Chapter 3307:1-11 Health Care Services

3307:1-11-01 Health care services - establishment of program and definitions.

(A) Establishment of program

(1) Health care

(a) Pursuant to section 3307.39 of the Revised Code, a health care program is hereby established for certain benefit recipients and their dependents who meet eligibility requirements specified in this chapter and in any medical or ancillary plan offered.

(b) The health care program shall consist of such medical plans and ancillary plans as the retirement board may offer from time-to-time.

(c) Benefit recipients shall provide any information requested by the retirement system to validate the eligibility of any enrollee in a medical plan or ancillary plan offered by the retirement system.

(d) Any person who obtains coverage, subsidy, or payment of claims in a medical plan and/or ancillary plan as the result of false or misleading information shall be immediately terminated from the health care program. Any amounts paid for which a person is not entitled shall be repaid pursuant to section 3307.47 of the Revised Code. The retirement system may collect amounts due in any other manner the system considers appropriate, as provided by law.

(2) Long-term care insurance

Pursuant to section 3307.391 of the Revised Code, long-term care insurance coverage may be made available for certain teachers, benefit recipients and their dependents who meet eligibility requirements specified in this chapter and in any long-term care insurance offered by the retirement system.

(B) Definitions for purposes of this chapter

(1) "Ancillary plan" means a plan offered to provide auxiliary coverage, such as dental or vision coverage.

(2) "Benefit recipient" means a primary recipient, a survivor annuitant, or a survivor benefit recipient as defined in paragraphs (B)(13), (B)(18) and (B)(19) of this rule.

(3) "Child" means a biological child, legally adopted child, or stepchild of a living or deceased primary recipient or member, or a child for whom a primary recipient or member has been legally appointed as guardian prior to the child attaining age twenty-six.

(4) "Dependent" means a child under age twenty-six, a sponsored dependent, or a spouse as defined in paragraphs (B)(3), (B)(15) and (B)(16) of this rule.

(5) "Disability benefit recipient" means a member in the defined benefit plan who is receiving a monthly disability benefit or a participant in the combined plan who is receiving a monthly disability benefit.

(6) "Disabled adult child" means a person age twenty-six or older who has never been married; is a biological or legally adopted child prior to age eighteen, or a stepchild of a living or deceased primary recipient or member, or a child for whom a primary recipient has been legally appointed as guardian prior to the child attaining age eighteen; continuously meets the requirements for physical or mental incompetency as set forth in paragraphs (H) and (I) of rule 3307:1-8-01 of the Administrative Code, and either:

(a) Was adjudged physically or mentally incompetent by a court prior to age eighteen, or age twenty-two if he or she was attending school on at least a two-thirds full-time basis, or

(b) Was continuously physically or mentally incompetent and continuously unable to earn a living where both conditions occurred prior to age eighteen, or age twenty-two if he or she was attending school on at least a two-thirds full-time basis.

(7) "Enrollee" means any individual described in this chapter who participates in a medical plan or ancillary plan offered by the retirement system.

(8) "Enrollment cycle" means a period of time during which an enrollee is not permitted to terminate his or her enrollment and must continue paying monthly premiums.

(9) "Entity" means any public or private organization that acts as an employer and is not limited to an employer as defined in section 3307.01 of the Revised Code.

(10) "Medical plan" means a plan offered to provide medical or prescription drug coverage or any combination thereof.

(11) "Ohio retirement system" includes highway patrol retirement system, police and fire pension fund, public employees retirement system, and school employees retirement system.

(12) "Premium" means a monthly amount that is required to be paid by a benefit recipient to continue enrollment for health care coverage for the benefit recipient and/or any dependent.

(13) "Primary recipient" means a disability benefit recipient or service retiree as defined in paragraphs (B)(5) and (B)(14) of this rule.

(14) "Service retiree" means a member in the defined benefit plan who is granted a monthly service retirement benefit or a participant in the combined plan who is granted a monthly service retirement benefit under the defined benefit portion of the combined plan.

(15) "Sponsored dependent" means a disabled adult child or a person age twenty-six or older whose permanent residence is with an unmarried primary recipient.

(16) "Spouse" means a person currently married to a primary recipient or a person who was married to a member or primary recipient at the time of the member's or primary recipient's death.

(17) "Subsidy" means the portion, if any, of the medical plan monthly cost waived by the retirement board.

(18) "Survivor annuitant" means a beneficiary of a service retiree, who was eligible for health care coverage as a dependent at the time of the service retiree's death and who is receiving a monthly service retirement benefit under an optional plan of payment as defined in section 3307.60 of the Revised Code.

