(A) Eligibility
The following individuals shall be eligible to
participate in a medical plan offered by the retirement system:
(1) A service retiree
with an effective benefit date:
(a) Before January 1, 2004; or
(b) Between January 1, 2004 and July 1, 2023 and the benefit is
based on fifteen or more years of total service credit; or
(c) After July 1, 2023 and the benefit is based on twenty or more
years of total service credit.
(2) A service retiree who
began receiving service retirement benefits with no break in monthly benefits
following the termination of disability benefits, with a disability effective
benefit date:
(a) Before January 1, 2004; or
(b) Between January 1, 2004 and July 1, 2023 and the service
retiree benefit is based on fifteen or more years of total service credit;
or
(c) After July 1, 2023 and the service retiree benefit is based
on twenty or more years of total service credit.
(3) A disability benefit
recipient.
(4) A survivor annuitant
who was eligible for health care coverage as a dependent at the time of the
service retiree's death.
(5) A survivor benefit
recipient 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 where the effective date of survivor
benefits or the effective date of disability benefits of the deceased member
is:
(a) Before January 1, 2004; or
(b) Between January 1, 2004 and July 1, 2023 provided that the
deceased member or disability benefit recipient had fifteen or more years of
total service credit at the time of death; or
(c) After July 1, 2023 provided the deceased member or disability
benefit recipient had twenty or more years of total service credit at the time
of death.
(6) A survivor benefit
recipient 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.
(7) Dependents, to the
extent that a medical plan and/or ancillary plan allows for dependent
coverage.
(8) Notwithstanding
paragraphs (A)(1) to (A)(7) of this rule, an individual not eligible for
medicare coverage is not eligible for primary coverage in a medical plan
offered by the retirement system if the individual is employed and has access
to an entity's medical plan or if similarly situated, non-retired
employees have access to an entity's medical plan, provided the medical
plan includes prescription coverage. The retirement board may require each
enrollee to annually file a verification of employment statement disclosing the
availability for enrollment as an employee in an entity's medical
plan.
(a) When an individual is enrolled in an entity's medical
plan and a medical plan offered by the retirement system, coverage in the
retirement system's medical plan will be limited to secondary coverage
applied only to those covered medical expenses not paid by the entity's
medical plan.
(b) An employed individual not eligible for medicare who does not
file a verification of employment statement with the retirement system when
requested by the retirement system; does not enroll in the entity's
medical plan when eligible to enroll, or is excluded from the entity's
medical plan based upon being an enrollee in the retirement system's
medical plan is not eligible to enroll or remain enrolled in a medical plan
offered by the retirement system.
(9) An individual
enrolled in a medical plan offered by the retirement system shall enroll in
medicare part A, if the enrollee is able to enroll in medicare part A without
being required to pay a premium, and part B upon first attaining eligibility
for each.
(B) Effective date
The effective date of coverage for enrollees in a
medical plan shall be determined as follows:
(1) Initial enrollment:
When a monthly benefit payment begins, medical coverage shall begin for
a:
(a) Service retiree:
(i) On the effective
benefit date when the service retirement application is received on or before
the effective benefit date, provided the service retiree enrolls by the end of
the month of the effective benefit date; or
(ii) On the first day of
the month following the date the service retirement application is received
when the effective benefit date is prior to the date the service retirement
application is received, provided the service retiree enrolls by the end of the
month following the month the service retirement application is
received.
(b) Disability benefit recipient:
(i) On the effective
benefit date when the disability benefit recipient is granted disability
benefits on or before the effective benefit date, provided the disability
benefit recipient enrolls by the end of the month of the effective benefit
date.
(ii) On the first day of
the month following the date the disability benefit is granted when the
effective benefit date is prior to the date the disability benefit is granted,
provided the disability benefit recipient enrolls by the end of the month
following the month the disability benefit is granted.
(c) Survivor benefit recipient:
(i) On the effective
benefit date when a survivor benefit recipient enrolls by the end of the third
month following the month of the member's or disability benefit
recipient's death.
(ii) On the first of the
month following the receipt of a survivor benefit application submitted after
the third month following the month of the member's or disability benefit
recipient's death provided the survivor benefit recipient enrolls by the
end of the month following the month the survivor benefit application is
received.
(d) Survivor annuitant:
(i) On the first of the
month following the month of the service retiree's death, provided a
survivor annuitant enrolls by the end of the third month following the month of
the service retiree's death.
(ii) On the first of the
month following the month of the service retiree's death when a survivor
annuitant was enrolled as a service retiree's dependent at the time of the
service retiree's death.
