LAwell Terms & Conditions

By enrolling in LAwell benefits, you have read, agreed to, and will abide by the full Terms and Conditions for LAwell program members as follows:

Enrollment and Election Changes

•   Only the LAwell eligible City of Los Angeles Employee is allowed to make LAwell elections for themselves and their dependents. Dependents are not allowed to make LAwell elections for themselves.

•   Making changes to your elections and dependent information requires you to provide an electronic signature of the choices you enter. If you prefer not to make changes electronically, call the Benefits Service Center for assistance at 833-4LA-WELL (833-452-9355), Monday – Friday, 8:00 a.m. to 5:00 p.m. (For TDD or TTY service, call 800-735-2922.)

•   If you decide to make changes electronically, completion of an event will serve as your consent.

•   You agree that your information, and the information you provided for your eligible dependents, is true and accurate to the best of your knowledge.

•   Your enrollment, and the enrollment of any of your dependents, is conditional and may require further action. Any required documentation to complete your or your dependents’ enrollment, such as birth certificates, a Cash-In- Lieu Affidavit or an Affidavit of Domestic Partnership must be submitted to the LAwell program by the deadline on your confirmation statement. Failure to comply with these required actions will result in the cancellation of your conditional coverage, and any expenses incurred after coverage is canceled, including expenses incurred before your cancellation notice, will be your responsibility. You can find all these forms at keepingLAwell.com/forms.

•   Any and all election changes are made prospectively only. The LAwell Program will not make any election changes in coverage retroactively, nor close any gaps in coverage.

•   You will not be able to re-enroll your dropped dependents until the next Open Enrollment period or within 30 days of a qualifying life event.

•   LAwell benefit enrollment does not guarantee access to services. Your benefits will become effective the date you call or enroll online, however it may take multiple weeks for your information to be completely processed by all affected insurance providers. You may visit your doctor after enrollment, but it is recommended that you wait until you receive your insurance card.

•   The effective dates of coverage for employees returning to work or LAwell eligibility from a break in LAwell coverage will vary as outlined in the “Losing Eligibility for LAwell Benefits” section of the enrollment guide.

Eligibility

•   LAwell processes, such as eligibility, are based on employment details maintained and recorded in the city-wide system by the Personnel section of the employing department. Any changes in employment details, such as employee status, job classification and salary, must be updated by the employing department in the city-wide system before LAwell benefits eligibility can be changed.

•   Only the dependent relationships identified by the LAwell program are permissible eligible dependents, and they can only be added/removed to LAwell coverage as specified by the LAwell program rules or by specific court order.

•   You must drop coverage for any enrolled dependents within 30 days of the date they lose eligibility (e.g., within 30 days of a divorce). If you fail to remove ineligible dependents, or otherwise fraudulently obtain LAwell program benefits for yourself or your dependents, you will be required to pay all costs for any benefits that were paid on their behalf; you will have your coverage retroactively terminated; and at the sole discretion of the City of Los Angeles, you may be subject to disciplinary action.

•   Your eligibility for LAwell benefits is evaluated on a biweekly basis per pay period as outlined in the LAwell Enrollment Guide and on keepingLAwell.com. Not meeting eligibility requirements in any pay period will result in either:

- the discontinuation of the City subsidy applied to your LAwell benefits
or
- the termination of your LAwell benefits.

Dual Coverage

•   Dual LAwell coverage by LAwell employees in a relationship with or as a parent of another LAwell employee is not permissible. Any City employee is not permitted to be simultaneously covered as both an employee and a dependent under LAwell’s medical, dental, vision, life, or AD&D coverages.

Benefit Plan Premiums

•   LAwell members are financially responsible for their share benefit premiums. If any payments are missed through payroll deductions, for any reason, the LAwell member will be billed outside of payroll.

•   LAwell benefits are not on a per-use basis. LAwell members must pay their share of benefit premiums, regardless if they use their benefits or not.

Life Insurance

•   Employees returning to work or LAwell eligibility from a break in LAwell coverage (aka Rehire and Reinstate employees) are required to submit a new Medical History Statement (MHS) when enrolling into certain life insurance coverage levels and/or supplemental disability coverage.

The Terms and Conditions of the LAwell Program are subject to change without notice and are provided in their entirety above or in the LAwell Enrollment Guidebook.

To complete your enrollment, you must provide any required paperwork to the LAwell Benefits Service Center at TELUS Health, PO BOX 9929, PROVIDENCE RI 02940-4029 or to the Personnel Department, Employee Benefits Division by the due date on the confirmation statement you receive after enrolling.

Dependent Care Reimbursement Account (DCA), Health Care Flexible Spending Account (FSA) and FSA Debit Card Terms and Conditions

By enrolling in an LAwell Healthcare FlexibleSpending Account (FSA) and/or Dependent Care Account (DCA), you understand that:

•   The annual amount you have elected is irrevocable.

