Rule 5505-7-11 | Dental and vision coverage.
(A) For the purpose of this rule:
(1) "Age and service retirant" shall mean a former member that applied for and was granted retirement benefits as described in section 5505.16 of the Revised Code.
(2) "Benefit recipient" shall mean an age and service retirant or disability retirant that is receiving a pension benefit as described in division (A)(1) of section 5505.17 of the Revised Code that qualifies for health care coverage pursuant to paragraph (D) of rule 5505-7-04 of the Administrative Code. Benefit recipient does not include a member participating in the "Deferred Retirement Option Plan."
(3) "Child" shall mean a biological child, lawfully adopted child, child placed for adoption or stepchild of a benefit recipient or member provided that such child has not yet attained age twenty-six. "Child" shall also mean a child for whom a benefit recipient or member has been legally appointed as guardian, provided that such child has not yet attained age eighteen.
(4) "Dependent" shall mean a spouse or child as defined in this rule.
(5) "Disability retirant" shall mean a former member that applied for and was granted retirement benefits as described in section 5505.18 of the Revised Code.
(6) "Member" shall have the same meaning as division (I) of section 5505.01 of the Revised Code.
(7) "Retirant" shall mean an age and service retirant or disability retirant.
(8) "Spouse" shall mean a wife or husband of a retirant or member as set forth in a statutorily valid certificate.
(B)
(1) Except as provided in paragraph (B)(2) of this rule, the state highway patrol retirement system may offer dental or vision coverage that is administered by a third-party administrator(s) to benefit recipients and dependents provided that the benefit exceeds the premium set by the board for coverage under this rule.
(2) A spouse of a benefit recipient shall cease to be eligible for coverage on the first day of the month following the date of the final decree of divorce or dissolution from the benefit recipient.
(C) Enrollment
(1) Except as provided in paragraph (C)(2) of this rule, a benefit recipient's application for dental or vision coverage must be received by the retirement system not later than sixty days after the benefit recipient's eligibility of retirement benefits, as defined in rule 5505-3-01 of the Administrative Code.
(2) A benefit recipient that does not enroll as provided in paragraph (C)(1) of this rule may enroll by filing an application for enrollment in dental or vision coverage during one of the following:
(a) The annual open enrollment period:
(b) Within sixty days of involuntary termination of coverage under another group plan, and with proof of such termination.
(3) A benefit recipient may enroll a dependent in coverage during the annual open enrollment period or at any time outside of open enrollment if any of the following apply and the application is received not later than sixty days after the occurence of the event:
(a) The benefit recipient may enroll a new spouse upon marriage;
(b) The benefit recipient may enroll an eligible child upon the birth or adoption of the child;
(c) The benefit recipient may enroll an eligible dependent who has involuntarily lost vision and dental coverage from another source;
(d) The benefit recipient is ordered to enroll a child pursuant to a national medical support order;
(e) The dependent first achieves an eligibility threshold as described in this rule.
(4) Enrollment of a benefit recipient or eligible dependent under this rule shall be made on an application provided by the retirement system.
(D) After the death of a retirant or member, dependents are eligible or become eligible for dental and vision coverage if the retirant or member was eligible to be a benefit recipient at the time of death.
(E) Effective date of coverage
(1) The effective date of coverage of a benefit recipient or eligible dependent shall be the first day of the month following the system's receipt of the benefit recipient's application, provided enrollment is valid under this rule.
(2) Notwithstanding paragraph (E)(1) of this rule, in the case of enrollment during open enrollment, the effective date of coverage shall be January first of the following year.
(F) The following provisions apply to the dental and vision coverage offered by the retirement system:
(1) The coverage shall be in effect for a calendar year.
(2) An individual enrolled in coverage may voluntarily terminate the individual's enrollment in the coverage or a dependent's enrollment in the coverage only at the end of each calendar year by filing the notice of cancellation in a form and manner approved by the retirement system during the open enrollment period.
(3) Notwithstanding paragraphs (F)(1) and (F)(2) of this rule, an individual enrolled in coverage may voluntarily terminate the individual's enrollment in the coverage by submitting proof to the retirement system that the individual has obtained other coverage through an employer or a spouse's employer.
Last updated August 5, 2024 at 7:44 AM
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