(19) "Survivor benefit recipient" means a person receiving a monthly survivor benefit under section 3307.66 of the Revised Code or the combined plan, provided such person was eligible as a dependent of the member or disability recipient at the time of the member's or disability recipient's death.

(20) "Total service credit" has the same meaning as used in section 3307.50 of the Revised Code, and as used in this chapter such credit shall not include any credit purchased under former section 3307.741 of the Revised Code, but shall include credit purchased under sections 145.297, 145.298, 3307.54 (as it existed until July 31, 2014), and 3309.33 of the Revised Code.

Replaces: 3307:1-11-01

Effective: 6/10/2016
Five Year Review (FYR) Dates: 06/10/2021
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, 1/1/04 (Emer.), 3/22/04, 8/9/07, 5/14/09, 10/28/10, 1/1/13, 1/1/14 (Emer), 2/10/14

3307:1-11-02 Health care services - health care fund.

(A) The retirement board shall designate the amount of contributions, if any, that are to be allocated to the health care fund described in division (H) of section 3307.14 of the Revised Code for any year. Any contributions shall be funded by employer contributions to the employer's trust fund and shall include any employer contributions previously allocated by the retirement board for health care coverage described in section 3307.39 of the Revised Code, together with any earnings credited thereon, with respect to individuals participating in the plan described in either the STRS defined benefit plan or the defined contribution plan in which an individual may receive definitely determinable benefits. Contributions to the health care fund are subordinate to the contributions to the employer's trust fund for retirement benefits under the plans described in the STRS defined benefit plan and the defined contribution plan 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 per cent of the total aggregate actual contributions made to the 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.

(B) If any rights of an individual who is eligible to receive coverage authorized under section 3307.39 of the Revised Code and paid from the health care fund are forfeited as provided in the applicable provisions of the medical plans 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.

(C) The assets of the health care fund shall be used only for the payment of health care coverage, qualified medical expenses, dental and vision coverage, and to partially reimburse medicare part B monthly premiums paid by eligible benefit recipients, if applicable.

(D) At no time prior to the satisfaction of all liabilities under this rule and section 3307.39 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 (C) 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.

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

(F) It is the intent of the 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 retirement 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.

(G) 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, benefit recipients, or their dependents.

Replaces: 3307:1-11-12

Effective: 6/10/2016
Five Year Review (FYR) Dates: 06/10/2021
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
Prior Effective Dates: 1/22/09 (Emer), 4/29/09 (Emer), 7/16/09, 6/12/2014

3307:1-11-03 Health care services - medical plan.

(A) Eligibility

The following individuals shall be eligible to participate in a medical plan offered by the retirement system:

(1) A service retiree with an effective benefit date:

(a) Before January 1, 2004; or

(b) Between January 1, 2004 and July 1, 2023 and the benefit is based on fifteen or more years of total service credit; or

(c) After July 1, 2023 and the benefit is based on twenty or more years of total service credit.

(2) A service retiree who began receiving service retirement benefits with no break in monthly benefits following the termination of disability benefits, with a disability effective benefit date:

(a) Before January 1, 2004; or

(b) Between January 1, 2004 and July 1, 2023 and the service retiree benefit is based on fifteen or more years of total service credit; or

(c) After July 1, 2023 and the service retiree benefit is based on twenty or more years of total service credit.

(3) A disability benefit recipient.

(4) A survivor annuitant.

(5) A survivor benefit recipient under division (C)(1) of section 3307.66 of the Revised Code who was eligible for coverage as a dependent at the time of the member's or disability benefit recipient's death where the effective date of survivor benefits or the effective date of disability benefits of the deceased member is:

(a) Before January 1, 2004; or

(b) Between January 1, 2004 and July 1, 2023 provided that the deceased member had fifteen or more years of total service credit at the time of death; or

(c) After July 1, 2023 provided the deceased member had twenty or more years of total service credit at the time of death.

(6) A survivor benefit recipient under division (C)(2) of section 3307.66 of the Revised Code who was eligible for coverage as a dependent at the time of the member's or disability benefit recipient's death.

(7) Dependents, to the extent that a medical plan and/or ancillary plan allows for dependent coverage.

