Chapter 3307:1-11 Health Care Services

(A) Pursuant to sections 3307.39, 3307.391 and 3307.61 of the Revised Code a health care program is hereby established for:

(1) Recipients of benefits under sections 3307.50 to 3307.79 of the Revised Code; and

(2) Recipients of benefits under a plan established under section 3307.81 of the Revised Code that provides health care coverage; and

(3) The spouses and dependents of the foregoing recipients who meet the conditions of eligibility specified by this chapter of the Administrative Code as well as the conditions of eligibility for participation in any medical or ancillary plan offered. The health care program shall consist of such medical plans and ancillary plans as the retirement board may from time-to-time offer. The retirement board shall review the program, the plans and benefits offered at least every two years.

(B) As used in this chapter of the Administrative Code:

(1) “Child” and “children” shall mean any biological child, lawfully adopted child, stepchild or a child for which a benefit recipient has been legally appointed a guardian. Also included is any child who resides in the benefit recipient’s home and receives fifty per cent or more financial support from the benefit recipient as determined by the state teachers retirement system.

(2) “Medical plan” shall mean a plan offering health, medical, hospital, or prescription coverage or benefits or any combination thereof.

(3) “Ancillary plan” shall mean a plan offering ancillary benefits such as dental, vision or long-term care coverage.

(4) “Sponsored dependent” includes:

(a) A blood relative living in the residence of a benefit recipient, or in a convalescent center or any other type of institution that retains a sponsored dependent temporarily;

(b) A blood relative not living in the home of a benefit recipient, but receiving one-half or more support from the benefit recipient, as demonstrated by completion of a financial status form provided by the retirement system or the most recent federal income tax return;

(c) Any person living in the home of a benefit recipient or in a convalescent center or other institution that retains the sponsored dependent temporarily, if the person received one-half or more support from the recipient, as demonstrated by completion of a financial status form provided by the retirement system or the most recent federal income tax return;

(d) Any person living in the home of an unmarried recipient of a service or disability benefit or in a convalescent center or any other type of institution that retains a sponsored dependent temporarily, notwithstanding that the service or disability benefit recipient does not claim sponsored dependent as a financial dependent for federal tax purposes.

(5) “Plan enrollee” means any individual described in rule 3307:1-11-02 of the Administrative Code who participates in the medical plans offered by the retirement system.

(6) “Total service credit” shall be as defined by section 3307.50 of the Revised Code, and as used in this chapter such credit shall not include any credit purchased under section 3307.741 of the Revised Code.

Effective: 05/14/2009

R.C. 119.032 review dates: 02/26/2009 and 05/14/2014

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.391, 3307.61

Prior Effective Dates: 12/23/1976, 11/28/1977, 3/17/1989 (Emer.), 6/1/1989, 9/23/1991 (Emer.), 5/28/1992, 6/22/1992(Emer.), 9/10/1992, 2/13/1993, 9/1/1996, 7/3/1997, 9/16/1998 (Emer.), 11/27/1998, 5/25/2000, 7/1/2001 (Emer.), 9/17/2001, 1/1/2004 (Emer.), 3/22/2004, 8/9/2007

Subject to the requirements of Chapter 3307:1-11 of the Administrative Code the specific requirements of the various plans that may be offered, the following shall be eligible to participate in the medical and ancillary plans offered by the retirement system:

(A) A person granted service benefits under sections 3307.50 to 3307.79 of the Revised Code or under a plan that provides health care coverage under section 3307.81 of the Revised Code whose effective date of benefits is prior to January 1, 2004.

(B) A person granted service benefits under sections 3307.50 to 3307.79 of the Revised Code or under a plan that provides health care coverage under section 3307.81 of the Revised Code with fifteen or more years of total service credit whose benefit effective date is January 1, 2004 or later.

(C) A person granted disability benefits under sections 3307.50 to 3307.79 of the Revised Code or under a plan that provides health care coverage under section 3307.81 of the Revised Code.

(D) A person granted disability benefits with an effective date prior to January 1, 2004 under sections 3307.50 to 3307.79 of the Revised Code or under a plan that provides health care coverage under section 3307.81 of the Revised Code who begins service retirement benefits with no break in receipt of monthly benefits following the termination of disability benefits. Service credit used to determine health care eligibility shall be the service credit used in the calculation of service retirement benefits, which does not include service credit purchased under section 3307.741 of the Revised Code.

(E) A person granted disability benefits with an effective date on or after January 1, 2004 under sections 3307.50 to 3307.79 of the Revised Code or under a plan that provides health care coverage under section 3307.81 of the Revised Code who begins service retirement benefits with no break in receipt of monthly benefits following the termination of disability benefits provided the former member has fifteen or more years of Ohio-valued service credit. Service credit used to determine health care eligibility shall be the service credit used in the calculation of service retirement benefits, which does not include service credit purchased under section 3307.741 of the Revised Code.

(F) A person granted continuing beneficiary benefits under section 3307.60 of the Revised Code provided:

(1) The effective date of monthly benefits is before January 1, 2004; or

(2) The effective date of monthly benefits is January 1, 2004 or later and the deceased member had fifteen or more years of service credit.

