3307:1-11-06 Health care services - open enrollment and plan changes.

 

 

 

TO BE RESCINDED

 

3307:1-11-06               Health care services - open enrollment and plan changes.

 

 

 

(A)   The state teachers retirement system may annually offer an open-enrollment period during which eligible benefit recipients may enroll or change medical plans for themselves and eligible dependents.

 

(B)     The medical plan option selected by the eligible benefit recipient during open enrollment cannot be changed for the next calendar year, with the following exceptions:

 

(1)    A change in plan administrators, plan levels or both may occur if any of the following conditions are met:

 

(a)   The plan enrollee requests the change within three months before or after the effective date of medicare benefits.

 

(b)   The plan enrollee requests the changes within thirty-one days of receiving a first full monthly benefit.

 

(c)       The  plan  enrollee  is  enrolled  in  a  medicare  health  maintenance organization (HMO) and requests the change at any time.

 

(d)   The plan enrollee requests the change within thirty-one days of one of the following qualifying events:

 

(i)   Marriage

 

(ii)    Birth, adoption, placement for adoption or legal guardianship of a child

 

(iii)   Death

 

(iv)   Divorce or dissolution

 

(v)   Legal separation

 

(vi)   Full loss of premium subsidy

 

(vii)   Termination of other coverage, or

 

 

 

(viii)    Upon initial eligibility and enrollment into medicare parts A and B or part B only.

(e)    The plan enrollee who enrolls as the beneficiary of a service retirement benefit recipient and who was enrolled as a dependent at the time of the service retirement benefit recipient's death requests a change of plans or plan administrators by the end of the third month following the month of the service retirement benefit recipient's death.

(2)   A plan enrollee may change plan administrators only if the following occur:

(a)      The plan enrollee is enrolled in a commercial health maintenance organization (HMO) or preferred provider organization (PPO) and experiences a loss of a key provider from the network.

(b)   The plan enrollee moves to another service area, which results in different state teachers retirement system sponsored medical care plans being available.

(c)     The plan enrollee wants to add a sponsored dependent to his or her coverage and the medical plan he or she is enrolled in does not allow sponsored dependents.

Effective:                                                             06/10/2016

Five Year Review (FYR) Dates:                         03/23/2016

CERTIFIED ELECTRONICALLY

Certification

05/31/2016

Date

Promulgated Under:                           111.15

Statutory Authority:                           3307.04

Rule Amplifies:                                  3307.39

Prior Effective Dates:                         12/23/76, 11/28/77, 3/17/89 (Emer.), 6/1/1989,

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.), 1/1/04 (Emer.), 3/22/04,

5/14/09, 6/12/14, 9/4/14