(8) Notwithstanding paragraphs (A)(1) to (A)(7) of this rule, an individual not eligible for medicare coverage is not eligible for primary coverage in a medical plan offered by the retirement system if the individual is employed and has access to an entity's medical plan or if similarly situated, non-retired employees have access to an entity's medical plan, provided the medical plan includes prescription coverage and provides equivalent coverage at a cost no more than what is available to full-time employees as defined by the entity. The retirement board may require each enrollee to annually file a verification of employment statement disclosing the availability for enrollment as an employee in an entity's medical plan.

(a) When an individual is enrolled in an entity's medical plan and a medical plan offered by the retirement system, coverage in the retirement system's medical plan will be limited to secondary coverage applied only to those covered medical expenses not paid by the entity's medical plan.

(b) An employed individual not eligible for medicare who does not file a verification of employment statement with the retirement system when requested by the retirement system; does not enroll in the entity's medical plan when eligible to enroll, or is excluded from the entity's medical plan based upon being an enrollee is not eligible to enroll or remain enrolled in a medical plan offered by the retirement system.

(B) Effective date

The effective date of coverage for enrollees in a medical plan shall be determined as follows:

(1) Initial enrollment: When a monthly benefit payment begins, medical coverage shall begin for a:

(a) Service retiree:

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

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

(b) Disability benefit recipient:

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

(ii) On the first day of the month following the date the disability benefit is granted when the effective benefit 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 recipient:

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

(ii) On the first of the month following the receipt of a survivor benefit application submitted after the third month following the month of the member's or disability benefit recipient's death provided the survivor benefit recipient enrolls by the end of the month following the month the survivor benefit application is received.

(d) Survivor annuitant:

(i) On the first of the month following the month of the service retiree's death, provided a survivor annuitant enrolls by the end of the third month following the month of the service retiree's death.

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

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

(a) Open enrollment: The retirement system may offer an open enrollment period during which eligible benefit recipients may enroll or change medical plans for themselves and eligible dependents. 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: A person may enroll under the following circumstances when a benefit recipient submits his or her application to enroll within thirty-one days from the date of a qualifying event, provides any other required documentation, the application is approved by the retirement system, and the person meets all other eligibility requirements:

(i) Benefit recipients:

(a) A benefit recipient may enroll based upon his or her loss of health care coverage that provided minimum essential coverage as defined under the federal Patient Protection and Affordable Care Act of 2010 for coverage beginning the first of the month in which coverage is lost.

(b) A benefit recipient may enroll based upon his or her enrolling in medicare parts A and B or only medicare part B for coverage beginning the first of the month medicare coverage begins.

(ii) Provided the benefit recipient is enrolled, dependents may be enrolled as follows:

(a) A primary recipient may enroll his or her new spouse for coverage beginning the first of the month following the date of marriage or the first day of the month of marriage when the date of marriage is on the first day of the month.

(b) A benefit recipient may enroll a child for coverage beginning the day of birth, legal adoption, or the date the benefit recipient was legally appointed as guardian of that child.

(c) A benefit recipient may enroll a dependent who lost health care coverage that provided minimum essential coverage as defined under the federal Patient Protection and Affordable Care Act of 2010 for coverage beginning the first of the month in which coverage is lost.

(d) A benefit recipient may enroll a dependent based upon the dependent enrolling in medicare parts A and B or only medicare part B for coverage beginning the first of the month medicare coverage begins.

(C) Premium

(1) The premium for an enrollee in a medical plan shall be based upon the total service credit used in the calculation of the primary recipient's benefit, the effective benefit date, and such other factors as the retirement board may find relevant in its sole discretion.

(2) The premium for an enrollee in a medical plan shall be pre-paid through a monthly deduction from the monthly benefit unless the amount of the monthly benefit will not cover the total premium. In that case, the benefit recipient will be billed directly by the retirement system for any premium balance owed for an initial period not to exceed three months and authorizes the retirement system to electronically debit the premium balance owed each month from the benefit recipient's bank account. It will be the sole responsibility of the benefit recipient to provide and maintain the information and available funds required for the retirement system to complete the monthly electronic debit. Should the retirement system be unable to debit the payment electronically after the initial three month period, enrollment in the health care program may be terminated. If for any reason payment is not received on or before the first business day of the month the premium is due, enrollment in the health care program may be terminated.

(3) The following benefit recipients are eligible to receive a subsidy:

(a) A service retiree either with an effective benefit date prior to August 1, 2023 and fifteen or more years of total service credit, or with an effective benefit date on or after August 1, 2023 and twenty or more years of total service credit.

(b) A disability benefit recipient.

