3307:1-11-03 Health care services - cost.

 

 

 

3307:1-11-03               Health care services - cost.

 

 

 

(A)   AnA plan enrollee's cost to participate in the medical plan health care program will be determined as follows:

 

(1)   Costs shall be based upon service credit, the effective date of benefits, and such other factors as the state teachers retirement board may find relevant. Except as provided in paragraph (A)(3)(c) of this rule, service credit used in calculating an a plan enrollee's cost shall be the service credit used in the calculation of service retirement benefits, which excludes service credit purchased under section 3307.741 of the Revised Code. The state teachers retirement board shall annually review costs and premiums charged for participation in the medical plan health care program and shall establish a schedule for determining or calculating plan enrollee costs and premiums.

 

(2)    Enrolled benefit recipients shall pay all costs or premiums through benefit deduction unless the amount of a benefit will not cover such costs. In that case, the benefit recipient will be billed directly by the state teachers retirement system for any balance remaining through invoices for an initial period not to exceed three months and then by monthly electronic debit of the balance owed. It will be the sole responsibility of the benefit recipient to provide and maintain the information and available funds required for the retirement system to complete the monthly electronic debit. Should the retirement system be unable to debit the payment electronically after the initial three month period, enrollment in the health care program may be terminated. In all events, if payment is not received on or before the first business day of the month the premium is due, enrollment in the health care program may be terminated. Participation in and coverage under the medical plan may be terminated in the event payment is not made within thirty days.

 

(3)   The state teachers retirement board will not waive any portion of the cost for:

 

(a)   Service benefit recipients with less than fifteen years of total service credit with an effective date of benefits before January 1, 2004.

 

(b)   Spouses or dependents of service and disability benefit recipients.

 

(c)    Any service benefit recipient who retires or who makes application to retire on or after March 17, 1989 and: who

 

has purchased service credit under former section 3307.741 of the Revised Code in order to become eligible for benefits under section 3307.58 of the Revised Code.

 

 

 

 

Until such time as the service benefit recipient is eligible for benefits under section 3307.58 of the Revised Code without regard to service credit purchased under such section, the benefit recipient and all eligible dependents are eligible for participation in the health care program only by paying all premium and associated costs. At such time as the benefit recipient would be eligible for service retirement benefits under section 3307.58 of the Revised Code without regard to service credit purchased under such section, the retirement board may waive a portion of the cost for a benefit recipient with fifteen or more years of total service credit.

(i) Who has purchased service credit under section 145.28, 3307.73, 3307.741, 3307.78 or 3309.301 of the Revised Code in order to become eligible for benefits under section 3307.58 of the Revised Code; or for whom service credit has been purchased under section 145.297, 145.298, 3307.54 or 3309.33 of the Revised Code in order for the member to become eligible for retirement effective on or after September 1, 1996.

(ii) Until such time as the service benefit recipient is eligible for benefits under section 3307.58 of the Revised Code without regard to service credit purchased under such sections, the benefit recipient and all eligible dependents are eligible for participation in the health coverage program only by paying all premium and associated costs. At such time as the benefit recipient becomes eligible for service retirement benefits under section 3307.58 of the Revised Code without regard to service credit purchased under such sections, the state teachers retirement board may waive a portion of the cost for a benefit recipient with fifteen or more years of total service.

(4)

(a)   If benefits have been granted under section 3307.60 of the Revised Code and the effective date of the benefit recipient's retiree's monthly benefits is before January 1, 2004, for the later of five years from January 1, 2004 or the effective date of survivor benefits as defined under the above section benefits to a service retiree's beneficiary, costs for the survivor benefit recipientsbeneficiary and dependents shall be calculated based upon the member's retiree's years of service and other factors as the state teachers retirement board may find relevant. After the five year subsidy period, the state teachers retirement board will not waive any portion of the cost.

(b)   If benefits have been granted under section 3307.60 of the Revised Code and the effective date of the benefit recipient's retiree's monthly benefits is on or after January 1, 2004, the member retiree must have had fifteen or more years of service credit for the survivor service retiree's beneficiary and dependents to qualify for the five year total subsidy period. In the event the benefit recipient retiree named multiple beneficiaries under division (A)(4) of section 3307.60 of the Revised Code, the percent subsidy for which the benefit recipient retiree was eligible will be allocated equally among the surviving beneficiaries for the five year subsidy period. After the five year subsidy period, the state teachers retirement board will not waive any portion of the cost.

(5)

(a)   If benefits have been granted under division (C)(1) of section 3307.66 of the Revised Code as the result of the death of a member eligible for service retirement, and the effective date of survivor benefits is before January 1, 2004, for the later of five years from January 1, 2004 or the effective date of survivor benefits as defined under the above section, costs for the survivor benefit recipients and dependents shall be calculated based upon the member's years of total service credit and other factors as the state teachers retirement board may find relevant. After the five year subsidy period, the state teachers retirement board will not waive any portion of the cost.

(b)   If benefits have been granted under division (C)(1) of section 3307.66 of the Revised Code as the result of the death of a member eligible for service retirement, and the effective date of survivor benefits is on or after January 1, 2004, the member must have had fifteen or more years of total service credit for the survivor and dependents to qualify for the five year subsidy period unless the member was receiving state teachers retirement system disability benefits pursuant to section 3307.62 of the Revised Code at the time of death. If the member was receiving a disability benefits recipient at the time of death, the effective date of disability benefits is used for determining whether the member had fifteen or more years of total service credit for the survivor to qualify for the five year subsidy period.

(c)    If benefits are granted under division (C)(2) of section 3307.66 of the Revised Code as the result of the death of a member, for the later of five years from January 1, 2004 or the effective date of survivor benefits as defined under the above section, costs shall be calculated based upon the greater of the member's years of total service credit or

fifteen years and other factors as the state teachers retirement board may find relevant. After the five year subsidy period, the state teachers retirement board will not waive any portion of the cost.

(B)   AnA plan enrollee's cost to participate in the an ancillary plans plan shall be the full cost of coverage as specified by the state teachers retirement board.

Effective:                                                     02/10/2014

R.C. 119.032 review dates:                         11/26/2013 and 06/01/2016

CERTIFIED ELECTRONICALLY

Certification

01/31/2014

Date

Promulgated Under:                           111.15

Statutory Authority:                           3307.04

Rule Amplifies:                                  3307.39, 3307.61

Prior Effective Dates:                         12/23/76, 11/28/77, 3/17/89 (Emer.), 6/1/89, 9/23/91

(Emer.), 5/28/92, 6/22/92 (Emer.), 9/10/92, 2/13/93,

9/1/96, 7/3/97, 9/16/98 (Emer.), 7/3/97, 9/16/98 (Emer.), 11/27/98, 5/25/00, 7/1/01 (Emer.), 9/17/01, 9/17/02, 1/1/04 (Emer.), 3/22/04, 10/27/06, 1/6/08,

5/14/09