3307:1-11-02 Health care services - eligibility.

 

 

 

3307:1-11-02               Health care services - eligibility.

 

 

Subject to the requirements of Chapter 3307:1-11 of the Administrative Code the specific requirements of the various plans that may be offered, the following shall be eligible to participate in the medical and ancillary plans offered by the retirement system:

 

(A)    A  person  granted  service,  disability  or  survivor  benefits  granted  under  sections

3307.50 to 3307.79 of the Revised Code or under a plan that provides health care coverage under section 3307.81 of the Revised Code whose effective date of benefits is prior to January 1, 2004.

 

(B)   A person granted service benefits under a plan established under section 3307.81 of the Revised Code that provides health care coverage sections 3307.50 to 3307.79 of the Revised Code or under a plan that provides health care coverage under section 3307.81 of the Revised Code with fifteen or more years of Ohio-valued service credit whose benefit effective date is January 1, 2004 or later.

 

(C)The spouse of the service or disability benefit recipients, including a spouse who becomes married to such a recipient after the effective date of a benefit.

 

(C)A person granted disability benefits under sections 3307.50 to 3307.79 of the Revised Code or under a plan that provides health care coverage under section 3307.81 of the Revised Code.

 

(D)A person granted disability benefits under sections 3307.50 to 3307.79 of the Revised Code or under a plan that provides health care coverage under section 3307.81 of the Revised Code who converts to service retirement with no break in receipt of monthly benefits.

 

(E)A  person  granted  survivor  benefits  under  section  3307.60  of  the  Revised  Code provided:

 

(1)The effective date of monthly survivor benefits is before January 1, 2004; or

 

(2)The effective date of monthly survivor benefits is January 1, 2004 or later and the deceased member had fifteen or more years of service credit.

 

(F) A person granted survivor benefits under section 3307.66(C)(2) of the Revised Code.

 

(G)A person granted survivor benefits under section 3307.66 (C)(1) of the Revised Code provided:

 

(1)The effective date of survivor benefits or the effective date of disability benefits of the deceased member is before January 1, 2004; or

 

(2)The effective date of survivor benefits is January 1, 2004 or later and the deceased member had fifteen or more years of service credit.

 

 

(D)(H) The dependent children of the foregoing benefit recipients, including children born after the effective date of a benefit, provided that such children are:

(1)   Unmarried and under age eighteen; or

(2)   Unmarried, and under age twenty-two if the benefit recipient's effective date of benefits was January 1, 2003, or later or under age twenty-three if the effective date of benefits was prior to January 1, 2003, and the dependent is attending school on at least a two-thirds of full-time basis and dependent solely on the benefit recipient for support, provided that in the case of the recipient of a benefit effective prior to January 1, 2003 such children under the age of twenty-three may qualify if they meet the other requirements of this paragraph. the benefit recipient is providing at least fifty per cent or more financial support. If dependent children are survivors of a member who was receiving benefits at the time of death, the effective date of the member's benefits is used for determining the maximum age in which the children qualify for health care coverage.

(3)   Unmarried and unable to earn a living because of a mental or physical condition that was disabling prior to the date a child reached the maximum age specified by paragraph (D)(1) or (D)(2) of this rule, provided:

(a)    An impartial, independent physician appointed by the retirement system confirms that the child has a mentally or physically disabling condition that was disabling before the child reached age eighteen, or if the child is attending school on at least a two-thirds of full-time basis, that such condition was disabling before the age specified by paragraph (D)(2) of this rule and the child was claimed as a dependent on the benefit recipient's federal income tax return for the current or preceding calendar year; or

(b)    An impartial, independent physician appointed by the retirement system confirms that the child has a mentally or physically disabling condition that was disabling before the child reached age eighteen, or if the child is attending school on a least a two-thirds of full-time basis, that such condition was disabling before the age specified by paragraph (D)(2) of this rule and the child is incapable of earning at least sixteen thousand dollars annually; or

(c)   The child attends an adult workshop or school for the mentally retarded or developmentally disabled operated by a county or state board of mental retardation and developmental disabilities.

(d)  Annual confirmation of a child's status is required for the child to continue to qualify for coverage.

(e)    The chair of the medical review board shall determine whether a child meets the requirements of this division. Determinations made by the chair may be appealed to another independent physician appointed as hearing officer in accordance with procedures specified by the retirement system. The decision of such hearing officer shall be deemed the final decision of the retirement board.

(I) The spouse of a service or disability benefit recipient described in paragraphs (A), (B), (C) or (D) of this rule including a spouse who becomes married to such a recipient after the effective date of benefits.

(E)(J) A sponsored dependent of the foregoing benefit recipients, to the extent that a medical or ancillary plan allows coverage for sponsored dependents.

Effective:                                03/22/2004

R.C. 119.032 review dates:    12/18/2003 and 03/01/2009

CERTIFIED ELECTRONICALLY

Certification

03/12/2004

Date

Promulgated Under:   111.15

Statutory Authority:   3307.04

Rule Amplifies:           3307.39, 3307.61

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.)