Current through all regulations passed and filed through September 16, 2024
(A) Eligibility.
(1) Persons eligible to participate in the
state employee health benefit fund are:
(a)
Permanent full-time and permanent part-time employees of the state of Ohio who
are paid by warrant of the director of the office of budget and management, and
who normally have earnings every pay period, including elected and appointed
officials;
(b) Any other employees
of the state of Ohio who are paid by warrant of the director of the office of
budget and management who are eligible to participate in the state employee
health benefit fund pursuant to any applicable state or federal law;
(c)
Eligible
dependents of persons under sections
124.824 and
742.63 of the Revised Code;
and
(d) Eligible dependents
of persons described in paragraphs (A)(1)(a),
(A) (1)(b), and
(A)(1)(c) of this rule who have elected to participate in the
fund.
(2) The director
determines eligibility of all employees of the state and
dependents, and
also
establishes criteria for determining the
eligibility of dependents.
(B) Enrollment.
(1) Employees, elected, and appointed
officials are eligible to enroll during the first thirty-one days of employment
or term of office for benefit coverage, including vision and dental
coverage.
(2) An open enrollment
period
will be established by the director. During such
period, eligible employees, elected and appointed officials, and their
dependents who are not covered by the state employee health benefit fund may
enroll without imposition of any limitations or waiting periods. Coverage for
those persons enrolling during an open enrollment period
will be
effective on the first day of the new benefit year.
(3) The director, in compliance with
applicable state and federal law,
determines qualifying events that allow an
employee, elected, or appointed official to make coverage changes outside of an
open enrollment period.
(C) The director determines the
effective dates of coverage for employees, elected and appointed officials, and
their dependents.
(D) The director
establishes employee, elected, and appointed official
contribution levels for the benefits provided by the state employee health
benefit fund.
(E) Termination of
coverage.
(1) Employees, elected and appointed
officials, and their dependents will cease to be covered by the fund due to:
(a) Termination of state employment by the
employee or the elected or appointed officials term of office;
(b) A qualifying event, as determined by
applicable state or federal law; or
(c) Cessation of the employee's, elected or
appointed official's contributions to the fund, unless such contributions are
waived by statute or rule.
(2) Any coverage will cease at the end of the
last day of the month in which the qualifying event as listed
in paragraph (E)(1)(a), (E) (1)(b), or (E)(1)(c) of this rule,
occurs.
(F) The
director determines the benefits, any deductibles, co-payments,
co-insurance, and conditions or limitations of such benefits to be provided to
employees, elected, and appointed officials covered by the state employee
health benefit fund. The director may also make such changes to the benefits
from time to time as may be required to reasonably provide health care for such
employees, elected and appointed officials, and their dependents with funds
available for such purposes.
