742-7-12 Health care discount program.

(A) OP&F may offer a discount in the non-subsidized portion of the health care contributions established by OP&F’s board of trustees for eligible members or eligible survivors who meet the criteria established by OP&F’s board of trustees.

(1) In order to request a discount for those eligible members or eligible survivors, the request must be filed with OP&F according to OP&F’s establishedthe form and it must be received by OP&F prior to the date published in OP&F’s form in order to be eligible for the discount for the applicable period, except as otherwise provided in paragraph (G) of this rule. If an eligible member or eligible survivor fails to file an application by the deadline date, no discount for that year, including a retroactive discount, may be granted by OP&F, even if the person meets the criteria established by OP&F’s board of trustees.

(B) For purposes of determining household income, the applicant must certify the household income of the applicant and a member of his/her household for the year immediately preceding the period over which the discount is requested regardless of whether or not the spouse or member of the household are enrolled in health care coverage provided through insurance companies who have a contractual relationship with OP&F, which may include, but not be limited to, the following:

(1) The annual benefit paid by OP&F to the eligible member or eligible survivor;

(2) Annuity payments or benefits paid to the eligible member or eligible survivor or a member of their household;

(3) Death benefits paid to the eligible member or eligible survivor or a member of their household;

(4) The annual income of the eligible member’s spouse or the eligible survivor’s spouse;

(5) Social security benefits paid to the eligible member or eligible survivor or a member of their household;

(6) Welfare benefits paid to the eligible member or eligible survivor or a member of their household;

(7) Workers compensation benefits paid to the eligible member or eligible survivor or a member of their household;

(8) Child or spousal support paid to the eligible member or eligible survivor or a member of their household; and

(9) Unemployment benefits or assistance paid to the eligible member or eligible survivor or a member of their household.

(10) Income from investment, including, but not limited to interest and dividends.

(11) Any other income that is reportable according to the Internal Revenue Code of 1986, as amended.

(C) OP&F’s board of trustees initially established discounts on contributions for the period July 1, 2001 through June 30, 2002. The board of trustees then re-evaluated and changed discounts on contributions for the period July 1, 2002 through June 30, 2003 and for the period July 1, 2003 through December 31, 2004, subject to the right to apply for the discount as part of the 2004 annual change period election period for plan year 2004. For plan year 2005 and thereafter, the discount amount established by the board of trustees shall be effective on January first of each year through and including December thirty-first of that year.

(D) OP&F will provide a written notice to the applicant on whether or not the discount has been granted.

(E) If the discount has been granted by OP&F, a change in the household income of that eligible member or eligible survivor shall not impact the discount granted to that person for the discount period provided the person originally met the criteria at the time the application was filed with OP&F. If the discount has not been granted by OP&F and a decline in the household income of that eligible member or eligible survivor occurs from and after the deadline date referenced in paragraph (A)(1) of this rule, the eligible member or eligible survivor shall not be allowed to enroll or receive the discount.

(F) By filing the application, the eligible member or survivor authorizes OP&F to recover any discount granted as a result of a false or inaccurate statement made by the eligible member or eligible survivor or their authorized representative and OP&F reserves the right to request additional information for verification purposes only.

(G) For new eligible members or eligible survivors enrolling in health care, OP&F will consider the application if the application is requested and filed within ninety days from the date on which OP&F sent the discount application form to the eligible member or eligible survivor, based on the current address shown on OP&F’s books and records, but in no event will OP&F consider a discount application if it has been requested and filed more than ninety days after the member elected the health care coverage. For these type of cases where the application has been timely filed and the person meets the criteria established by OP&F’s board of trustees, the discount will be effective the month following receipt of the discount application once OP&F has granted the discount to such eligible persons so no prorations will be made.

(H) For purposes of this rule, a “member of the household” shall include any eligible child, as defined in the health care plan referenced in rule 742-7-13 of the Administrative Code.

HISTORY: Eff 1-29-01; 4-9-01 (Emer.); 6-24-01; 8-30-01; 6-26-02 (Emer.); 9-13-02; 10-6-03

Rule promulgated under: RC 111.15

Rule authorized by: RC 742.10

Rule amplifies: RC 742.45

R.C. 119.032 review dates: 07/21/2003 and 10/06/2008