RD849 - Line of Duty Act Eligibility Determination Report 2021
The Line of Duty Act (LODA) program, Title 9.1 of the Code of Virginia, was established in 1972. LODA provides benefits to eligible family members of eligible employees and volunteers killed in the line of duty and to those eligible employees and volunteers disabled in the line of duty and their eligible family members.
Employers fund LODA benefits in one of two ways:
• Participation in the Line of Duty Death and Health Benefits Trust Fund (LODA Fund) administered by the Virginia Retirement System (VRS).
• Self-funding by the employer or through the employer’s insurance company.
Initially, the Department of Accounts (DOA) administered the program, with VRS overseeing the LODA Trust Fund. However, the 2017 General Assembly passed House Bill 1345 making VRS the LODA program administrator and the Virginia Department of Human Resource Management (DHRM) responsible for administering the LODA Health Benefits Plans.
As required in Title 9.1, the benefits include premium-free medical coverage, one-time retroactive health insurance premium reimbursement, and, in the case of approved death claims, a one-time death benefit payment. The one-time retroactive health insurance premium reimbursement covers health insurance premiums paid between the date the employer ceased to subsidize medical premiums and the health benefits plan enrollment date.
As established in statute, VRS makes eligibility decisions for eligible individuals who are permanently disabled or whose death occurred in the line of duty because of a work-related accident or a presumptive illness. In addition to determining eligibility, VRS issues benefit payments on behalf of the LODA Fund participating employers, issues notification for benefit payments for employers who opted not to participate in the LODA Fund (LODA Fund non-participating employers), and handles the daily management of the program, including actuarial oversight of the LODA Fund. VRS partners with DHRM, the Virginia State Police and the VRS medical review board to administer the program. The VRS medical review board is an independent, third-party administrator comprised of physicians and other healthcare professionals who review medical records provided by the LODA claimant.
The LODA Health Benefits Plans administered by DHRM provide premium-free medical coverage for approved LODA applicants, eligible spouses, and eligible dependent children. Eligibility for applicants, spouses, and dependents is defined in § 9.1-400 of the Code of Virginia. DHRM uses income verification, remarriage, death of health plan participant, dependent eligibility based on age, return to full duty and Medicare eligibility due to age (approved applicants with a date of disability after July 1, 2017) to determine eligibility for the LODA Health Benefits Plans.
As required by Chapter 552 of the 2021 Special Session I Acts of Assembly, this report summarizes the LODA program claims data, eligibility decisions and program costs for fiscal year 2021 (FY 2021).
The specific requirement in Item 492(H) of the 2021 Appropriation Act is cited below:
“The Virginia Retirement System and the Department of Human Resource Management shall report annually on or before January 1 to the Governor and the Virginia General Assembly the detailed aggregate of eligibility determinations for employees in accordance with § 9.1-400. This report shall tabulate claims data, types of injuries and associated costs with provided benefits. In accordance with § 9.1-408, the name of the employer or employee shall not appear in such publications and all documents to determine eligibility shall remain confidential."