5505-7-04 Health care.

 

 

 

TO BE RESCINDED

 

5505-7-04                    Health care.

 

 

 

(A)   Eligible benefit recipients and dependents may enroll in any plan offered pursuant to section 5505.28 of the Revised Code.

 

(1)   The annual premium cost for each category of coverage shall be determined by the board prior to the annual open enrollment period.

 

(2)   The benefit recipient shall pay the excess premium cost of an additional plan option.

 

(3)     Open enrollment for any additional plan option shall be established, as necessary by the board.

 

(4)   A retirant who has access to medical coverage through employment must secure it as primary coverage, regardless of cost. In the board's discretion, this provision may be waived if the board deems that cost to be excessive. If the retirant has medical coverage through employment, the retirement system's medical coverage may be secondary; however, the retirement system will still offer primary dental and vision coverage.

 

(B)   The spouse and dependent children of a retirant who is receiving a monthly benefit, are eligible for health care, subject to the following conditions:

 

(1)    A spouse is a wife or husband as set forth in a statutorily-valid certificate of marriage or as recognized by judgment of a court establishing a common-law relationship.

 

(2)   Health care will not be provided to a spouse who is receiving pension benefits from another public retirement system if the spouse has at one time received health care benefits from the other public retirement system.

 

(3)   Dependent children are step-children that are residing in the same household as the retirant, natural children, or adopted children.

 

(4)    The board may require documented proof of marriage or parenthood before approving spouse or dependent coverage.

 

(5)   A spouse who has access to medical coverage through employment must secure it as primary coverage, regardless of cost. In the board's discretion, this provision may be waived if the board deems the cost to be excessive. If the

 

 

spouse has medical coverage through employment, the retirement system's medical coverage may be secondary; however, the retirement system will still offer primary dental and vision coverage.

(6)   The board reserves the right to deny coverage for failure to provide satisfactory proof of eligibility.

(7)    Eligibility for dependent health care coverage is independent of eligibility for survivor benefits.

(C)    Upon the death of a retirant or member, the surviving spouse, dependent children, and step-children are eligible for health care coverage, subject to the following conditions:

(1)    A spouse is a wife or husband as set forth in a statutorily-valid certificate of marriage or as recognized by judgment of a court establishing a common-law relationship.

(2)   Dependent children are natural or adopted children.

(3)     Dependent step-children, residing in the same household as the retirant or member, who had coverage at the time of the retirant's or member's death, may continue coverage, provided the surviving spouse elects to continue coverage.

(4)   In the event a surviving spouse remarries, health care coverage eligibility shall continue for the surviving spouse or any dependent step-children only if coverage existed prior to the remarriage.

(D)    Only benefit recipients and covered dependents who are enrolled under one of the health care plans are eligible for prescription drug coverage.

(E)   Nothing shall prohibit the board from implementing cost control measures as may be deemed necessary.

(F)   Health care eligibility for dependent children of a deceased member or retirant shall terminate when pension benefit eligibility terminates.

(G)    Health care eligibility for the spouse, dependent children, and step-children shall terminate under the following conditions:

(1)   At the end of the month in which the spouse is no longer married to the benefit recipient.

(2)    At the end of the month in which the child or step-child (a) is no longer a dependent of the retirant, (b) is no longer a full-time student, (c) marries, or

(d) attains age twenty-three, whichever occurs first.

(H)     Retirants and benefit recipients who are receiving benefits in accordance with sections 5505.16, 5505.17, and 5505.18 of the Revised Code and are insured under medicare part B will be reimbursed, upon the receipt of evidence of coverage, for the lesser of the cost of coverage or an amount established by the board.

(1)      Evidence shall consist of a copy of the health insurance card or other verification provided by the social security administration.

(2)    The reimbursement amount for the following year shall be established by the board no later than the December meeting.

(3)     Reimbursement shall become effective no later than the first full month following receipt of evidence, and will be paid as a monthly addition to the pension payment.

(4)     Reimbursement will not be made to benefit recipients who are eligible to receive reimbursement from another entity (e.g., employer, other public retirement system, etc.)

(I)    Anyone who is eligible but who does not enroll for medicare part B coverage will have reduced coverage. Medical claims that would have been covered by medicare part B will not be covered.

(J)    Anyone who is eligible for a benefit based only on an election in accordance with section 5505.162 of the Revised Code shall not be eligible for health care coverage or medicare part B reimbursement.

(K)     An alternative payee under section 5505.261 of the Revised Code shall not be eligible for health care coverage or medicare part B reimbursement.

(L)  A benefit recipient can not be covered by more than one public retirement system.

(M)   If the cost of coverage through an employer, pursuant to paragraph (A)(4) or (B)(5)

of this rule, exceeds twenty-five per cent of gross wages, the retirant may apply for a hardship exemption on a form prescribed by the board.

(N)     All  provisions  of  this  rule  are  subject  to  the  current  health  care  contracts  and amendments.

Effective:	08/08/2011
R.C. 119.032 review dates:	05/20/2011
CERTIFIED ELECTRONICALLY
Certification
07/29/2011
Date
Promulgated Under:	111.15
Statutory Authority:	5505.28
Rule Amplifies:	5505.28
Prior Effective Dates:	1/1/1987, 2/1/1990, 11/1/1190, 2/1/1992, 3/15/1992,
	12/1/1994, 6/1/1996, 10/1/1996, 10/21/2005,
	9/28/2010