3307:1-11-05 Health care services - medicare part B reimbursement.

(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 an amount determined by the board, provided 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 monthly reimbursement amount for medicare part B for which the recipient was eligible shall be divided equally among all beneficiaries and shall only be paid to a beneficiary if he or she becomes eligible 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 and such reimbursement shall be based upon service credit and an amount determined by the board. 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, except as provided in paragraph (B) of this rule. 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 began receiving continuing monthly benefits pursuant to section 3307.60 of the Revised Code prior to January1, 2008, 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) The recipient or beneficiary shall certify the amount paid by the recipient or beneficiary for medicare part B coverage, and no reimbursement amount provided under this rule shall exceed the amount paid by the recipient or beneficiary.

(E) 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.

Effective: 03/27/2014
R.C. 119.032 review dates: 01/08/2014 and 06/01/2016
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
Prior Effective Dates: 2/23/76, 11/28/1977, 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, 1/1/04 (Emer.), 3/22/04, 11/9/06, 1/1/07 (Emer.), 4/1/07, 2/26/09