Ohio Administrative Code
Title 145 - Public Employees Retirement System
Chapter 145-4 - Health Care Coverage
Section 145-4-25 - Dental and vision coverage
Universal Citation: OH Admin Code 145-4-25
Current through all regulations passed and filed through September 16, 2024
(A) As used in this rule:
(1)
"Benefit recipient" means person receiving a benefit from
the public employees retirement system. "Benefit" means monthly amounts paid to
an individual pursuant to section
145.32,
145.33,
145.331,
145.332,
145.35,
145.36,
145.361,
145.37,
145.384,
145.45,
or
145.46
of the Revised Code, or section
9.02,
article X, or article XI of the combined plan docment.
(2)
"Dependent"
means:
(a)
The
spouse of a benefit recipient.
(b)
The biological or
legally adopted child of a benefit recipient who is under the age of
twenty-six.
(c)
The grandchild of a benefit recipient for whom the
benefit recipient has been ordered pursuant to section
3109.19
of the Revised Code, or equivalent order from another state, to provide dental
and vision coverage.
A benefit recipient shall inform the retirement system, in writing, not later than thirty days after an eligible dependent no longer meets the requirements of this rule. The retirement system may require a benefit recipient to certify the status of an individual as an eligible dependent for coverage. Failure to provide certification within sixty days of the request by the retirement system shall result in the denial or withdrawal of coverage for such individual until the open enrollment period.
(3)
"Initial benefit
payment" has the same meaning as in rule
145-1-65
of the Administrative Code.
(B)
(1)
Except as provided in paragraph (B)(2) of this rule,
the public employees 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 public
employees retirement board for coverage under this rule.
(2)
(a)
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.
(b)
A dependent described in paragraph (A)(2)(b) of this
rule shall cease to be eligible for coverage on the first day of the month
following the child's twenty-sixth birthday. A dependent described in paragraph
(A)(2)(c) of this rule shall cease to be eligible for dental and vision
coverage on the first day of the month following the dependent's eighteenth
birthday.
(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 thirty days after the benefit recipient's initial benefit payment.
During the thirty-day period, the applicant may make one change to the filed
application.
(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 an eligible 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 occurrence 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 benfit recipient is ordered to enroll a child
pursuant to a national medical support order;
(e)
The dependent
first achieves an eligibility threshold descibed 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) Effective date of coverage
(1)
The effective
date of dental and vision coverage of a benefit recipient receiving a benefit
pursuant to section
145.32,
145.33,
145.331,
145.332,
division (B) (1) of section
145.37,
or
145.384
of the Revised Code, or section
9.02
of the combined plan document shall be the later of the following:
(a)
The effective
benefit date of the benefit that is the basis of the coverage;
(b)
The first day of
the month during which an application for the benefit is received by the
retirement system.
(c)
If the retirement system or health care administrator
has not paid claims for coverage for an eligible benefit recipient or eligible
dependent, the benefit recipient may elect an effective date of coverage that
is after the date descibed in paragraph (D)(1)(a) or (D)(1)(b) of this rule but
is not later than thirty days after the inital benefit payment. An election
under this paragraph shall be made not later than thirty days after the initial
benefit payment.
(2)
The effective
date of dental and vision coverage of a benefit recipient receiving a benefit
pursuant to section
145.35,
145.36,
145.361,
division (B)(2) of section
145.37,
145.45,
or
145.46
of the Revised Code, or Article X or Article XI of the combined plan document
shall be the first day of the month following the initial benefit
payment.
(3)
Notwithstanding paragraphs (D)(1) and (D)(2) of this
rule, in the case of enrollment during open enrollment, the effective date of
coverage shall be January first of the following year.
(E) 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 can 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)
The system shall
require the automatic withholding of coverage premiums from the benefit paid to
the enrolled individual.
(F) The retirement system shall offer continuation coverage, as applicable, in accordance with the requirements of the Consolidated Omnibus Budget and Reconciliation Act 1985 ("COBRA"), 42 U.S.C.A. 300gg-1.
Effective:
1/1/2022
Five Year Review (FYR) Dates:
09/29/2026
Promulgated
Under:
111.15
Statutory Authority:
145.09,
145.58
Rule Amplifies:
145.58
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