(c) A survivor annuitant with an effective benefit date between January 1, 2011 and December 1, 2014 is eligible to receive a subsidy for five years from the effective benefit date if the deceased service retiree had fifteen or more years of total service credit. In the event the service retiree named multiple beneficiaries under division (A)(4) of section 3307.60 of the Revised Code, the subsidy for which the service retiree was eligible will be allocated equally among the survivor annuitants for the five year subsidy period. No subsidy shall be provided to an individual who becomes a survivor annuitant on or after January 1, 2015.

(d) A survivor benefit recipient with an effective benefit date between January 1, 2011 and December 1, 2014 is eligible to receive a subsidy for five years from the effective benefit date if:

(i) The survivor benefit recipient has been granted survivor benefits under division (C)(1) of section 3307.66 of the Revised Code and the member had fifteen or more years of service; or

(ii) The survivor benefit recipient has been granted survivor benefits under division (C)(2) of section 3307.66 of the Revised Code, subsidy for the survivor benefit recipient and dependents shall be calculated based upon the greater of the member's years of total service credit or fifteen years, and other factors as the retirement board may find relevant in its sole discretion.

(iii) No subsidy shall be provided to individuals who become survivor benefit recipients on or after January 1, 2015.

(D) Open enrollment and plan changes

(1) The retirement system may offer an open-enrollment period during which benefit recipients may enroll in or change medical plans for themselves and eligible dependents.

(2) Once coverage under a medical plan begins, a benefit recipient can request a change of medical plans during the plan year as follows:

(a) A change to any other available medical plan may occur when an enrolled benefit recipient provides required documentation and requests a change:

(i) Within thirty-one days of: receipt of the first regular monthly benefit payment; marriage, divorce, legal separation or dissolution; birth, adoption, or legal appointment as guardian of a child; death; or full loss of subsidy; or

(ii) Within three months of enrolling in medicare parts A and B or only medicare part B.

(b) A change to another medical plan may occur at any time when an enrolled benefit recipient requests a change and provides documentation that evidences one of the following events:

(i) Loss of a key provider from a medical plan's provider network.

(ii) Relocation of permanent residence to another service area not covered by the enrollee's current medical plan.

(iii) Addition of a sponsored dependent when the medical plan in which the primary recipient is enrolled does not allow sponsored dependents.

(iv) Benefit recipient enrolled in a medicare fully insured medical plan.

Replaces: 3307:1-11-02, 3307:1-11-03, 3307:1-11-04, 3307:1-11-06

Effective: 6/10/2016
Five Year Review (FYR) Dates: 06/10/2021
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, 6/22/1992 (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, 9/27/01, 9/17/02, 1/1/04 (Emer.), 3/22/04, 7/1/06, 10/27/06, 1/08/07, 12/6/07, 1/6/08, 5/14/09, 8/12/10 (Emer.), 10/28/10, 6/6/11, 1/1/13, 1/1/14 (Emer.), 2/10/2014, 6/12/14, 9/4/14, 12/10/2015

3307:1-11-04 Health care services - health care assistance program.

(A) The retirement board authorizes health care assistance for certain benefit recipients who apply, qualify, and are approved for the health care assistance program.

(B) The following benefit recipients shall be eligible to apply annually for health care assistance under the health care assistance program on a form provided by the retirement system, if they are eligible for and enrolled in medicare, and if they meet the total household income requirements of paragraph (C) of this rule:

(1) A service retiree who qualifies for a subsidy and has twenty-five or more years of total service credit at retirement.

(2) A disability benefit recipient who qualifies for a subsidy.

(3) A survivor annuitant or survivor benefit recipient who was enrolled in the health care assistance program as of December 31, 2015, continues to meet all other health care assistance program requirements, and remains continuously enrolled in the health care assistance program.

(4) A survivor annuitant or survivor benefit recipient who is eligible for a subsidy and the deceased member or primary recipient had twenty-five or more years of total service credit.

(5) A survivor benefit recipient eligible for a subsidy who is receiving survivor benefits under division (C)(2) of section 3307.66 of the Revised Code.

(C) A benefit recipient's total household income shall not exceed 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 or another amount determined by the retirement board for any of the amounts below:

(1) The benefit recipient's monthly benefit annualized at the time of the application for the health care assistance program;

(2) The total estimated household earnings and reportable earnings according to the Internal Revenue Code of all persons in the benefit recipient's household for the year coverage is being requested; and

(3) The combined total liquid assets for all persons within the benefit recipient's household, which includes cash and all monies readily available 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.

(D) Applicants for the health care assistance program shall provide all information requested by the retirement system, including copies of any federal income tax return for the benefit recipient and each person in the benefit recipient's household to verify the income and assets reported on the application and, if applicable, verification of medicare enrollment.