(G) A person granted survivor benefits under division (C)(2) of section 3307.66 of the Revised Code.

(H) A person granted survivor benefits under division (C)(1) of section 3307.66 of the Revised Code provided:

(1) The effective date of survivor benefits or the effective date of disability benefits of the deceased member is before January 1, 2004; or

(2) The effective date of survivor benefits is January 1, 2004 or later and the deceased member had fifteen or more years of service credit.

(I) The dependent children of the foregoing benefit recipients, including children born after the effective date of a benefit, provided that such children:

(1) Are unmarried, and under age eighteen; or

(2) Are unmarried, under age twenty-two if the benefit recipient’s effective date of benefits was January 1, 2003, or later or under age twenty-three if the effective date of benefits was prior to January 1, 2003, and the dependent is attending school on at least a two-thirds full-time basis and the benefit recipient is providing at least fifty per cent or more financial support. If dependent children are survivors of a member who was receiving benefits at the time of death, the effective date of the member’s benefits is used for determining the maximum age in which the children qualify for health care coverage.

(3) Are unmarried, unable to earn a living because of a mental or physical condition that was disabling prior to the date the child reached the maximum age specified by paragraph (I)(1) or (I)(2) of this rule, provided the child has been continuously disabled and unable to earn a living since being adjudged physically or mentally incompetent. An impartial, independent physician appointed by the retirement system must confirm that the child has a mental or physical condition that incapacitated the child before the maximum age specified by paragraph (I)(1) or (I)(2) of this rule. In addition, the child shall meet one of the conditions outlined in paragraph (I)(3)(a) or (I)(3)(b) of this rule.

(a) As used in paragraph (I)(3) of this rule, “unable to earn a living” means that the child was incapable of earning at least sixteen thousand dollars a year for any year before January 1, 2008 and that the child was incapable of earning the federal minimum wage as of January first of the current year multiplied by two thousand eighty hours, increased by fifty per cent and rounded to the nearest thousand dollars for each year thereafter. The applicant must file with the state teachers retirement system requested documentation to verify earnings which may include copies of federal income tax returns and copies of the most recent annual social security earnings statement.

(b) The child attends an adult workshop or school for the mentally retarded or developmentally disabled operated by a county or state board of mental retardation and developmental disabilities.

(c) Confirmation of a child’s status on a schedule determined by the chair of the medical review board is required for the child to continue to qualify for coverage. Failure to respond by the deadlines specified by the state teachers retirement system in requests for additional information, requests to schedule medical examinations or any other requests made by the retirement system in conjunction with the determination of the incapacitated status shall result in termination of eligibility to participate in the medical and ancillary plans or any other benefits authorized in Chapter 3307. of the Revised Code effective the first of the month following the deadline for the request.

(d) The chair of the medical review board shall determine whether a child meets the requirements of this division. Determinations made by the chair may be appealed to another independent physician appointed as hearing officer in accordance with procedures specified by the retirement system. The decision of such hearing officer shall be deemed the final decision of the retirement board.

(4) Have been adjudged physically or mentally incompetent under the requirements set forth in the version of this rule in effect prior to January 8, 2007, provided such children continuously meet the requirements as defined therein. Upon the first date that such a child no longer meets all of the eligibility requirements set forth in the version of this rule in effect prior to January 8, 2007, such child shall no longer qualify as a dependent child.

(J) The spouse of a service or disability benefit recipient described in paragraph (A), (B), (C) or (D) of this rule including a spouse who becomes married to such a recipient after the effective date of benefits.

(K) A sponsored dependent of the foregoing benefit recipients, to the extent that a medical or ancillary plan allows coverage for sponsored dependents.

(L) Effective January 1, 2009, a plan enrollee, who is not eligible for medicare part B is not eligible for primary coverage in a medical plan offered pursuant to section 3307.39 of the Revised Code if the plan enrollee is employed and has access to a medical plan with prescription coverage available through the employer or if employees of that employer in comparable positions have access to a medical plan available through the employer provided the medical plan with prescription coverage available through the employer is equivalent to the medical plan with prescription coverage at the cost available to full-time employees as defined by the employer. As used in this rule, “employer” means a public or private entity that acts as an employer and is not limited to an “employer” as defined in section 3307.01 of the Revised Code.

(1) Any secondary coverage provided by a medical plan offered by the retirement system pursuant to section 3307.39 of the Revised Code to a plan enrollee subject to paragraph (L) of this rule shall apply only to those medical expenses not paid by the medical plan with prescription coverage available through the employer and which are covered in the medical plan offered by the retirement system under section 3307.39 of the Revised Code.

(2) The board may require each plan enrollee to annually file a statement disclosing the availability of a medical plan with prescription coverage available through the employer with the board or its designee. The statement shall include the name of the employer, the medical plan available through the employer and such other information that may be required. If a plan enrollee does not enroll in the medical plan available through an employer when it becomes available to a plan enrollee, no medical plan coverage will be provided by the state teachers retirement system while the individual was eligible for available employer coverage.

