Ohio Administrative Code
Title 3307:1 - Defined Benefit
Chapter 3307:1-11 - Health Care Services
Section 3307:1-11-01 - Health care services - establishment of program and definitions
Universal Citation: OH Admin Code 3307:1-11-01
Current through all regulations passed and filed through March 18, 2024
(A) Establishment of health care program
(1)
Pursuant to section
3307.39
of the Revised Code, a health care program is hereby established for certain
benefit recipients and their dependents who meet eligibility requirements
specified in this chapter and in any medical or ancillary plan offered.
(2) The health care
program shall consist of such medical plans and ancillary plans as the
retirement board may offer from time-to-time.
(3) Benefit recipients
shall provide any information requested by the retirement system to validate
the eligibility of any enrollee in a medical plan or ancillary plan offered by
the retirement system.
(4) Any person who
obtains coverage, subsidy, or payment of claims in a medical plan and/or
ancillary plan as the result of false or misleading information shall be
immediately terminated from the health care program. Any amounts paid for which
a person is not entitled shall be repaid pursuant to section
3307.47
of the Revised Code. The retirement system may collect amounts due in any other
manner the system considers appropriate, as provided by law.
(B) Definitions for purposes of this chapter
(1) "Ancillary plan" means a plan offered to
provide auxiliary coverage, such as dental or vision coverage.
(2) "Benefit recipient" means a primary
recipient, a survivor annuitant, or a survivor benefit recipient as defined in
paragraphs (B)(13), (B)(18) and (B)(19) of this rule.
(3) "Child" means a biological child, legally
adopted child, or stepchild of a living or deceased primary recipient or
member, or a child for whom a primary recipient or member has been legally
appointed as guardian prior to the child attaining age twenty-six.
(4) "Dependent" means a child under age
twenty-six, a sponsored dependent, or a spouse as defined in paragraphs (B)(3),
(B)(15) and (B)(16) of this rule.
(5) "Disability benefit recipient" means a
member in the defined benefit plan who is receiving a monthly disability
benefit or a participant in the combined plan who is receiving a monthly
disability benefit.
(6) "Disabled
adult child" means a person age twenty-six or older who has never been married;
is a biological or legally adopted child prior to age eighteen, or a stepchild
of a living or deceased primary recipient or member, or a child for whom a
primary recipient has been legally appointed as guardian prior to the child
attaining age eighteen; continuously meets the requirements for physical or
mental incompetency as set forth in paragraphs (F) and (G) of rule
3307:1-8-01 of
the Administrative Code, and either:
(a) Was
adjudged physically or mentally incompetent by a court prior to age twenty-two,
or
(b) Was continuously physically
or mentally incompetent and continuously unable to earn a living where both
conditions occurred prior to age twenty-two.
(7) "Enrollee" means any individual described
in this chapter who participates in a medical plan or ancillary plan offered by
the retirement system.
(8)
"Enrollment cycle" means a period of time during which an enrollee is not
permitted to terminate his or her enrollment and must continue paying monthly
premiums.
(9) "Entity" means any
public or private organization that acts as an employer and is not limited to
an employer as defined in section
3307.01
of the Revised Code.
(10) "Medical
plan" means a plan offered to provide medical or prescription drug coverage or
any combination thereof.
(11) "Ohio
retirement system" includes highway patrol retirement system, police and fire
pension fund, public employees retirement system, and school employees
retirement system.
(12) "Premium"
means a monthly amount that is required to be paid by a benefit recipient to
continue enrollment for health care coverage for the benefit recipient and/or
any dependent.
(13) "Primary
recipient" means a disability benefit recipient or service retiree as defined
in paragraphs (B)(5) and (B)(14) of this rule.
(14) "Service retiree" means a member in the
defined benefit plan who is granted a monthly service retirement benefit or a
participant in the combined plan who is granted a monthly service retirement
benefit under the defined benefit portion of the combined plan.
(15) "Sponsored dependent" means a disabled
adult child.
(16) "Spouse" means a
person currently married to a primary recipient or a person who was married to
a member or primary recipient at the time of the member's or primary
recipient's death.
(17) "Subsidy"
means the portion, if any, of the medical plan monthly cost waived by the
retirement board.
(18) "Survivor
annuitant" means a beneficiary of a service retiree, who was eligible for
health care coverage as a dependent at the time of the service retiree's death
and who is receiving a monthly service retirement benefit under an optional
plan of payment as defined in section
3307.60
of the Revised Code.
(19) "Survivor
benefit recipient" means a person receiving a monthly survivor benefit under
section
3307.66
of the Revised Code or the combined plan, provided such person was eligible as
a dependent of the member or disability recipient at the time of the member's
or disability recipient's death.
(20) "Total service credit" has the same
meaning as used in section
3307.50
of the Revised Code, and as used in this chapter such credit shall not include
any credit purchased under former section
3307.741 of the
Revised Code, but shall include credit purchased under sections
145.297,
145.298,
3307.54 (as it existed
until July 31, 2014), and
3309.33
of the Revised Code.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.