145-4-09 Definition of "eligible dependent" for health care coverage.

 

 

 

TO BE RESCINDED

 

145-4-09                      Definition of "eligible dependent" for health care coverage.

 

 

 

(A)  As used in this chapter, "eligible dependent" means any of the following:

 

(1)   The spouse of a primary benefit recipient. The spouse shall be an individual of the opposite gender who establishes a marriage by a valid marriage certificate recognized by Ohio law.

 

(2)   The biological or legally adopted child of a primary benefit recipient, provided the child has never been married and to whom all of the following apply:

 

(a)   The child is one of the following:

 

(i)   Under age eighteen;

 

(ii)     Under age twenty-two if the child is a full-time student at an education organization described in section 170(b)(1)(A)(ii) of the Internal Revenue Code or certain institutional on-farm training program pursuant to section 152(f)(2) of the Internal Revenue Code for at least five months of the calendar year;

 

(iii)     Is permanently and totally disabled prior to the limiting ages set forth in paragraph (A)(2)(a)(i) or (A)(2)(a)(ii) of this rule. For purposes of this paragraph "permanently and totally disabled" means the individual is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than twelve months.

 

(b)   Provides not more than one-half of his or her own support for the calendar year.

 

(c)     Resides at the same principal place of abode as the primary benefit recipient for more than one-half of the calendar year, unless all of the following apply:

 

(i)     The parents of a child are divorced, legally separated, separated under a written separation agreement, or are living apart at all times during the last six months of the calendar year, and the primary benefit recipient is a parent of the child;

 

 

 

(ii)    The child is in the custody of one or both of the parents for more than one-half of the calendar year;

(iii)    The child receives over one-half of his or her support during the calendar year from the parents, subject to the provisions of section 152 of the Internal Revenue Code regarding multiple support agreements.

(d)    Is a citizen, resident, or national of the United States or a resident of Canada or Mexico. For adopted children, the child has the same principal place of abode as, and is a member of the household of, the primary benefit recipient, who is a U.S. citizen or national.

(3)   The grandchild of a primary benefit recipient for whom the benefit recipient has been ordered pursuant to section 3109.19 of the Revised Code to provide for the health care coverage, provided that the grandchild would, but for the grandchild relationship, meet the requirements of this paragraph.

(4)    A child who is an eligible dependent under paragraph (A)(2) or (A)(3) of this rule and for whom the primary benefit recipient is ordered to provide health care coverage pursuant to a court order, divorce decree, or national medical support notice.

(B)   Upon the death of a primary benefit recipient, any individual who would have been treated as an eligible dependent of the benefit recipient but for the recipient's death shall be treated as an eligible dependent of the primary benefit recipient for purposes of this chapter until the individual reaches the age limitation set forth in paragraph (A)(2)(a) of this rule or provides more than one-half of his or her own support.

(C)   A benefit recipient shall inform the retirement system, in writing, not later than thirty days after an eligible dependent no longer meets the requirements of this rule.

(D)    The retirement system may require a benefit recipient to certify the status of an individual as an eligible dependent for purposes of health care coverage. Failure to provide certification within sixty days of the request by the retirement system, shall result in the denial or withdrawal of health care coverage for such individual until the next annual health care open enrollment period.

Effective:	01/01/2009
R.C. 119.032 review dates:	09/26/2008
CERTIFIED ELECTRONICALLY
Certification
12/09/2008
Date
Promulgated Under:	111.15
Statutory Authority:	145.09, 145.58.
Rule Amplifies: Prior Effective Dates:	145.38, 145.46, 145.58. 10/27/06; 1/1/05.