Effective: 05/14/2009

R.C. 119.032 review dates: 02/26/2009 and 05/14/2014

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.61

Prior Effective Dates: 12/23/1976, 11/28/1977, 3/17/1989(Emer.), 6/1/1989, 9/23/1991 (Emer.), 5/28/1992, 6/22/1992 (Emer.), 9/10/1992, 2/13/1993, 9/1/1996, 7/3/1997, 9/16/1998 (Emer.), 11/27/1998, 5/25/2000, 7/1/2001 (Emer.), 9/27/2001, 1/1/2004 (Emer.), 3/22/2004, 1/08/2007, 12/6/2007

(A) An enrollee’s cost to participate in the medical plan will be determined as follows:

(1) Costs shall be based upon service credit, the effective date of benefits, and such other factors as the state teachers retirement board may find relevant. Except as provided in paragraph (A)(3)(c) of this rule, service credit used in calculating an enrollee’s cost shall be the service credit used in the calculation of service retirement benefits, which excludes service credit purchased under section 3307.741 of the Revised Code. The state teachers retirement board shall annually review costs and premiums charged for participation in the medical plan and shall establish a schedule for determining or calculating enrollee costs and premiums.

(2) Enrolled benefit recipients shall pay all costs or premiums through benefit deduction unless the amount of a benefit will not cover such costs. In that case, the benefit recipient will be billed directly by the state teachers retirement system. Participation in and coverage under the medical plan may be terminated in the event payment is not made within thirty days.

(3) The state teachers retirement board will not waive any portion of the cost for:

(a) Service benefit recipients with less than fifteen years of total service credit with an effective date of benefits before January 1, 2004.

(b) Spouses or dependents of service and disability benefit recipients.

(c) Any service benefit recipient who retires or who makes application to retire on or after March 17, 1989 and:

(i) Who has purchased service credit under section 145.28, 3307.73, 3307.741, 3307.78 or 3309.301 of the Revised Code in order to become eligible for benefits under section 3307.58 of the Revised Code; or for whom service credit has been purchased under section 145.297, 145.298, 3307.54 or 3309.33 of the Revised Code in order for the member to become eligible for retirement effective on or after September 1, 1996.

(ii) Until such time as the service benefit recipient is eligible for benefits under section 3307.58 of the Revised Code without regard to service credit purchased under such sections, the benefit recipient and all eligible dependents are eligible for participation in the health coverage program only by paying all premium and associated costs. At such time as the benefit recipient becomes eligible for service retirement benefits under section 3307.58 of the Revised Code without regard to service credit purchased under such sections, the state teachers retirement board may waive a portion of the cost for a benefit recipient with fifteen or more years of total service.

(4)

(a) If benefits have been granted under section 3307.60 of the Revised Code and the effective date of the benefit recipient’s monthly benefits is before January 1, 2004, for the later of five years from January 1, 2004 or the effective date of survivor benefits as defined under the above section, costs for the survivor benefit recipients and dependents shall be calculated based upon the member’s years of service and other factors as the state teachers retirement board may find relevant. After the five year period, the state teachers retirement board will not waive any portion of the cost.

(b) If benefits have been granted under section 3307.60 of the Revised Code and the effective date of the benefit recipient’s monthly benefits is on or after January 1, 2004, the member must have had fifteen or more years of service credit for the survivor and dependents to qualify for the five year total subsidy period. In the event the benefit recipient named multiple beneficiaries under division (A)(4) of section 3307.60 of the Revised Code, the percent subsidy for which the benefit recipient was eligible will be allocated equally among the surviving beneficiaries for the five year subsidy period. After the five year period, the state teachers retirement board will not waive any portion of the cost.

(5)

(a) If benefits have been granted under division (C)(1) of section 3307.66 of the Revised Code as the result of the death of a member eligible for service retirement, and the effective date of survivor benefits is before January 1, 2004, for the later of five years from January 1, 2004 or the effective date of survivor benefits as defined under the above section, costs for the survivor benefit recipients and dependents shall be calculated based upon the member’s years of total service credit and other factors as the state teachers retirement board may find relevant. After the five year period, the state teachers retirement board will not waive any portion of the cost. 3307:1-11-03 2

(b) If benefits have been granted under division (C)(1) of section 3307.66 of the Revised Code as the result of the death of a member eligible for service retirement, and the effective date of survivor benefits is on or after January 1, 2004, the member must have had fifteen or more years of total service credit for the survivor and dependents to qualify for the five year subsidy period unless the member was receiving state teachers retirement system disability benefits at the time of death. If the member was receiving disability benefits at the time of death, the effective date of disability benefits is used for determining whether the member had fifteen or more years of total service credit to qualify for the five year subsidy.

(c) If benefits are granted under division (C)(2) of section 3307.66 of the Revised Code as the result of the death of a member, for the later of five years from January 1, 2004 or the effective date of survivor benefits as defined under the above section, costs shall be calculated based upon the greater of the member’s years of total service credit or fifteen years and other factors as the state teachers retirement board may find relevant. After the five year period, the state teachers retirement board will not waive any portion of the cost.

(B) An enrollee’s cost to participate in the ancillary plans shall be the full cost of coverage as specified by the state teachers retirement board.

