3307:1-11-11 Health care assistance.

 

 

 

3307:1-11-11               Health care premium assistance.

 

 

 

(A)  As used in this rule:

 

(1)   "Earnings" shall mean the total of all job-related income, pension, disability and survivor benefits received, 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 mean one hundred fifty per cent of the poverty level amount rounded to the nearest one thousand dollars for the size of the family unit involved as determined by the United States department of health and human services. Such amounts shall be determined as of September first of each twenty thousand dollars per calendar year, 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 retirant or benefit recipient 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) of rule 3307:1-11-01 of the Administrative Code.

 

(4)(5) "Qualifying enrollee" shall include persons who:

 

(a)  Were either:

 

(i)   Granted service retirement under sections 3307.50 to 3307.79 of the Revised Code with at least twenty-five years of service credit before retirement and not excluded from premium waiver under the terms of paragraph (A)(4)(a) of rule 3307:1-11-03 of the Administrative Code; or

 

(ii)   Granted disability benefits under sections 3307.50 to 3307.79 of the Revised Code, and

 

(b)   Had annual earnings not greater than: the

 

(i) The low-income earnings threshold for a the family unit of one if the person described in paragraph (A)(4)(a) of this rule and has no

 

 

spouse or dependent children; or

(ii) The low-income earnings threshold for a family unit of two if the person described in paragraph (A)(4)(a) of this rule has a spouse or any dependent children, regardless of number; and

(c)   Had total liquid assets that did not exceed ten twenty thousand dollars if for the family unit of the person described in paragraph (A)(4)(a) of this rule has no spouse or twenty thousand dollars if that person has a spouse.

(5)(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 member for any group medical health care plan offered by the state teachers retirement system.

(B)   A qualified enrollee may make application for assistance on a form provided by the retirement system. The effective date of the discounted premium health care assistance program shall be the first of the month following receipt of an approved 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 individual who fails to supply all requested information within three months of filing shall be canceled.

(C)    A qualified enrollee receiving the discounted premium 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 the individual no longer qualifying for the program and all assistance benefits shall be terminated.

(D)    On and after January July 1, 2004 and provided that the retirement board has not acted to terminate the assistance program hereby created, enrollees whose applications are granted under this rule shall qualify for a reduction in the amount

of thirty per cent in the premiums otherwise payable for participation in a health care plan offered by the retirement system.:

(1) A minimum monthly health care premium in a health plan offered by the retirement system, and

(2) Health assistance plan benefits as determined by the board through certain health plans offered by the state teachers retirement system.

(3) A "qualifying enrollee" may elect to accept only the minimum health care premium and forego the health assistance plan benefits.

(4) The minimum monthly health care premium will not be in effect for any period the qualifying enrollee fails to provide verification of the individual's 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 benefits 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 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.

(E)(F) Assistance under this rule granted 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 shall immediately repay the amounts of any 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:                                08/26/2004 R.C. 119.032 review dates:                           03/01/2009

CERTIFIED ELECTRONICALLY

Certification

08/16/2004

Date

Promulgated Under:   111.15

Statutory Authority:   3307.04

Rule Amplifies:           3307.39

Prior Effective Dates: 1/1/2004 (Emer.), 3/22/04