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

(A) Pursuant to sections 3307.39 and 3307.391 of the Revised Code, a health care program is hereby established for certain service retirement and disability benefit recipients and certain dependents of those benefit recipients who meet the conditions of eligibility specified by this chapter of the Administrative Code and the conditions of eligibility for participation 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 from time-to-time offer. The retirement board shall review the medical and ancillary plans offered at least every two years.

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

(1) "Ancillary plan" shall mean a plan offering auxiliary coverage, such as dental or vision coverage.

(2) "Child" shall mean a biological child, lawfully adopted child or stepchild of a member, of a primary service retirement benefit recipient, or of a disability benefit recipient or a child for whom a member, a primary service retirement benefit recipient, or disability benefit recipient has been legally appointed as guardian, provided that such child has not yet attained age twenty-six.

(3) "Dependent" shall mean a spouse, child, or sponsored dependent as defined in this rule.

(4) "Disabled adult child" shall mean any biological child, child lawfully adopted prior to age eighteen, stepchild of a deceased member, primary service retirement benefit recipient or disability benefit recipient or a child for which a deceased member, primary service retirement benefit recipient or disability benefit recipient has been legally appointed as guardian prior to age eighteen and who is permanently and totally disabled. To determine an adult child meets and continues to meet the requirements in paragraph (C)(4)(b) or (C)(4)(c) of this rule, the same procedure for the determination of "physical or mental incompetency" as outlined in paragraph (I) of rule 3307:1-8-01 of the Administrative Code for survivor benefit eligibility shall be followed. The disabled adult child shall also meet one of the following requirements:

(a) Has never married and has been adjudged physically or mentally incompetent by a court prior to age eighteen or age twenty-two if the child was attending school on at least a two-thirds full-time basis and the child's physical or mental incompetency has been continuous since the court's initial adjudication, or

(b) Has never married and has attained age twenty-six and has been unable to earn a living because of a mental or physical condition that was disabling prior to age eighteen or age twenty-two if the child was attending school on at least a two-thirds full-time basis, provided the disabled adult child has been continuously disabled and unable to earn a living from the initial date that the disabled adult child was determined to have a mental or physical condition that was disabling. The chair of the medical review board shall determine that the child has a mental or physical condition that incapacitated the child before the maximum age specified in this paragraph. As used herein, "unable to earning a living" means that a child was incapable of earning at least sixteen thousand dollars a year for any year before January 1, 2008, and was incapable of earning for each year since January 1, 2008, the federal minium wage as of January first for each year multiplied by two thousand eighty hours, increased by fifty per cent and rounded to the nearest thousand dollars for each year thereafter , or

(c) Has never married, has attained age twenty-six and attends an adult workshop or school for the developmentally disabled operated by a county or state department of developmental disabilities. If attendance has not been continuous since age eighteen or age twenty-two if the child was attending school on at least a two-thirds full-time basis, additional earnings verification may be required in accordance with paragraph (C)(4)(b) of this rule.

(5) "Medical plan" shall mean a plan offering health, medical, hospital, or prescription drug coverage or any combination thereof.

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

(7) "Primary service retirement benefit recipient" shall mean a member who applied for and was granted service retirement benefits under the plan described in sections 3307.50 to 3307.79 of the Revised Code or a plan established under section 3307.81 of the Revised Code that provides health care coverage.

(8) "Retiree," "Service retiree," "Service benefit recipient," "service retirement benefit recipient," and "recipient of a service retirement benefit" shall mean a member who applied for and was granted service retirement benefits under the plan described in sections 3307.50 to 3307.79 of the Revised Code or a plan established under section 3307.81 of the Revised Code.

(9) "Sponsored dependent" includes:

(a) A disabled adult child living in the residence of a primary service retirement benefit recipient, or disability benefit recipient, or in a convalescent center or any other type of institution that retains a disabled adult child temporarily;

(b) A disabled adult child not living in the home of a primary service retirement benefit or disability benefit recipient, but receiving one-half or more support from the primary service retirement benefit recipient or disability 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) One person age twenty-six or older living in the home of an unmarried primary service retirement benefit recipient or disability benefit recipient or in a convalescent center or any other type of institution that retains a person temporarily, notwithstanding that the primary service retirement benefit recipient or disability benefit recipient does not claim the sponsored dependent as a financial dependent for federal income tax purposes.

(10) "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 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.

(D) A primary service retirement benefit recipient or disability benefit recipient shall provide any information requested by the retirement system to validate the eligibility of a disabled adult child in any medical or ancillary plan offered by the retirement system.

Effective: 02/10/2014
R.C. 119.032 review dates: 11/26/2013 and 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, 1/1/04 (Emer.), 3/22/04, 8/9/07, 5/14/09, 10/28/10, 1/1/13, 1/1/14 (Emer)