3307:1-11-02 Health care services - eligibility.

Subject to the requirements of Chapter 3307:1-11 of the Administrative Code and 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 primary service retirement benefit recipient whose benefit effective date is prior to January 1, 2004.

(B) A primary service retirement benefit recipient with fifteen or more years of total service credit whose benefit effective date is January 1, 2004 or later.

(C) A disability benefit recipient.

(D) A primary service retirement benefit recipient who was receiving disability benefits and whose benefit effective date is prior to January 1, 2004 and who began receiving 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 total service credit used in the calculation of service retirement benefits, which shall not include service credit purchased under section 3307.741 of the Revised Code.

(E) A primary service retirement benefit recipient who was receiving disability benefits; whose benefit effective date is January 1, 2004 or later; and who began receiving service retirement benefits with no break in receipt of monthly benefits following the termination of disability benefits, provided the benefit recipient has fifteen or more years of total service credit. Service credit used to determine health care eligibility shall be the total service credit used in the calculation of service retirement benefits, which shall not include service credit purchased under section 3307.741 of the Revised Code.

(F) A person receiving benefits under a joint and survivor annuity or annuity certain plan of payment described in section 3307.60 of the Revised Code who was eligible for coverage as a dependent of the primary service retirement benefit recipient at the time of the primary service retirement benefit recipient's death, provided:

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

(2) The effective date of the person's monthly benefits is January 1, 2004 or later and the primary service retirement benefit recipient had fifteen or more years of total service credit at the time of retirement.

(G) A person granted survivor benefits 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.

(H) A person granted survivor benefits 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, 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 total service credit at the time of death.

(I) Dependents of the primary service retirement benefit recipients and disability benefit recipients described in paragraphs (A) to (E) of this rule, including children born after the effective date of a benefit, and to the extent that a medical or ancillary plan allows coverage for sponsored dependents.

(J) 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 (J) 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 retirement system while the individual was eligible for available employer coverage.

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 , 3307.61
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.), 9/27/01, 1/1/04 (Emer.), 3/22/04, 1/08/07, 12/6/07, 5/14/09, 8/12/10 (Emer.), 10/28/10, 1/1/13, 1/1/14 (Emer)