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Medicare Premium Reimbursement

The purpose of the Peralta CCD Medicare Reimbursement Plan is to reimburse eligible retirees for the cost of Medicare premiums. Please see the Plan Document provided for more details.

Announcements

Did you know that you may be eligible to recieve a reimbursement of your Medicare Premiums? The Distirict reimburses premiums paid by the retiress and spouse or domestic partner. All you have to do is provide verification of the amount paid. If you are on the Districts Kaiser plan, make sure that you are enrolled in the Kaiser Senior Advantage Plan. 

On Feb. 6, 2007, the Board of Trustees ratified the Medical Reimbursement programs and improved eligibility criteria to include all retirees and dependents. Reimbursements occur quarterly March, June, September and December of each year. Submit your documentation by March 15 in order to be inclided in the first quarter reimbursement cycle.  Read More...
Plan Documents
 2014 Medicare Reimbursement Plan Policy Statement  
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This is the 2014 Medicare Reimbursement Plan Policy Statement.

(Updated 1-23-2014)

  File size: 316 K
 Medicare Premium Reimbursement Plan SPD  
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This is the Medicare Parts A and B Premium Reimbursement Plan Summary Plan Description.

  File size: 115 K
Forms
 2014 Medicare A & B Premium Claim Form  
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2014 Medicare A & B Premium Claim Form - Request for Reimbursement. This form must accompany reimbursements processed on or after January 1, 2014 through December 31, 2014. Complete sections B & C.

(Updated 11-20-2013)
  File size: 122 K
 2013 Medicare A & B Premium Claim Form  
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2013 Medicare A & B Premium Claim Form - Request for Reimbursement. This form must accompany reimbursements processed on or after January 1, 2013 through December 31, 2013. Complete sections B & C.

(Updated 11-27-2012)
  File size: 120 K
 Medicare A & B Enrollment Exceptions and/or Acknowledgement Form  
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This is the Medicare A & B Enrollment Exceptions and/or Acknowledgement Form.

(Updated 6-13-2013)

  File size: 38 K
 Direct Deposit Form  
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Attached is the Direct Deposit Form for Benefit Dynamics.  PLEASE NOTE:  All new retirees will be REQUIRED to sign up for direct deposit at the time of retirement in order to begin receiving reimbursement. 

(Updated 2-13-2012)

  File size: 70 K

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