3307:1-11-06 Health care services - open enrollment and plan changes.

(A) The state teachers retirement system may annually offer an open-enrollment period during which benefit recipients may enroll or change medical plans for themselves and qualified dependents.

(B) The health plan selected by the benefit recipient during open enrollment cannot be changed for the next calendar year, with the following exceptions:

(1) A change in plan administrators, plan levels or both may occur if any of the following conditions are met:

(a) The enrollee requests the change within three months before or after the effective date of medicare benefits.

(b) The enrollee requests the changes within thirty-one days of receiving a first full monthly benefit.

(c) The enrollee is enrolled in a medicare health maintenance organization (HMO) and requests the change at any time.

(d) The enrollee requests the change within thirty-one days of one of the following events:

(i) Marriage

(ii) Birth, adoption, placement for adoption or legal guardianship of a child

(iii) Death

(iv) Divorce or dissolution

(v) Legal separation, or

(vi) Full loss of premium subsidy

(2) An enrollee may change plan administrators only if the following occur:

(a) The enrollee is enrolled in a commercial health maintenance organization (HMO) or preferred provider organization (PPO) and experiences a loss of a key provider from the network.

(b) The enrollee moves to another service area, which results in different state teachers retirement system sponsored health care plans being available.

(c) The enrollee wants to add a sponsored dependent to his or her coverage and the health plan he or she is enrolled in does not allow sponsored dependents.

Effective: 05/14/2009
R.C. 119.032 review dates: 02/26/2009 and 05/14/2014
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39 , 3307.61
Prior Effective Dates: 12/23/1976, 11/28/1977, 3/17/1989 (Emer.), 6/1/1989, 9/23/1991 (Emer.), 5/28/1992, 6/22/1992 (Emer.), 9/10/1992, 2/13/1993, 9/1/1996, 7/3/97, 9/16/98 (Emer.), 11/27/1998, 5/25/2000, 7/1/2001 (Emer.), 1/1/2004 (Emer.), 3/22/2004