145-4-01 Health care definitions.

 

 

 

145-4-01                      Health care coverage.

 

 

 

(A)  Upon the recommendation of the actuary retained by the public employees retirement board, the board shall determine annually the portion of premium or claim cost it shall pay for eligible primary benefit recipients enrolled in the basic health care plan or one of the alternative plans offered by the retirement board.

 

(B)    Prior to April 1, 1993 the retirement board shall enroll eligible primary benefit recipients and eligible dependents only if the monthly benefit payable by the public employees retirement system is sufficient to provide this coverage through monthly premium deductions. Beginning April 1, 1993, Health care coverage for an eligible primary benefit recipient or eligible dependent shall may be available. If the monthly premium for coverage exceeds the monthly benefit, the benefit recipient shall pay the retirement system the premiums billed by the retirement system for coverage subsequent to April 1, 1993. The initial billing to a benefit recipient shall be computed so that subsequent billings . Billings shall conform with a calendar quarter billing schedule payable three months before the beginning of each calendar quarter for which coverage will be effective.

 

(C)   The effective date of health care coverage for eligible benefit recipients and enrolled dependents shall be:

 

(1)    The first of the month following retirement board approval of a disability benefit application or the effective date of the disability benefit, whichever is later.

 

(2)   The first of the month following the date a completed application for benefits pursuant to section 145.32 or 145.331 of the Revised Code or article IX of the combined plan document, is filed with the retirement system or the effective date of the benefit, whichever is later.

 

(3)    The first of the month following the death of the contributor or retirant, or attainment of eligibility for benefits pursuant to section 145.45 of the Revised Code, whichever is later.

 

(D)   Beginning April 1, 1993 an An ineligible individual may be enrolled in a health care plan offered by the retirement system's health care administrator(s). Such ineligible individual shall pay all required premiums directly to the health care administrator. The retirement system shall not be responsible for any premiums, claims, or withholding of premiums for such health care coverage.

 

(E)If a surviving spouse of a deceased member or a surviving spouse of a retirant remarries on or after June 29, 1996, such new spouse or dependent children of such new spouse shall not be eligible for coverage as a dependent under the retirement

 

 

 

system's health care plan or one of its alternative plans.

(F) On or after October 9, 2000, minor unmarried children of a retirant who dies after retirement may be eligible for dependent health care coverage until age eighteen or age twenty-two if the child is attending an institution of learning or training pursuant to a program designed to complete in each school year the equivalent of at least two-thirds of the full-time curriculum requirements of such institution, under all of the following requirements.

(1) The retirant selected a plan of payment described in division (B)(2)(b), (B)(2)(c) or (B)(2)(d) of section 145.46 of the Revised Code or section 9.03(e)(2)(ii), 9.03(e)(2)(iii), or 9.03(e)(2)(iv) of the combined plan document .

(2) A child of the retirant was designated as the retirant's beneficiary under the plan of payment and survives the retirant.

(3) Natural or adopted children not designated by the retirant as the retirant's beneficiary were covered for dependent health care coverage prior to the retirant's death.

(G)(E) Except as otherwise provided in rule 145-4-05 of the Administrative Code, an eligible benefit recipient may waive health care coverage. Such waiver is effective beginning the first of the month following the retirement system's receipt of the waiver. The waiver is effective as to both the benefit recipient and the recipient's dependents. A benefit recipient may revoke the waiver by filing a health care enrollment application:

(1)    During the annual open enrollment period for health care coverage under the retirement system, however, the waiver remains effective until January first of the next year;

(2)    Within thirty-one days of involuntary termination of coverage under another group plan, and with proof of such termination, however, the waiver remains effective until the first of the following month if the application is received by the fifteenth day of the preceding month, otherwise the waiver remains effective until the first of the next succeeding month;

(3)    At any other time for any other circumstances, however, the waiver remains effective for an additional six calendar months.

Effective:                                01/01/2005 R.C. 119.032 review dates:                           10/03/2007

CERTIFIED ELECTRONICALLY

Certification

08/24/2004

Date

Promulgated Under:   111.15

Statutory Authority:   145.09.

Rule Amplifies:           145.325, 145.58.

Prior Effective Dates: 4/15/04, 1/1/03, 8/8/02,

3/22/02, 10/9/00, 5/4/00,

6/29/96, 4/1/93, 12/9/88,

8/20/76.