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 STRS defined benefit plan 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 benefit recipient provides the board with certification of participation in the medicare part B insurance program. Each benefit recipient who qualifies for medicare part B 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. Beginning January 1, 2015, medicare part B reimbursement shall only be provided if the recipient of a service retirement, disability or survivor benefit is enrolled in a medical plan offered pursuant to section 3307.39 of the Revised Code. A person who begins receiving survivor benefits under section 3307.66 of the Revised Code on or after January 1, 2015 is not eligible to receive medicare part B reimbursement.

(B) If a service retirement benefit recipient dies and the benefit recipient had selected a joint and survivor annuity or annuity certain 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 benefit 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 as specified in paragraph (C) of this rule.

(C) Each beneficiary eligible under rule 3307:1-11-02 of the Administrative Code who is receiving a continuing monthly benefit under a joint and survivor annuity or annuity certain plan of payment described in section 3307.60 of the Revised Code, who qualifies to enroll in medicare part B, and who, on or after January 1, 2015 is enrolled in a medical plan offered pursuant to section 3307.39 of the Revised Code shall be eligible for reimbursement for a portion of the cost of the medicare part B premium provided the beneficiary 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 under a joint and survivor annuity or annuity certain plan of payment described in 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 who was named by a primary service retirement benefit recipient before January 1, 2008 under a joint and survivor annuity or annuity certain plan of payment described in section 3307.60 of the Revised Code and who begins receiving continuing benefits no later than December 1, 2014 , the board shall make reimbursement for a portion of the cost of medicare part B only 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 under a joint and survivor annuity or annuity certain plan of payment described in section 3307.60 of the Revised Code prior to January 1, 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 under a joint and survivor annuity or annuity certain plan of payment described insection 3307.60 of the Revised Code effective January 1, 2008, but no later than December 1, 2014 , 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 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: 09/04/2014
R.C. 119.032 review dates: 06/01/2016
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