145-4-03 Health care coverage.

 

 

 

145-4-03                      Health care coverage.

 

 

 

(A)Dental, vision, and health care coverage for an eligible primary benefit recipient may be available upon application on a form provided by the public employees retirement system. For dependent health care coverage that commences on and after January 1, 2007, a primary benefit recipient may enroll an eligible dependent as defined in rule 145-4-09 of the Administrative Code.

 

(B)Applications for health care coverage must be received by the public employees retirement system not later than sixty days after the benefit recipient's initial benefit payment. If the application is received more than sixty days after the benefit recipient's initial benefit payment, the retirement system shall not accept the application and enrollment may occur only during the next annual health care open enrollment period.

 

(C)Upon the recommendation of the actuary retained by the board, the board shall determine annually the portion of the self-supporting rate it shall pay for eligible benefit recipients and eligible dependents enrolled in health care coverage.

 

(D)If the monthly premium for dental, vision, or health care coverage exceeds the monthly benefit, the benefit recipient shall pay the premiums as directly billed by the retirement system or a third party under contract with the board to administer collection of monthly premiums. Billings shall conform to a monthly billing schedule.

 

(E)An ineligible individual, as defined in section 145.58 of the Revised Code, may be enrolled in a health care plan administered by a third party health care administrator(s). Such ineligible individual shall pay all required premiums directly to the health care administrator in the time and manner prescribed by the third party health care administrator. The retirement system shall not be responsible for any premiums, claims, or withholding of premiums for such health care plan.

 

(F) An eligible benefit recipient may waive health care coverage. Such waiver is effective beginning the first of the month following the retirement system's receipt of the waiver. The waiver is effective as to both the benefit recipient waiving coverage and the benefit recipient's dependents. A benefit recipient may revoke the waiver by filing an application for enrollment in health care coverage during one of the following:

 

(1)The annual open enrollment period for health care coverage, except that the waiver remains effective until January first of the next year;

 

(2)Within thirty-one days of involuntary termination of coverage under another group plan, and with proof of such termination, except that the waiver remains effective until the first of the following month if the application is received by the fifteenth day of the preceding month, otherwise the waiver remains effective until the first day of the next succeeding month.

 

 

 

(G) An individual who is eligible for health care coverage from more than one benefit may not enroll for health care coverage simultaneously under more than one benefit.

(H) Regardless of the reason for eligibility, all enrolled benefit recipients and dependents shall enroll in medicare part B at the benefit recipient or eligible dependent's first eligible date.

Replaces:                                                     145-4-01.

Effective:                                                     01/01/2007

R.C. 119.032 review dates:                         09/29/2008

CERTIFIED ELECTRONICALLY

Certification

10/17/2006

Date

Promulgated Under:                           111.15

Statutory Authority:                           145.09, 145.58.

Rule Amplifies:                                  145.325, 145.58.

Prior Effective Dates:                         1/1/05; 4/15/04; 1/1/03; 8/8/02; 3/22/02; 10/9/00;

5/4/00; 6/29/96; 4/1/93; 12/9/88; 8/20/76.