Ohio Administrative Code › Title 3309 - School Employees Retirement System › Chapter 3309-1 - General Provisions › Section 3309-1-35 - Health care

Current through all regulations passed and filed through July 1, 2024
(A) Definitions
As used in this rule:
(1) "Benefit recipient" means an age and
			 service retirant, disability benefit recipient, or a beneficiary as defined in
			 section 3309.01 of the Revised Code, who
			 is receiving monthly benefits due to the death of a member, age and service
			 retirant or disability benefit recipient.
(2) "Member" has the same meaning as in
			 section 3309.01 of the Revised
			 Code.
(3) "Age and service
			 retirant" means a former member who is receiving a retirement allowance
			 pursuant to section 3309.34,
			 3309.35,
			 3309.36 or
			 3309.381 of the Revised Code. A
			 former member with an effective retirement date after June 13, 1986 must have
			 accrued ten years of service credit, exclusive of credit obtained after January
			 29, 1981 pursuant to sections
			 3309.021,
			 3309.301,
			 3309.31, and
			 3309.33 of the Revised
			 Code.
(4) "Disability benefit
			 recipient" means a member who is receiving a benefit or allowance pursuant to
			 section 3309.35,
			 3309.39,
			 3309.40 or
			 3309.401 of the Revised
			 Code.
(5) "Dependent" means an
			 individual who is either of the following:
(a)
			 A spouse of an age and service retirant, disability benefit recipient, or
			 member,
(b) A biological, adopted
			 or step-child of an age and service retirant, disability benefit recipient,
			 member, deceased age and service retirant, deceased disability benefit
			 recipient, or deceased member or other child in a parent-child relationship in
			 which the age and service retirant, disability benefit recipient, member,
			 deceased age and service retirant, deceased disability benefit recipient, or
			 deceased member has or had custody of the child, so long as the child:
(i) Is under age twenty-six, or
(ii) Regardless of age is permanently and
			 totally disabled, provided that the disability existed prior to the age and
			 service retirant's, disability benefit recipient's, or member's death and prior
			 to the child reaching age twenty-six. For purposes of this paragraph
			 "permanently and totally disabled" means the individual is unable to engage in
			 any substantial gainful activity by reason of any medically determinable
			 physical or mental impairment which can be expected to result in death, or
			 which has lasted or can be expected to last for a continuous period of not less
			 than twelve months.
(6) "Health care coverage" means any of the
			 following group plans offered by the system:
(a) A medical and prescription drug
			 plan;
(b) Limited wraparound
			 coverage, which provides limited benefits that wrap around an individual health
			 insurance plan; or
(c) An excepted
			 benefit health reimbursement arrangement, which provides reimbursement of
			 medical expenses incurred under an individual health insurance plan.
(7) "Premium" means a monthly
			 amount that may be required to be paid by a benefit recipient to continue
			 enrollment for health care coverage for the recipient or the recipient's
			 eligible dependents.
(8) "Employer"
			 and "public employer" have the same meaning as in section
			 3309.01 of the Revised
			 Code.
(9) "Marketplace counselor"
			 means an individual licensed to determine eligibility for, and enroll
			 individuals in, a marketplace plan.
(10) "Marketplace plan" means an individual
			 health plan available through either a state or federal health insurance
			 marketplace.