145-4-13 Waiver program grandfathered.

 

 

 

145-4-13                      Waiver program grandfathered.

 

 

 

(A)   This rule applies to a benefit recipient who irrevocably waived health care coverage under the version of rule 145-4-04 of the Administrative Code in effect prior to January 1, 2007, and an individual who irrevocably waived health care coverage in another Ohio retirement system prior to January 1, 2007.

 

(B)

 

(1)    In the event that an eligible benefit recipient of this system who also was an eligible benefit recipient of another Ohio retirement system irrevocably waived health care coverage under rule 145-4-04 of the Administrative Code in order to be covered by the other Ohio retirement system, this system shall transfer to the other system annually for covered benefit recipients and dependents for each month covered an amount equal to the sum of:

 

(a)   The lesser of this system's average monthly medical cost including health maintenance organization or health insuring corporation cost per benefit recipient less the cost paid by the benefit recipient, or the other system's average monthly medical cost including health maintenance organization or health insuring corporation cost per benefit recipient.

 

(b)    The lesser of this system's average monthly cost of the prescription drug program per benefit recipient, or the other system's average monthly cost of the prescription drug program per benefit recipient.

 

(c)   The lesser of the monthly cost of the medicare part B premium that would be reimbursed by this system for the benefit recipient, or the monthly cost of the medicare part B premium that would be reimbursed by the other system for the benefit recipient.

 

(2)   This system shall transfer the amounts due pursuant to paragraph (B)(1) of this rule no later than the last business day of February each year for the preceding calendar year after the following occur:

 

(a)   This system receives from the other system a list containing the names of benefit recipients and the number of months during which the recipients were covered by the other system for the preceding calendar year; and

 

(b)   This system prepares an itemized accounting of the amount transferred for each such benefit recipient.

 

(C)  Where an eligible benefit recipient or dependent of an eligible benefit recipient of this

 

 

system has waived health care coverage in another Ohio retirement system prior to January 1, 2007, this system shall be responsible to provide health care coverage only if the other Ohio retirement system pays annually to this system for covered benefit recipients and dependents for each month covered, an amount equal to the sum of:

(1)       The lesser of this system's average monthly medical including health maintenance organization or health insuring corporation cost per benefit recipient less the cost paid by the benefit recipient, or the other system's average monthly medical including health maintenance organization or health insuring corporation cost per benefit recipient.

(2)     The lesser of this system's average monthly cost of the prescription drug program per benefit recipient, or the other system's average monthly cost of the prescription drug program per benefit recipient.

(3)    The lesser of the monthly cost of the medicare part B premium that would be reimbursed by this system for the benefit recipient, or the monthly cost of the medicare part B premium that would be reimbursed by the other system for the benefit recipient.

(D) For coverage years commencing on and after January 1, 2016, eligibility for health care coverage of dependents of eligible benefit recipients described in paragraph (C) of this rule shall be determined by rule 145-4-14 of the Administrative Code. A dependent may enroll in other available coverage as defined in rule 145-4-14 of the Administrative Code or, if the dependent does not voluntarily terminate coverage, elect continuation coverage from this system as described in paragraph (H) of rule 145-4-03 of the Administrative Code.

Effective:	01/01/2015
Five Year Review (FYR) Dates:	09/26/2018
CERTIFIED ELECTRONICALLY
Certification
10/27/2014
Date
Promulgated Under:	111.15
Statutory Authority:	145.09, 145.58
Rule Amplifies: Prior Effective Dates:	145.58, 145.584 08/1/98, 2/3/00, 1/1/03, 1/1/07, 4/6/07 (Emer.), 7/1/07, 1/1/09, 1/7/13 (Emer.), 3/24/13