•   Your per pay period deduction may be adjusted to meet your annual election amount if you miss any payroll contributions during the calendar year.

•   The funds you deposit must be used by the end of the grace period (or March 15 of the next calendar year), or you will forfeit any unclaimed balance.

• Per Internal Revenue Code regulations, unused funds do not roll over to subsequent years. You must spend the funds you elect during the calendar year you make your election for.

• The deadline for filing claims for eligible expenses is April 30 of the next calendar year, or you will forfeit any unclaimed balance.

•   Per Internal Revenue Code regulations, any funds that you contribute through pre-tax payroll deductions cannot be refunded.

•   You must keep sufficient documentation (such as invoices and receipts) for all expenses, including HCFSA transactions paid with the debit card, and you will provide documentation when requested.

•   The available FSA debit card is an optional convenience, and not all eligible expenses are available to purchase through the debit card. You may still need to file a paper claim in certain expense situations.

•    You have read, agree to, and will abide by all FSA and DCA rules of the LAwell program and the City’s flexible spending accounts administrator, WageWorks. These full rules are available at keepingLAwell.com and at wageworks.com.

IMPORTANT: You must keep your records up-to-date. Immediately inform your employer if your mailing address or other personal information changes.

Transit Subsidy Account and Parking Subsidy Account Terms and Conditions

By participating in the Transit Subsidy Account (TSA) and/or Parking Subsidy Account (PSA), your completion of an election event will serve as your agreement that you have read, agreed to, and will abide by the full TERMS AND CONDITIONS for the LAwell Program TSA and PSA as follows:

•  Per Internal Revenue Code regulations, any funds that you contribute through pre-tax payroll deductions cannot be refunded.

•  You may enroll, suspend, or modify your participation in the TSA/PSA programs at any time during the year. Any changes must be requested in accordance with the TSA/PSA payroll change schedule. You are not entitled to a refund of contributions for late change requests.

•  A $1.50 administrative fee will be deducted from each paycheck. This is a flat fee for any combination of flexible spending accounts (FSA) administered by the City’s FSA administrator, WageWorks. Only one administrative fee applies if you are enrolled in more than one account (e.g., TSA/PSA program; Healthcare Flexible Spending Account; Dependent Care Reimbursement Account).

•  The minimum contribution to the TSA/PSA is $10 per pay period.

•  You are not required to make your transit purchases in the month you make your contribution. Funds can be accumulated and used whenever you wish.

•  The TSA/PSA balance in your WageWorks account cannot exceed $1,500 total. The program administrator may suspend TSA/PSA payroll deductions if they exceed the TSA/PSA maximum account balance.

•  Once you have your first payroll deduction, you must create an account via the WageWorks website at wageworks.com and place an order to use your available funds. Please note that it may take up to two pay periods from your initial payroll deduction before you are able to create an online account and place your first order.

•  TSA/PSA orders must be placed by the 10th of the month via the WageWorks website for funding to be placed on your card or to have your name added to the list of authorized users at your chosen lot for the following month.

•  There are no “use it or lose it” provisions that happen at year-end; funds roll over to subsequent years until you terminate from the City or transfer to DWP, at which point:

- Any balance remaining in your PSA will be forfeited.

- You will have 90 days to use any balance remaining in your TSA
before it is forfeited.

•  The program administrator may suspend employee TSA/PSA payroll deductions if they exceed the TSA/ PSA maximum account balance.

•  You have read, agree to, and will abide by all TSA and PSA rules of the LAwell and COMMUTEwell programs and by the City’s flexible spending accounts administrator, WageWorks. These rules are available at keepingLAwell.com, LACOMMUTEwell.com, and wageworks.com.

Additionally, the following terms and conditions apply to the PSA:

•  The PSA program cannot be used by employees at City-owned or leased lots (e.g., lots at City Hall East, Fig. Plaza, Police Admin. Building), as parking is provided directly to eligible employees, subject to availability of spaces, and is a pre-tax benefit.

•  In certain instances, parking passes can be purchased directly through WageWorks. You must purchase your parking pass by the 10th of the month to have your name added to the list of authorized users at your chosen lot for the following month. Your PSA will automatically be debited in the amount you select. You may also use your debit or credit card to cover the costs of a purchase if you have not yet accumulated enough in your PSA.

•  Employees can make a parking purchase directly at a garage/parking lot and file a claim to receive reimbursement from available PSA funds. In order to file a claim, employees must notify WageWorks before the 10th of the month and indicate the amount that they plan to spend in the following month. Claims may be filed up to six months after purchase through WageWorks. An employee’s PSA will be debited and a reimbursement check will be mailed to the address on file.

The Terms and Conditions of the COMMUTEwell program are subject to change without notice and are provided in their entirety at LACOMMUTEwell.com.

You must keep your records up to date. Please inform COMMUTEwell program staff if you have any of the following changes: work address change, vehicle change, employment change (e.g., changing departments/retiring), and work schedule change (day shift/night shift).