Effective: 05/14/2009

R.C. 119.032 review dates: 02/26/2009 and 05/14/2014

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.61

Prior Effective Dates: 12/23/1976, 11/28/1977, 3/17/1989 (Emer.), 6/1/1989, 9/23/1991 (Emer.), 5/28/1992, 6/22/1992 (Emer.), 9/10/1992, 2/13/1993, 9/1/1996, 7/3/1997, 9/16/1998 (Emer.), 7/3/1997, 9/16/1998 (Emer.), 11/27/1998, 5/25/2000, 7/1/2001 (Emer.), 9/17/2001, 9/17/2002, 1/1/2004 (Emer.), 3/22/2004, 10/27/2006, 1/6/2008

(A) The effective date of medical, dental and vision plan coverage for benefit recipients and enrolled dependents shall be determined as follows:

(1) Disability benefit recipients – if the recipient elects coverage when a benefit is granted, coverage shall begin on the first of the month following retirement board approval of the benefit payment.

(2) Service retirement or survivor benefit recipients – if the recipient elects coverage when a benefit is granted, coverage shall begin on the first of the month following the date the application is filed with the state teachers retirement system or effective date of retirement, whichever is later.

(3) If the recipient does not elect to enroll in a medical plan when a benefit is first granted and later applies for medical plan coverage, coverage shall begin as follows:

(a) Coverage will begin on the first day of January following an open enrollment period specified by the state teachers retirement system.

(b) Coverage will begin on the first of the month following termination of other group coverage if application for coverage is received and approved by the state teachers retirement system within the thirty-one days after the termination of such other coverage.

(4) Coverage will begin after the completion of a six-month waiting period following application for coverage by a recipient who is not at the time of application covered under another group health care plan or covered under another group plan that will not be terminating. The six-month period begins the month in which the application is received.

(5) Coverage for a new spouse enrolled by a service or disability benefit recipient will be effective on the first of the month following the marriage, if a written application is received by the retirement system within thirty-one days of the marriage or within the first month in which a change in plan of payment is effective that qualifies the new spouse for a monthly benefit upon the death of a service retirant.

(6)

(a) Coverage for a newborn or adopted child of a service, disability or survivor recipient will begin on the day of birth or adoption, provided that a written application is received by the retirement system within thirty-one days of birth or adoption.

(b) If coverage for other dependent children is already in effect and a written application is received by the retirement system later than thirty-one days after the birth or adoption, coverage shall be effective the first of the month after receipt of the application.

(c) If no coverage for other dependent children is already in effect and a written application is received by the retirement system later than thirty-one days after the birth or adoption, coverage shall not be effective until the completion of a six-month waiting period. The six-month waiting period begins the month in which the application is received.

(B) The effective date of long term care plan coverage shall be as specified by the plan administrator.

Effective: 07/01/2006

R.C. 119.032 review dates: 04/06/2006 and 04/01/2011

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.391

Prior Effective Dates: 12/23/76, 11/28/77, 3/17/89 (Emer.), 6/1/89, 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.), 9/17/01

(A) Pursuant to section 3307.39 of the Revised Code, each recipient of a service retirement, disability or survivor benefit under the plan described in sections 3307.50 to 3307.79 of the Revised Code who qualifies to enroll in medicare part B shall be eligible for reimbursement for a portion of the cost of the basic medicare part B premium provided the recipient provides the board with certification of participation in the medicare part B insurance program. Each recipient who qualifies for medicare part B in the future shall certify such participation. The board shall establish eligibility for medicare part B reimbursement and make reimbursement effective the first of the month following receipt of proper certification and such reimbursement shall be based upon service credit and a percentage determined by the board, provided the percentage shall not exceed three per cent and the reimbursement amount shall not be less than twenty-nine dollars and ninety cents nor more than ninety per cent of the basic medicare part B premium. Certification of a survivor’s medicare part B received within three months of the member’s death shall be deemed as being received in the month of the member’s death.

(B) If a recipient dies and the recipient selected a plan of payment to provide benefits continuing after the recipient’s death to more than one beneficiary pursuant to division (A)(4) of section 3307.60 of the Revised Code, the percentage reimbursement for medicare part B for which the recipient was eligible shall be allocated equally among all beneficiaries, irrespective of each beneficiary’s eligibility for medicare part B for the period specified in paragraph (C) of this rule.

(C) Each beneficiary receiving a continuing monthly benefit pursuant to section 3307.60 of the Revised Code who qualifies to enroll in medicare part B shall be eligible for reimbursement for a portion of the cost of the medicare part B premium provided the recipient provides the board with certification of participation in the medicare part B insurance program. Each beneficiary who qualifies for medicare part B in the future shall certify such participation. For the time periods outlined in paragraphs (C)(1), (C)(2) and (C)(3) of this rule, the board shall establish eligibility for medicare part B reimbursement and make reimbursement effective the first of the month following receipt of proper certification in accordance with paragraph (B) of this rule, if applicable. Such reimbursement shall be based upon service credit and a percentage determined by the board. The percentage shall not exceed three per cent and the reimbursement amount shall not be less than twenty-nine dollars and ninety cents nor more than ninety per cent of the basic medicare part B premium. Certification of a beneficiary’s medicare part B received within three months of the retiree’s death shall be deemed as being received in the month of the retiree’s death. Reimbursement shall be paid to beneficiaries for the period of time as follows:

(1) The board shall make reimbursement for a portion of the cost of medicare part B to a beneficiary or beneficiaries who are receiving continuing monthly benefits pursuant to section 3307.60 of the Revised Code and who are qualified to enroll in the medicare part B insurance program before January 1, 2008.

