742-7-13 Health care program.

(A) For purposes of the health care program referenced in section 742.45 of the Revised Code, the board of trustees of the police and fire pension fund (OP&F) shall initially establish the terms of a health care plan, which will address the following, among other things:

(1) Health are/prescription drug coverage through contracts with third party administrators;

(2) Schedule of benefits;

(3) Supplemental dental and vision benefits;

(4) Medicare part B, as more fully described in rule 742-7-09 of the Administrative Code;

(5) Eligibility criteria;

(6) Coverage provisions;

(7) Enrollment rights;

(8) Termination of coverage;

(9) Contributions and the provision for the payment of any excess contributions due;

(10) The subsidy offered by OP& F;

(11) The right to continue coverage upon the occurrence of certain events;

(12) Coordination with medicare and other plans and benefits;

(13) Administration of the program;

(14) Claims procedures;

(15) Subrogation rights;

(16) Excluded coverage; and

(17) Mandated coverage.

(B) The terms of the health care plan that outlines the eligibility criteria and OP&F subsidy may only be changed/amended by OP&F's board of trustees, which is intended to serve as an amendment to the health care plan. With the exception of the eligibility criteria, OP&F subsidy, and designation of third party administrators, which may only be changed/amended by OP&F's board of trustees, the plan committee, which consists of OP&F's executive director, director of member services and general counsel, may approve any other amendments to the health care plan for plan .

(C) OP&F's board of trustees shall annually establish the amount of OP&F's subsidy for that plan year, consistent with OP&F's health care funding policy.

(D) OP&F shall communicate a summary of the health care plan to its eligible participants. Nothing in the summary is meant to interpret, extend or change in any way the rules set forth in the health care plan.

Effective: 12/26/2013
R.C. 119.032 review dates: 10/11/2013 and 12/26/2018
Promulgated Under: 111.15
Statutory Authority: 742.10
Rule Amplifies: 742.45
Prior Effective Dates: 10/6/2003