3309-1-55 Responsibility for health care coverage.

 

 

 

3309-1-55                    Responsibility for health care coverage.

 

 

 

(A)  This rule amplifies division (DF) of section 3309.69 of the Revised Code.

 

(B)  For the purpose of this rule:

 

(1)     "Age and service retirant" means a former member who is receiving a retirement  allowance  pursuant  to  section  3309.34,  3309.35,  3309.36  or

3309.381 of the Revised Code.

 

(2)   "Cost paid by the benefit recipient" means the amount equal to the percentage as of January 1, 1998 paid by the benefit recipient multiplied by the system's cost per benefit recipient.

 

(3)    "Disability benefit recipient" means a member who is receiving a benefit or allowance  pursuant  to  section  3309.35,  3309.39,  3309.40  or  3309.41

3309.401 of the Revised Code.

 

(4)    "Eligible benefit recipient" means an age and service retirant, disability or survivor benefit recipient who is eligible for health care coverage under this system.

 

(5)    "Eligible dependent" means an eligible spouse or child of an eligible benefit recipient.

 

(6)   "Health care coverage" means the plan offered by this system including, but not limited to, the medical plan, the prescription drug program, and the medicare part B premium reimbursement.

 

(7)    "Ohio retirement system" means public employees retirement system, state teachers retirement system, school employees retirement system, Ohio police and fire pension fund, or highway patrol retirement system.

 

(8)   "Survivor benefit recipient" means a beneficiary receiving a benefit pursuant to section 3309.45 or 3309.46 of the Revised Code.

 

(C)   Health care coverage provided by this retirement system under sections 3309.69 and

3309.375 of the Revised Code shall pay covered medical expenses for eligible benefit recipients of this retirement system prior to payment under any available coverage from another Ohio retirement system if the available coverage is provided to the individual as the spouse or dependent of another person.

 

 

 

 

(D)    Health care coverage provided by this system shall pay only the covered medical expenses not paid or reimbursed by any available coverage from another Ohio retirement system if either of the following occur:

(1)     In the case of an eligible benefit recipient, the available coverage is not provided as a dependent of another person, and has been in effect for a longer time than the health care coverage provided by this system;

(2)     In the case of a dependent, the available coverage is not provided as the dependent of another person or is provided as the dependent of  another person but has been in effect for a longer time than the health care coverage provided by this system.

(E)    Except as otherwise provided in this rule, the school employees retirement system shall not be the system responsible for health care coverage for eligible benefit recipients or eligible dependents of eligible benefit recipients of this system who waive or are otherwise eligible for any available coverage from another Ohio retirement system after December 31, 2007.

(F)   Each eligible benefit recipient and eligible dependent enrolled in health care coverage provided by this system shall annually make a report to the system or, an entity designated by the system, stating whether the person has other available coverage. The report shall include any information requested by the system or entity.

(G)

(1)    If an eligible benefit recipient of this system who also was an eligible benefit recipient of another Ohio retirement system irrevocably waived such health care coverage in this system on or before December 31, 2007 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 including health maintenance organization 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 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 (G)(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.

(H)    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 on or before December 31, 2007, this system shall be responsible to provide health care coverage only if the other 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 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 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.

Effective:                                                     01/07/2013

R.C. 119.032 review dates:                         02/01/2016

CERTIFIED ELECTRONICALLY

Certification

12/28/2012

Date

Promulgated Under:                           111.15

Statutory Authority:                           3309.04

Rule Amplifies:                                  3309.375, 3309.69

Prior Effective Dates:                         8/10/98, 5/2/01, 3/1/07, 12/10/09