(2) When monthly benefits are paid to a beneficiary or beneficiaries named before January 1, 2008 pursuant to section 3307.60 of the Revised Code, the board shall make reimbursement for a portion of the cost of medicare part B to a beneficiary or beneficiaries who qualified to enroll in the medicare part B insurance program before January 1, 2008.

(3) The board shall make reimbursement for a portion of the cost of medicare part B for a five-year period starting January 1, 2008 to all beneficiaries who are receiving continuing monthly benefits pursuant to section 3307.60 of the Revised Code and who are not covered by paragraph (C)(1) of this rule. During the five-year time period, reimbursement shall only be paid for the period of time the beneficiary qualifies for such reimbursement pursuant to paragraph (C) of this rule. After the five-year period, the board shall not provide any reimbursement and the beneficiary or beneficiaries shall be responsible for the full cost of the medicare part B premium.

For beneficiaries who begin receiving continuing benefits pursuant to section 3307.60 of the Revised Code effective January 1, 2008, or later, and are not covered by paragraph (C)(2) of this rule, the board shall make reimbursement for a portion of the cost of medicare part B for a five-year period beginning the later of January 1, 2008, or the beneficiary’s effective date of receipt of the continuing benefit. During the five-year time period, reimbursement shall only be paid for the period of time the beneficiary qualifies for such reimbursement pursuant to paragraph (C) of this rule. After the five-year period, the board shall not provide any reimbursement and the beneficiary or beneficiaries shall be responsible for the full cost of the medicare part B premium.

(4) The board shall make no reimbursement for the cost of medicare part B to any beneficiary or beneficiaries who do not otherwise qualify as outlined in paragraph (C) of this rule.

(D) For purposes of section 3307.39 of the Revised Code and this rule, “basic premium” and “basic medicare part B premium” mean the amount of the standard monthly premium for individuals enrolled in medicare part B coverage as determined by the secretary of health and human services before any adjustments made to the premium, such as an increase in premium for late enrollment or an increase in premium due to a reduction in the premium subsidy based on income.

R.C. 119.032 review dates: 02/26/2009 and 02/26/2014

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39

Prior Effective Dates: 2/23/1976, 11/28/1977, 3/17/1989 (Emer.), 6/1/1989, 9/23/1991 (Emer.), 5/28/1992, 6/22/1992 (Emer.), 9/10/1992, 2/13/1993, 9/1/1996, 7/3/1997, 9/16/1998 (Emer.), 11/27/1998, 5/25/2000, 7/1/2001 (Emer.), 9/17/2001, 1/1/2004 (Emer.), 3/22/2004, 11/9/2006, 1/1/2007 (Emer.), 4/1/2007

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

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

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

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

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

(i) Marriage

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

(iii) Death

(iv) Divorce or dissolution

(v) Legal separation, or

(vi) Full loss of premium subsidy

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

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

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

Effective: 05/14/2009

R.C. 119.032 review dates: 02/26/2009 and 05/14/2014

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.61

Prior Effective Dates: 12/23/1976, 11/28/1977, 3/17/1989 (Emer.), 6/1/1989, 9/23/1991 (Emer.), 5/28/1992, 6/22/1992 (Emer.), 9/10/1992, 2/13/1993, 9/1/1996, 7/3/97, 9/16/98 (Emer.), 11/27/1998, 5/25/2000, 7/1/2001 (Emer.), 1/1/2004 (Emer.), 3/22/2004

(A) By applying and accepting participation in any of the medical plans, ancillary plans, supporting programs or other health care plan of any type established and offered by the state teachers retirement board (the “health care program”) each participating benefit recipient and enrollee, on behalf of herself or himself and each of their dependents covered under the health care program, acknowledges and agrees that the health care program may use or disclose all individually identifiable health information (as defined at 45 C.F.R. 160.103) pertaining to such participating benefit recipient, enrollee or dependent in the health care program for the payment (as defined at 45 C.F.R. 164.501) and health care operations (as defined at 45 C.F.R. 164.501) purposes of the health care program and otherwise use or disclose such individually identifiable health information as permitted by and under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. 160 and 164.

(B) The health care program, acting through the retirement board, shall require each person who as to the health care program constitutes a “business associate” (as defined at 45 C.F.R. 160.103) of the health care program to maintain the confidentiality of individually identifiable health information that it creates, maintains or receives on behalf of or from the health care program and to enter into a written agreement with the health care program which meets that standard for business associate contracts as specified at 45 C.F.R. 164.504(e). Individually identifiable health information that meets the requirements for deidentification of health information, as specified in 45 C.F.R. 164 may be used without limitation by the health care program and shall be and shall remain the property of the retirement system.

