Ohio Administrative Code|Rule 145-4-25 | Dental and vision coverage.

                                                
(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.


Last updated January 3, 2022 at 9:10 AM