(E) If the application for health care assistance is approved by the retirement system, health care assistance is provided through the end of the plan year. Health care coverage as determined by the retirement board through certain medical plans shall begin:

(1) January first of the following year for renewal applications received on or before December fifteenth of the current year; or

(2) The first day of the month following the date a new application is received for applications received on or before the fifteenth day of the month; or

(3) The first day of the second month from the date a new application is received for applications received after the fifteenth day of the month; or

(4) The later of the effective benefit date or the effective date established under paragraph (E)(2) or (E)(3) of this rule for "benefit recipients" who apply for the health care assistance program at the same time an application for service retirement benefits or disability benefits is filed with the retirement system.

(F) The health care assistance program may be changed or terminated by the retirement board at any time.

(G) Health care assistance under this rule provided 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 for health care assistance shall immediately repay the amounts of any health care 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. The retirement system may collect amounts due in any other manner the system considers appropriate, as provided by law.

Replaces: 3307: 1-11-11

Effective: 6/10/2016
Five Year Review (FYR) Dates: 06/10/2021
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
Prior Effective Dates: 1/1/04 (Emer.), 3/22/04, 7/1/04 (Emer.), 8/26/04, 7/1/07 (Emer.), 9/24/07, 5/14/09, 6/12/2014, 12/10/2015

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

(A) Pursuant to section 3307.39 of the Revised Code, certain benefit recipients who request reimbursement and verify enrollment in the medicare part B insurance program with the retirement system may be eligible for reimbursement for a portion of the cost of the basic medicare part B premium for months where eligible individuals are enrolled in both a medical plan offered by the retirement system and medicare part B. For approved requests received on or before the fifteenth day of a month, reimbursement begins the first of the month after the date the request is received; otherwise, reimbursement begins the first of the second month after the date the request is received. Reimbursement will be based on service credit in an amount as periodically determined by the retirement board that meets the provisions in division (B) of section 3307.39 of the Revised Code.

(B) The following benefit recipients who continually meet the provisions in paragraph (A) of this rule are eligible for reimbursement as specified in this rule:

(1) A primary recipient.

(2) A survivor benefit recipient with an effective benefit date that is on or before December 1, 2014.

(3) A survivor annuitant for whom reimbursement is calculated to be the amount of reimbursement the service retiree would have received divided by the number of survivor annuitants of the deceased service retiree, and

(a) Whose monthly survivor annuitant benefit began on or before December 1, 2014, was age sixty-five and was a named beneficiary prior to January 1, 2008; or

(b) Whose monthly survivor annuitant benefit began between January 1, 2008 and December 1, 2014, is eligible to receive a subsidy for a maximum of five years from the date he or she became a survivor annuitant.

(C) Upon request, a benefit recipient receiving medicare part B premium reimbursement under this rule shall certify the amount paid for medicare part B coverage. The reimbursement amount provided under this rule shall not exceed the amount paid by the benefit recipient.

(D) For purposes of section 3307.39 of the Revised Code and this rule, basic medicare part B premium means the amount of the standard monthly medicare part B premium determined by the United States secretary of health and human services prior to any premium increases, such as late enrollment penalties or income related monthly adjustment amount being made.

Replaces: 3307:1-11-05

Effective: 6/10/2016
Five Year Review (FYR) Dates: 06/10/2021
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
Prior Effective Dates: 12/23/76, 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, 9/30/04, 11/9/06, 1/1/07 (Emer.), 4/1/07, 3/27/14, 9/4/2014

3307:1-11-06 Health care services - responsibility for health care coverage.

(A) Except as otherwise provided in this rule, this retirement system shall be the system responsible for health care coverage for its eligible benefit recipients.

(B) A benefit recipient is not eligible for primary coverage in a medical plan offered by this retirement system if the benefit recipient is eligible for health care coverage in another Ohio retirement system in the following situations:

(1) When a benefit recipient is receiving a monthly benefit based on the same status as a service retiree, disability benefit recipient or survivor benefit recipient in this retirement system and from another Ohio retirement system and the effective benefit date in this system is

(a) Later than the effective benefit date in the other Ohio retirement system; or

(b) The same as the effective benefit date in the other Ohio retirement system and the benefit recipient has less service credit in this retirement system than in the other retirement system; or

(c) The same as the effective benefit date in the other Ohio retirement system and the benefit recipient has the same service credit in this retirement system as in the other Ohio retirement system and the teacher contributions in the account upon which the benefit in this retirement system is based are less than the employee contributions in the account upon which the benefit in the other Ohio retirement system is based.

