3307:1-11-04 Health care services - effective date.

(A) The effective date of coverage in medical and ancillary plans for plan enrollees shall be determined and is limited as follows:

(1) Initial enrollment: When a monthly benefit payment begins, medical and ancillary coverage shall begin as follows:

(a) Service retirement benefit recipients:

(i) On the benefit effective date when the service retirement application is received on or before the benefit effective date, provided the benefit recipient enrolls by the end of the month of the benefit effective date.

(ii) On the first day of the month following the date the service retirement application is received when the benefit effective date is prior to the date the service retirement application is received, provided the benefit recipient enrolls by the end of the month following the month the service retirement application is received.

(b) Disability benefit recipients:

(i) On the benefit effective date when the disability benefit recipient is granted disability benefits on or before the benefit effective date, provided the disability benefit recipient enrolls by the end of the month of the benefit effective date.

(ii) On the first day of the month following the date the disability benefit is granted when the benefit effective date is prior to the date the disability benefit is granted, provided the disability benefit recipient enrolls by the end of the month following the month the disability benefit is granted.

(c) Survivor benefit recipients:

On the benefit effective date when a survivor benefit recipient enrolls by the end of the third month following the month of the member's or disability benefits recipient's death.

(d) Service retiree beneficiary benefit recipients:

(i) On the first of the month following the month of the retiree's death, provided a service retiree beneficiary who was not enrolled as a dependent of a retiree at the time of the retiree's death enrolls by the end of the third month following the month of the retiree's death.

(ii) On the first of the month following the month of the retiree's death when a service retiree beneficiary was enrolled as a retiree's dependent at the time of the retiree's death.

(2) Subsequent enrollment: Coverage shall begin as follows if a benefit recipient does not enroll as permitted under paragraph (A)(1) of this rule and later applies to enroll:

(a) Open enrollment: Coverage will begin on the first day of the next plan year following an open enrollment period specified by the retirement system.

(b) Special enrollment: Except as otherwise specified in this paragraph, coverage will begin on the first of the month following any one of the following qualifying events if the application to enroll is received within thirty-one days of the qualifying event and approved by the retirement system:

(i) Termination of other coverage.

(ii) Coverage for a new spouse of a service retirement benefit recipient or disability benefit recipient.

(iii) Coverage for a biological newborn or lawfully adopted child or stepchild, which will begin on the day of birth or adoption.

Replaces: 330:1-11-04

Effective: 02/10/2014
R.C. 119.032 review dates: 06/01/2016
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, 7/1/06, 10/28/10, 6/6/11, 1/1/14 (Emer)