3307:1-11-04 Health care services - effective date.

 

 

 

3307:1-11-04               Health care services - effective date.

 

 

 

(A)   The effective date of medical, dental and vision plan coverage for benefit recipients and enrolled dependents shall be determined as follows:

 

(1)   Disability benefit recipients - if the recipient elects coverage when a benefit is granted, coverage shall begin on the first of the month following retirement board approval of the benefit payment.

 

(2)     Service retirement or survivor benefit recipients - if the recipient elects coverage when a benefit is granted, coverage shall begin on the first of the month following the date the application is filed with the state teachers retirement system or effective date of retirement, whichever is later.

 

(3)   If the recipient does not elect to enroll in a medical plan when a benefit is first granted and later applies for medical plan coverage, coverage shall begin as follows:

 

(a)     Coverage will begin on the first day of January following an open enrollment period specified by the state teachers retirement system.

 

(b)    Coverage will begin on the first of the month following termination of other group coverage if application for coverage is received and approved by the state teachers retirement system within the thirty-one days after the termination of such other coverage.

 

(4)   Through December 31, 2010, coverageCoverage will begin after the completion of a six-month waiting period following application for coverage by a recipient who is not at the time of application covered under another group health care plan or covered under another group plan that will not be terminating. The six-month period begins the month in which the application is received.

 

Effective January 1, 2011, coverage will begin after the completion of a ninety-day waiting period following application for coverage by a recipient who is not at the time of application covered under another group health care plan or covered under another group plan that will not be terminating. The ninety-day period begins the month in which the application is received.

 

(5)   Coverage for a new spouse enrolled by a service or disability benefit recipient will be effective on the first of the month following the marriage, if a written application is received by the retirement system within thirty-one days of the marriage or within the first month in which a change in plan of payment is effective that qualifies the new spouse for a monthly benefit upon the death of

 

 

a service retirant.

(6)

(a)     Coverage for a newborn or adopted child of a service, disability or survivor recipient will begin on the day of birth or adoption, provided that a written application is received by the retirement system within thirty-one days of birth or adoption.

(b)   If coverage for other dependent children is already in effect and a written application is received by the retirement system later than thirty-one days after the birth or adoption, coverage shall be effective the first of the month after receipt of the application.

(c)     Through December 31, 2010, if If no coverage for other dependent children is already in effect and a written application is received by the retirement system later than thirty-one days after the birth or adoption, coverage shall not be effective until the completion of a six-month waiting period. The six-month waiting period begins the month in which the application is received.

Effective January 1, 2011, if coverage for other dependent children is not already in effect and a written application is received by the retirement system later than thirty-one days after the birth or adoption, coverage shall not be effective until the completion of a ninety-day waiting period. The ninety-day waiting period begins the month in which the application is received.

(B)   The effective date of long term care plan coverage shall be as specified by the plan administrator.

Effective:                                                     10/28/2010

R.C. 119.032 review dates:                         04/01/2011

CERTIFIED ELECTRONICALLY

Certification

10/18/2010

Date

Promulgated Under:                           111.15

Statutory Authority:                           3307.04

Rule Amplifies:                                  3307.39, 3307.391

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.), 11/27/98, 5/25/00,

7/1/01 (Emer.), 9/17/01