(A) Each recipient of service,
disability, or survivor benefits who receives health care benefits from the
Ohio police and fire pension fund ("OP&F") and his/her enrolled dependents
shall enroll in medicare part "A" and "B" at his or her first eligibility date.
If a person covered under OP&F's health care plan fails to enroll in
medicare part "A" or "B" at his/her first eligibility date, OP&F's
appropriate third party administrators will process the claims of such person
in accordance with the terms of OP&F's health care plan and reserves all
rights to recover monies associated with a covered person's failure to comply
with such provisions.
(B)
(A) For purposes of
division (B) of section
742.45 of the Revised Code,
"satisfactory evidence of the payment for coverage" shall mean filing of the
medicare part "B" reimbursement statement in the form approved by OP&F or
the medicare billing statement, along with a copy of the applicant's medicare
card or a letter from medicare in lieu of a medicare card. No retroactive
reimbursement will be made. For any inaccurate or incorrect statement made on
the medicare part "B" reimbursement statement, OP&F reserves all rights to
recover monies associated with a covered person's failure to comply with such
provisions.
(C)
(B) In accordance with divisions (C) and (D) of
section 742.45 of the Revised Code,
OP&F shall not reimburse the medicare part "B" premium to a benefit
recipient who is receiving or should be receiving reimbursement for this
premium from any other source and the member or benefit recipient shall be
deemed to consent to the recovery of any overpayment by deduction from his/her
monthly pension or benefit. If another Ohio retirement system is responsible to
provide health care to such recipient, OP&F shall not be responsible to pay
the medicare part "B" reimbursement. No retroactive payment shall be
given.
(D)
(C) The recipient of the medicare part "B"
reimbursement shall be deemed to consent to the recovery of any overpayment by
deduction from his/her monthly pension or benefit. The monthly deduction shall
be an amount equal to the greater of:
(1) The
monthly amount determined by dividing the amount of the overpayment by the time
period over which the overpayment occurred;
(2) The monthly amount of OP&F's medicare
part "B" reimbursement on the month in which deductions are to commence;
or
(3) The monthly amount agreed to
in writing by the recipient.
(E)
(D) Effective January
1, 2002, the reimbursement of medicare part "B" payments made by OP&F to
eligible beneficiaries under section
742.45 of the Revised Code shall
not be considered "benefits" under division of property orders and child and
spousal support orders since these payments are reimbursement of expenses
incurred by such beneficiary.
Notes
Ohio Admin. Code
742-7-09
Five Year Review (FYR) Dates:
4/18/2022 and
04/18/2027
Promulgated
Under:
111.15
Statutory Authority:
742.10,
742.45
Rule Amplifies:
742.45
Prior Effective Dates: 07/15/1994, 02/17/1998, 01/29/2001,
11/30/2001 (Emer.), 02/22/2002, 03/14/2002 (Emer.), 05/31/2002, 10/06/2003,
12/23/2004, 12/20/2006 (Emer.), 03/19/2007, 05/17/2012, 01/01/2019 (Emer.),
03/29/2019
Effective: 3/29/2019
Five Year Review
(FYR) Dates: 4/6/2022
Promulgated Under:
111.15
Statutory
Authority: 742.10,
742.45
Rule
Amplifies: 742.45
Prior
Effective Dates: 07/15/1994, 02/17/1998, 01/29/2001, 11/30/2001 (Emer.),
02/22/2002, 03/14/2002 (Emer.), 05/31/2002, 10/06/2003, 12/23/2004, 12/20/2006
(Emer.), 03/19/2007, 05/17/2012