(2) Subsequent
enrollment: Coverage shall begin as follows if a benefit recipient does not
enroll as permitted under paragraph (B)(1) of this rule and later applies to
enroll:
(a) Open enrollment: The retirement system may offer an open
enrollment period during which eligible benefit recipients may enroll or change
medical plans for themselves and eligible dependents. Coverage will begin on
the first day of the next plan year following an open enrollment period
specified by the retirement system.
(b) Special enrollment: A person may enroll under the following
circumstances when a benefit recipient submits his or her application to enroll
within thirty-one days from the date of a qualifying event, provides any other
required documentation, the application is approved by the retirement system,
and the person meets all other eligibility requirements:
(i) Benefit
recipients:
(a) A benefit recipient
may enroll based upon his or her loss of health care coverage that provided
minimum essential coverage as defined under the federal Patient Protection and
Affordable Care Act of 2010, 124 Stat. 119 (2010), as amended, for coverage
beginning the first of the month in which coverage is lost.
(b) A benefit recipient
may enroll based upon his or her enrolling in medicare parts A and B or only
medicare part B for coverage beginning the first of the month medicare coverage
begins.
(ii) Provided the benefit
recipient is enrolled, dependents may be enrolled as follows:
(a) A primary recipient
may enroll his or her new spouse for coverage beginning the first of the month
following the date of marriage or the first day of the month of marriage when
the date of marriage is on the first day of the month.
(b) A benefit recipient
may enroll a child for coverage beginning the day of birth, legal adoption, or
the date the benefit recipient was legally appointed as guardian of that
child.
(c) A benefit recipient
may enroll a dependent who lost health care coverage that provided minimum
essential coverage as defined under the federal Patient Protection and
Affordable Care Act of 2010 for coverage beginning the first of the month in
which coverage is lost.
(d) A benefit recipient
may enroll a dependent based upon the dependent enrolling in medicare parts A
and B or only medicare part B for coverage beginning the first of the month
medicare coverage begins.
(C) Premium
(1) The premium for an
enrollee in a medical plan shall be based upon the total service credit used in
the calculation of the primary recipient's benefit, the effective benefit
date, and such other factors as the retirement board may find relevant in its
sole discretion.
(2) The premium for an
enrollee in a medical plan shall be pre-paid through a monthly deduction from
the monthly benefit unless the amount of the monthly benefit will not cover the
total premium. In that case, the benefit recipient will be billed directly by
the retirement system for any premium balance owed for an initial period not to
exceed three months and authorizes the retirement system to electronically
debit the premium balance owed each month from the benefit recipient's
bank account. It will be the sole responsibility of the benefit recipient to
provide and maintain the information and available funds required for the
retirement system to complete the monthly electronic debit. Should the
retirement system be unable to debit the payment electronically after the
initial three month period, enrollment in the health care program may be
terminated. If for any reason payment is not received on or before the first
business day of the month the premium is due, enrollment in the health care
program may be terminated.
(3) The following benefit
recipients are eligible to receive a subsidy:
(a) A service retiree either with an effective benefit date prior
to August 1, 2023 and fifteen or more years of total service credit, or with an
effective benefit date on or after August 1, 2023 and twenty or more years of
total service credit.
(b) A disability benefit recipient either with five or more years
total service credit with an effective benefit date prior to August 1, 2023, or
with six or more years of total service credit with an effective benefit date
on or after August 1, 2023.
(D) Open enrollment and plan
changes
(1) The retirement system
may offer an open-enrollment period during which benefit recipients may enroll
in or change medical plans for themselves and eligible dependents.
(2) Once coverage under a
medical plan begins, a benefit recipient can request a change of medical plans
during the plan year as follows:
(a) A change to any other available medical plan may occur when
an enrolled benefit recipient provides required documentation and requests a
change:
(i) Within thirty-one
days of receipt of the first regular monthly benefit payment or enrolling a
dependent with a qualifying event as described in paragraph (B)(2)(b) of this
rule.
(ii) Within three months
of benefit recipient or enrolled dependent enrolling in medicare parts A and B
or only medicare part B.
(b) A change to another medical plan may occur at any time when
an enrolled benefit recipient requests a change and provides documentation that
evidences one of the following events:
(i) Loss of a key
provider from a medical plan's provider network.
(ii) Relocation of
permanent residence to another service area not covered by the enrollee's
current medical plan.
(iii) Benefit recipient enrolled in a medicare fully insured
medical plan.