Replaces: 3307:1-11-07

Effective: 07/01/2006

R.C. 119.032 review dates: 04/01/2011

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.391

Prior Effective Dates: 12/23/76, 11/28/77, 3/17/89 (Emer.), 6/1/89, 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.), 9/17/01

(A) Enrolled benefit recipients will be notified in writing at least thirty days in advance of any change in coverage under the medical and ancillary plans.

(B) Benefit recipients will be notified in writing of any changes in the cost of their coverage at least sixty days prior to the effective date of a change.

(C) Notice, as required by any provision of this rule, shall be deemed sufficient, if notice is communicated by regular United States postal service to the benefit recipient at the last known address of the benefit recipient as maintained in the records of the retirement system.

Effective: 07/01/2006

R.C. 119.032 review dates: 04/06/2006 and 04/01/2011

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.391

Prior Effective Dates: 12/23/76, 11/28/77, 3/17/89 (Emer.), 6/1/89, 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.), 9/17/01

(A) Members of the state teachers retirement system may make application to participate in contracts for long-term care coverage offered pursuant to section 3307.391 of the Revised Code, provided:

(1) Application for coverage shall be made directly to the insurer during enrollment periods specified by the state teachers retirement system;

(2) Determination of eligibility for participation under the terms of any such contract shall be made by the insurer with approval of the state teachers retirement system; and

(3) Payment for coverage shall be made by the member to the insurer in such amounts and by such methods approved by the state teachers retirement system.

(B) The recipient of any benefit may make application to participate in any such contracts for long-term care coverage, subject to the same conditions as those applicable to members under the terms of paragraph (A) of this rule.

(C) A spouse, parent or parent-in-law of any individual who has made application pursuant to paragraph (A) or (B) of this rule may apply for coverage subject to the same conditions as those applicable to members under the terms of paragraph (A) of this rule, provided that in the case of a spouse, the individual participating pursuant to paragraph (A) or (B) of this rule agrees to remit the cost of such coverage along with his or her own payment.

Effective: 07/01/2006

R.C. 119.032 review dates: 04/06/2006 and 04/01/2011

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.391

Prior Effective Dates: 10/29/91 (Emer.), 1/27/92, 7/1/01 (Emer.), 9/17/01

(A) For the purpose of this rule:

(1) “Age and service retirant” means a former member who is receiving a retirement allowance pursuant to section 3307.57, 3307.58, 3307.59 or 3307.60 of the Revised Code.

(2) “Cost paid by the benefit recipient” means the amount equal to the percentage as of January 1, 1998 paid by the benefit recipient multiplied by the system’s cost per benefit recipient.

(3) “Dependent” means an eligible spouse or child of an eligible benefit recipient.

(4) “Disability benefit recipient” means a member who is receiving a disability benefit or allowance pursuant to section of 3307.57, 3307.63, or 3307.631 of the Revised Code.

(5) “Effective benefit date” means the date upon which a benefit allowance begins.

(6) “Eligible benefit recipient” means an age and service retirant, disability or survivor benefit recipient who is eligible for health care coverage under this system.

(7) “Health care coverage” means the plan offered by this system including, but not limited to, the medical plan, the prescription drug program, and the medicare Part B premium reimbursement.

(8) “Ohio retirement system” means public employees retirement system, state teachers retirement system, school employees retirement system, Ohio police and fire pension fund or highway patrol retirement system.

(9) “Survivor benefit recipient” means a beneficiary receiving a benefit pursuant to section 3307.60 or 3307.66 of the Revised Code.

(B) Except as otherwise provided in this rule, this retirement system shall be the system responsible for health care coverage for eligible benefit recipients who receive a benefit or allowance from this system.

(C) This retirement system shall not be the system responsible for health care coverage for eligible benefit recipients in the following situations.

(1) Where an eligible benefit recipient who is an age and service retirant of this system also is an eligible benefit recipient receiving an age and service benefit from another Ohio retirement system and the effective benefit date in this system is later than the effective benefit date in the other system.

(2)

(a) Where an eligible benefit recipient who is a disability benefit recipient of this system also is an eligible benefit recipient receiving an age and service benefit from another Ohio retirement system.

(b) Where an eligible benefit recipient who is a survivor benefit recipient of this system also is an eligible benefit recipient receiving an age and service benefit or a disability benefit from another Ohio retirement system.

(3) Where an eligible benefit recipient who is a disability benefit recipient of this system also is an eligible benefit recipient receiving a disability benefit from another Ohio retirement system and the effective benefit date of the benefit from this system is later than the effective benefit date in the other system.

(4) Where an eligible benefit recipient who is a survivor benefit recipient of this system also is an eligible benefit recipient receiving a survivor benefit from another Ohio retirement system and the effective benefit date of the benefit from this system is later than the effective benefit date in the other system.

(5)

(a) Where the effective benefit dates for an eligible benefit recipient in the situation described in paragraph (C)(1), (C)(3) or (C)(4) of this rule are the same in each system, and the benefit recipient has less service credit in this system than in the other system.