(2) Where an eligible disability benefit recipient or survivor benefit recipient of the retirement system is also receiving a service retirement benefit from another Ohio retirement system.

Replaces: 3307:1-11-10

Effective: 6/10/2016
Five Year Review (FYR) Dates: 06/10/2021
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
Prior Effective Dates: 8/1/98, 7/1/01 (Emer.), 9/17/01, 10/23/07 (Emer.), 1/20/08, 6/6/11, 7/10/2014

3307:1-11-07 Health care services - ancillary plans.

(A) General provisions

(1) Eligibility for enrollment in an ancillary plan is the same as eligibility for enrollment in a medical plan except as otherwise provided in this rule.

(2) Enrollment in an ancillary plan is the same as enrollment in a medical plan except as otherwise provided in this rule.

(3) The retirement board will not provide a subsidy for any portion of the monthly premium for enrollment in any ancillary plan.

(B) Dental and vision plans

(1) Enrollment

(a) Initial enrollment shall be the same as initial enrollment in a medical plan except that termination or other plan changes shall not be made until the end of the enrollment cycle unless there is a loss of eligibility under the plan.

(b) Subsequent enrollment shall be the same as subsequent enrollment in a medical plan except that open enrollment in dental and vision plans shall only occur at the end of the enrollment cycle.

Replaces: Part of 3307:1-11-03; Part of 3307:1-11-04

Effective: 6/10/2016
Five Year Review (FYR) Dates: 06/10/2021
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
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, 9/17/02, 1/1/04 (Emer.), 3/22/04, 7/1/06, 10/27/06, 1/6/08, 5/14/09, 10/28/10, 6/6/11, 1/1/14 (Emer.), 2/10/14, 9/4/14

3307:1-11-08 Health care services - disclosure.

(A) Health information

(1) By applying for and accepting coverage in the health care program each participating benefit recipient, on behalf of herself or himself and each of his or her 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 (2000), as amended) pertaining to such participating benefit recipient, 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.

(2) The health care program, acting through the retirement board, shall require each person and/or organization 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 identification 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.

(B) Notice

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's last known address as maintained in the retirement system's records.

Replaces: 3307:1-11-07; 3307:1-11-08

Effective: 6/10/2016
Five Year Review (FYR) Dates: 06/10/2021
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, 9/17/02, 7/1/06, 6/6/11

3307:1-11-09 Health care services - long-term care insurance.

(A) Teachers or benefit recipients and eligible dependents may make application for long-term care insurance offered pursuant to section 3307.391 of the Revised Code until September 30, 2018, provided:

(1) Application for long-term care insurance shall be made directly to the insurer during enrollment periods specified by the retirement system;

(2) Determination of eligibility for long-term care insurance shall be made by the insurer; and

(3) Payment for long-term care insurance shall be made by the teacher or benefit recipient directly to the insurer in such amounts and by such methods directed by the insurer.

(B) Any individual defined as eligible under the retirement system's group policy who has made proper application pursuant to this rule may apply for long-term care insurance 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) of this rule agrees to remit payment for the cost of such insurance along with his or her own payment.

(C) Effective October 1, 2018, the retirement system will no longer offer long-term care insurance.

Replaces: 3307:1-11-09

Effective: 6/10/2016
Five Year Review (FYR) Dates: 06/10/2021
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, 7/1/06, 6/6/11

3307:1-11-10 [Rescinded] Responsibility for health care coverage.

Effective: 6/10/2016
Five Year Review (FYR) Dates: 03/23/2016
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
Prior Effective Dates: 8/1/98, 7/1/01 (Emer.), 9/17/01, 10/23/07 (Emer.), 1/20/08, 6/6/11, 7/10/14

3307:1-11-11 [Rescinded] Health care assistance.

Effective: 6/10/2016
Five Year Review (FYR) Dates: 03/23/2016
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
Prior Effective Dates: 1/1/04 (Emer.), 3/22/04, 7/1/04 (Emer.), 8/26/04, 7/1/07 (Emer.), 9/24/07, 5/14/09, 6/12/2014, 12/10/2015

3307:1-11-12 [Rescinded] "Health care fund".

Effective: 6/10/2016
Five Year Review (FYR) Dates: 03/23/2016
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39
Prior Effective Dates: 1/22/09 (Emer), 4/29/09 (Emer), 7/16/09, 6/12/2014