive Medicare contributions due on covered wages after the effective date of coverage. The present employer and employee contribution rate for the Medicare program is 1.45% each, (total 2.9%) of the employee wages. I understand that my request to transfer to the group covered by Medicare is irrevocable and I will be permanently covered by Medicare as long as I am an eligible member of the California Public Employees' Retirement System. I understand that I may not change my decision to be covered by Medicare as long as my employment with the City of Saratoga continues. Name - please print Signature of member making election Date signed Social Security Number IMPORTANT NOTICE: To be valid, this election form must be returned to the address shown below on or before A late election form or an election form thaCis riot returned wiiÌ be considered the same as a "NO" vote in accordance with Section 599.4 of the California Administrative Code. BOARD OF ADMINISTRATION CALIFORNIA PUBLIC EMPLOYEES' RETIREMENT SYSTEM ACTUARIAL AND EMPLOYER SERVICES DIVISION PUBLIC AGENCY CONTRACT SERVICES P.O. BOX 942709 SACRAMENTO, CA 94229-2709 PERS-MED-70T (1199) REQlÆSTFOR TRANSFER (Medicare)