(b) Where the effective benefit dates and service credit for an eligible benefit recipient in the situation described in paragraph (C)(1), (C)(3) or (C)(4) of this rule are the same in each system, and the employee contributions in the account upon which the benefit in this system is based are less than the employee contributions in the account upon which the benefit in the other system was based.

(D)

(1)

(a) Where this system is responsible for health care coverage pursuant to this rule, an eligible benefit recipient of this system who also is an eligible benefit recipient of another Ohio retirement system may irrevocably waive such health care coverage in order to be covered by the other Ohio retirement system, if the other system has agreed in writing to offer such coverage. The waiver is revocable if the benefit recipient is no longer eligible for health care in the other system. Such recipient shall waive such coverage in writing to this system. Health care coverage in this system shall cease with the exception of the medicare Part B premium reimbursement when it is not available to the benefit recipient in the other Ohio retirement system beginning the first of the month following receipt of the waiver by this system.

(b) In the event a recipient has waived health care coverage as provided in paragraph (D)(1)(a) of this rule, this system shall:

(i) Promptly notify the other Ohio retirement system the benefit recipient has waived health care coverage and the effective date of such non-coverage; and

(ii) For covered benefit recipients and dependents transfer to the other system annually for each month covered an amount equal to the sum of:

(a) The lesser of this system’s average monthly medical including health maintenance organization cost per benefit recipient less the cost paid by the benefit recipient, or the other system’s average monthly medical including health maintenance organization cost per benefit recipient.

(b) The lesser of this system’s average monthly cost of the prescription drug program per benefit recipient, or the other system’s average monthly cost of the prescription drug program per benefit recipient.

(c) The lesser of the monthly cost of the medicare Part B premium that would be reimbursed by this system for the benefit recipient, or the monthly cost of the medicare Part B premium that would be reimbursed by the other system for the benefit recipient.

(d) This system shall transfer the amounts due pursuant to paragraph (D)(1)(b)(ii) of this rule no later than the last business day of February each year for the preceding calendar year after the following occur:

(i) This system receives from the system a list containing the names of benefit recipients and the number of months during which the recipients were covered by the other system for the preceding calendar year; and

(ii) This system prepares an itemized accounting of the amount transferred for each such benefit recipient.

(2)

(a) Where this system is not responsible for health care coverage pursuant to this rule, an eligible benefit recipient of another Ohio retirement system who also is an eligible recipient or dependent of an eligible benefit recipient of this system may irrevocably waive health care coverage in the other system to be covered by this system as a benefit recipient or dependent if otherwise eligible. Health care coverage in this system shall be effective the first of the month following the termination of coverage in the other system.

(b) Where an eligible benefit recipient or dependent of an eligible benefit recipient of this system has waived health care coverage in another Ohio retirement system, this system shall be responsible to provide health care coverage only if this system:

(i) Is promptly notified by the other system that the benefit recipient or dependent has waived health care coverage and the effective date of termination of coverage; and

(ii) For covered benefit recipients and dependents, the other system pays annually to this system for each month covered an amount equal to the sum of:

(a) The lesser of this system’s average monthly medical including health maintenance organization cost per benefit recipient less the cost paid by the benefit recipient, or the other system’s average monthly medical including health maintenance organization cost per benefit recipient.

(b) The lesser of this system’s average monthly cost of the prescription drug program per benefit recipient, or the other system’s average monthly cost of the prescription drug program per benefit recipient.

(c) The lesser of the monthly cost of the medicare Part B premium would be reimbursed by this system for the benefit recipient, or the monthly cost of the medicare Part B premium that would be reimbursed by the other system for the benefit recipient.

(E)

(1) Not later than three years from the effective date of this rule this system shall contact the other retirement systems to review the adequacy of the transfer of funds described in paragraph (D) of this rule.

(2) If there is a material change in this system’s plan or circumstances, this system shall notify the other Ohio retirement systems ninety days prior to the effective date of such change to discuss the impact of such change on this rule.

(F) The waiver program outlined in paragraphs (D) and (E) of this rule shall remain in place only for benefit recipients who waived coverage from this system or to this system prior to January 1, 2008. Effective January 1, 2008, benefit recipients shall not be permitted to waive coverage as outlined in paragraphs (D) and (E) of this rule as the Ohio police and fire pension fund discontinued its waiver program effective January 1, 2008, the Ohio public employees retirement system discontinued its waiver program effective January 1, 2007, and the school employees retirement system discontinued its waiver program effective March 1, 2007. The highway patrol retirement system has never participated with this system in the waiver program outlined in paragraphs (D) and (E) of this rule.

Effective: 01/20/2008

R.C. 119.032 review dates: 04/01/2001

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.61

Prior Effective Dates: 8/1/1998, 7/1/01 (Emer.), 9/17/01, 10/23/07 (Emer.)

(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 3307.662 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) of rule 3307:1-11-01 of the Administrative Code.

