3307:1-11-11 Health care assistance.
(A) As used in this rule:
(1) "Earnings" shall mean the total of all job-related income, pension, disability and survivor benefits received, including any portion of a benefit or increase for which a written notice of waiver has been filed with the retirement board pursuant to section 3307.44 of the Revised Code, with the public employees retirement board pursuant to section 145.562 of the Revised Code or with the school employees retirement board pursuant to section
3307.6623309.662 of the Revised Code, social security payments, welfare benefits, workers' compensation benefits, child or spousal support, unemployment benefits, investment income and all reportable income according to the Internal Revenue Code of 1986.(2) "Low-income earnings threshold" as used in this rule shall be equal to the minimum salary for a teacher with a bachelor's degree and five years experience as defined in section 3317.13 of the Revised Code, provided that in the event an individual experiences a life event once a calendar year has begun, such amounts shall be determined on a prorated basis as of the date the life event took place.
(3) "Liquid assets" shall include cash and all monies readily available to a family unit in savings accounts, checking accounts, money market accounts, trust funds, any publicly traded security or other investment vehicles as the board may from time to time specify.
(4) "Family unit" shall include the qualifying enrollee, spouse and children as defined in paragraph
(B)(1)(C)(2) of rule 3307:1-11-01 of the Administrative Code.(5) A "Qualifying enrollee" shall include
personsa person who:(a)
WereWas:(i) Granted service retirement under
sections 3307.50 to 3307.79 of theRevised Codethe STRS defined benefit plan with at least twenty-five years of total service credit at retirement that is notservice credit excluded from premium waiver under the terms ofparagraph (A)(3)(c) of rule 3307:1-11-03 of the AdministrativeCode orservice credit purchased under former section 3307.741 of the Revised Code; or(ii) Granted disability benefits under the STRS defined benefit plan
sections 3307.50 to 3307.79 of the Revised Code, or(iii)
BeneficiariesEligible beneficiaries, as defined in paragraph (F) of rule 3307:1-11-02 of the Administrative Code, of retired teachers with at least twenty-five years of total service credit at retirementand none of the service credit is excluded from premium waiverunder the terms of paragraph (A)(3)(c) of rule 3307:1-11-03ofthe Administrative Code orthat is not service credit purchased under former section 3307.741 of the Revised Code; or(iv)
SurvivorsEligible survivors, as defined in paragraph (H) of rule 3307:1-11-02 of the Administrative Code, of either active teachers or disabled teachers eligible to retire with at least twenty-five years of total service credit at retirementand none ofthe service credit is excluded from premium waiver under theterms of paragraph (A)(3)(c) of rule 3307:1-11-03 of theAdministrative Code orthat is not service credit purchased under former section 3307.741 of the Revised Code; or(v)
SurvivorsEligible survivors, as defined in paragraph (G) of rule 3307:1-11-02 of the Administrative Code, of either active teachers or disabled teachers not eligible for service retirement; and(b) Had annual earnings not greater than the low-income earnings threshold for the family unit of the person described in paragraph (A)(5)(a) of this rule and
(c) Had total liquid assets that did not exceed twenty-three thousand eight hundred dollars for the family unit of the person described in paragraph (A)
(4)(5)(a) of this rule.(6) "Life event" includes the death of a spouse, divorce, loss of job or other events as the board may from time to time specify.
(7) "Minimum monthly health care premium" shall mean the lowest monthly premium charged any
memberbenefit recipient for anygroup medicalhealthcareplan offered by thestate teachersretirement system.(B) A
qualifiedqualifying enrollee may make application for health care assistance on a form provided by the retirement system. The effective date of the participation inthe health care assistance program shall be the first of the month following the approval of the application. All applications for assistance must be received no later than the fifteenth of the month to be considered for approval for an effective date starting the next month.
(1) Each applicant shall demonstrate eligibility by providing the information specified on the form, which shall include copies of any federal tax return for the applicant, the spouse and any dependent children necessary to validate the earnings reported on an application and shall also include verification of medicare enrollment if applicable.
(2) An
application of an individualapplicant who fails to supply all requested information within three months of filing shall be canceled.(C) A
qualifiedqualifying enrollee receiving health care assistance must annually verify continuing eligibility on a form provided by the retirement system to continue participation in the program. Failure to file the form or supply all requested information shall result in theindividualenrollee no longer qualifying for the program and all health care assistancebenefitsshall be terminated.(D) On and after July 1, 2004 and provided that the retirement board has not acted to terminate the health care assistance program hereby created, enrollees whose applications are
grantedapproved under this rule shall qualify for:(1) A minimum monthly health care premium in a health plan offered by the retirement system, and
(2) Health care assistance
plan benefitsas determined by the board through certain health plans offered by thestate teachersretirement system.(3)
A "qualifying enrollee" may elect to accept only the minimum health carepremium and forego the health assistance plan benefits.(4)(3) The minimum monthly health care premium will not be in effect for any period the qualifying enrollee fails to provide verification ofthe individual'shis or her medicare enrollment.(E) For qualifying enrollees making application for health care assistance at the same time application for service retirement or disability benefits are made,
the benefitshealth care assistance as described in paragraph (D) of this rule shall take affect the first of the month following the approval of the health care assistance application or the first of the month after the monthly benefit amount is finalized, whichever is later. All applications for health care assistance must be received no later than thefifteenth of the month to be considered for approval for an effective date starting the next month.
(F)
AssistanceHealth care assistance under this rulegrantedprovided as the result of false information submitted on an application shall be terminated immediately. Any person who submits false or misleading information in connection with an application for health care assistance shall immediately repay the amounts of any health care assistance provided to date. If such amounts remain unpaid, they shall be deducted from any future amounts payable under Chapter 3307. of the Revised Code.Effective: 06/12/2014
R.C. 119.032 review dates: 03/24/2014 and 06/01/2016
CERTIFIED ELECTRONICALLY
Certification
06/02/2014
Date
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
Prior Effective Dates: 7/1/04 (Emer.), 8/26/04, 7/1/07 (Emer.), 9/24/07,
5/14/09
Document Information
- Effective Date:
- 6/12/2014
- File Date:
- 2014-06-02
- Last Day in Effect:
- 2014-06-12
- Five Year Review:
- Yes
- Rule File:
- 3307$1-11-11_FF_A_RU_20140602_0810.pdf
- Related Chapter/Rule NO.: (1)
- Ill. Adm. Code 3307:1-11-11. Health care assistance