(5) “Qualifying enrollee” shall include persons who:

(a) Were:

(i) Granted service retirement under sections 3307.50 to 3307.79 of the Revised Code with at least twenty-five years of total service credit at retirement that is not service credit excluded from premium waiver under the terms of paragraph (A)(3)(c) of rule 3307:1-11-03 of the Administrative Code or service credit purchased under section 3307.741 of the Revised Code; or

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

(iii) Beneficiaries of retired teachers with at least twenty-five years of total service credit at retirement and none of the service credit is excluded from premium waiver under the terms of paragraph (A)(3)(c) of rule 3307:1-11-03 of the Administrative Code or service credit purchased under section 3307.741 of the Revised Code; or

(iv) Survivors of either active teachers or disabled teachers eligible to retire with at least twenty-five years of total service credit at retirement and none of the service credit is excluded from premium waiver under the terms of paragraph (A)(3)(c) of rule 3307:1-11-03 of the Administrative Code or service credit purchased under section 3307.741 of the Revised Code; or

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

(B) A qualified enrollee may make application for health care assistance on a form provided by the retirement system. The effective date of the participation in the 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 individual who fails to supply all requested information within three months of filing shall be canceled.

(C) A qualified 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 the individual no longer qualifying for the program and all assistance benefits shall 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 granted 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 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.

(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: 05/14/2009

R.C. 119.032 review dates: 02/26/2009 and 05/14/2014

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.61

Prior Effective Dates: 7/1/04 (Emer.), 8/26/04, 7/1/07 (Emer.), 9/24/07

(A) Within the Employers’ Trust Fund described in section 3307.14(B) of the Revised Code, there shall be a separate account established pursuant to section 401(h) of the Internal Revenue Code for the purpose of funding the coverage authorized under sections 3307.39 and 3307.61 of the Revised Code. This account shall be known as the “Health Care Fund.” The assets in the Health Care Fund shall be accounted for separately from the other assets of the state teachers retirement system, but may be commingled with the other assets of the system for investment purposes. Investment earnings and expenses shall be allocated on a reasonable basis. All assets in the Health Care Fund shall be held in trust for the exclusive benefit of retirants, benefit recipients, and dependents.

(B) The state teachers retirement board shall designate the amount of contributions, if any, that are to be allocated to the Health Care Fund for any year. Any contributions shall be funded by employer contributions to the Employers’ Trust Fund and shall include any employer contributions previously allocated by the state teachers retirement board for health care benefits described in section 3307.39 and 3307.61 of the Revised Code, together with any earnings credited thereon, with respect to individuals participating in the plan described in either sections 3307.50 to 3307.79 of the Revised Code or section 3307.81 of the Revised Code in which an individual may receive definitely determinable benefits. Contributions to the Health Care Fund are subordinate to the contributions to the Employers’ Trust Fund for retirement benefits under the plans described in sections 3307.50 to 3307.79 of the Revised Code and section 3307.81 of the Revised Code in which an individual may receive definitely determinable benefits. At no time shall contributions to the Health Care Fund, when added to contributions for any life insurance benefits provided on behalf of eligible benefit recipients, be in excess of twenty-five percent of the total aggregate actual contributions made to state teachers retirement system since the inception of the Health Care Fund, excluding contributions to fund past service credit. In any event, all contributions to the Health Care Fund shall be reasonable and ascertainable.

(C) If any rights of an individual who is eligible to receive coverage authorized under sections 3307.39 and 3307.61 of the Revised Code and paid from the Health Care Fund are forfeited as provided in the applicable provisions of the medical and ancillary plans offered by the retirement system, an amount equal to the amount of such forfeiture shall be applied as soon as administratively possible to reduce employer contributions allocated to the Health Care Fund.

(D) The assets of the Health Care Fund shall only be used for the payment of health care benefits, qualified medical expenses, dental and vision coverage, if applicable, and to reimburse the Medicare Part B premiums paid by eligible benefit recipients.

(E) At no time prior to the satisfaction of all liabilities under this rule and sections 3307.39 and 3307.61 of the Revised Code shall any assets in the Health Care Fund be used for, or diverted to, any purpose other than as provided in paragraph (D) of this rule and for the payment of administrative expenses relating to the Health Care Fund. Assets in the Health Care Fund may not be used for retirement, disability, or survivor benefits, or for any other purpose for which the other funds of the system are used.

(F) Upon satisfaction of all liabilities under this rule, any assets in the Health Care Fund, if any, that are not used as provided in paragraph (E) of this rule shall be returned to the employers, as required by section 401(h)(5) of the Internal Revenue Code.

(G) It is the intent of the state teachers retirement board in adopting this rule to codify its compliance in all respects with sections 401(a) and 401(h) of the Internal Revenue Code and regulations interpreting those sections. In applying this rule, the board will apply the interpretation that achieves compliance with those sections and preserves the qualified status of the system as a governmental plan under sections 401(a) and 414(d) of the Internal Revenue Code.

(H) This rule is intended to codify past and current practices and procedures of the system with respect to the funding and payment of health care coverage and does not confer any new rights to or create any vested interest in receiving health care coverage for members, retirees, survivors, beneficiaries, or their dependents.

Effective: 07/16/2009

R.C. 119.032 review dates: 07/16/2014

Promulgated Under: 111.15

Statutory Authority: 3307.04

Rule Amplifies: 3307.39, 3307.61