| (1) An ORP participant is eligible for ORP disabled
retiree status in the GBP if the ORP participant is not otherwise
eligible to participate in the GBP as an employee/retiree and is certified
by a licensed physician designated by ERS as disabled as provided
in paragraph (2) of this subsection. An ORP participant may apply
for disabled retiree status in the GBP by filing a written application
for ORP disabled retiree status in the GBP or having an application
filed with ERS by the ORP participant's spouse, employer, or legal
representative. In addition to an application for ORP disabled retiree
status in the GBP, an ORP participant must file with ERS the results
of a medical examination of the ORP participant. After an ORP participant
applies for ORP disabled retiree status in the GBP, ERS may require
the ORP participant to submit additional information about the disability.
ERS will prescribe forms for the information required by this section.
(2) If a licensed physician designated by ERS finds
that the ORP participant is mentally or physically disabled from the
further performance of duty and that the disability is probably permanent,
the physician will certify the disability. The executive director
is authorized to approve ORP disabled retiree status in the GBP after
a certification of disability is made. Once each year during the first
five years after an ORP participant enrolls in the GBP as an ORP disabled
retiree, and once in each three-year period after that, ERS may require
an ORP disabled retiree to undergo a medical examination by a physician
ERS designates. If an ORP disabled retiree refuses to submit to a
medical examination as provided by this section, ERS will suspend
the ORP disabled retiree's enrollment in the GBP until the ORP disabled
retiree submits to an examination. ERS will terminate the ORP disabled
retiree's coverage in the GBP and notify the ORP participant in writing
if:
(A) ERS concurs with a certification issued by the
designated physician which finds that an ORP disabled retiree is no
longer mentally or physically disabled from the further performance
of duty; or
(B) an ORP disabled retiree refuses for more than one
year to submit to a required medical examination.
(3) The effective date of coverage for an ORP disabled
retiree in the GBP is the first of the month following the date the
application for ORP disabled retiree status in the GBP is approved
by ERS, or the first of the month following the date employment is
terminated, whichever is later.
(g) Former members of the Legislature. A former member
of the Legislature authorized by §1551.108(1) of the Act to continue
to participate in the GBP is eligible for the coverage, other than
disability income insurance coverage, in effect on the day before
the member leaves office.
(h) Former employees of the Legislature. A former employee
of the Legislature authorized by §1551.108(2) of the Act to continue
to participate in the GBP is eligible for the coverage, other than
disability income insurance coverage, in effect on the day before
the employee terminates employment.
(i) Former board members. Subject to the limitations
of this subsection, a former member of a board or commission or of
the governing body of an institution of higher education, as both
are described in §1551.109 of the Act, is eligible to continue
the coverage, other than disability income insurance coverage, in
effect on the day before the member leaves office if no lapse in coverage
occurs after the end of the term of office. Life insurance overage
may not exceed Election II.
(j) Continuation of GBP health, dental and vision coverage
only for certain spouses and dependent children of employee/retirees,
and for certain terminating employees, their spouses, and dependent
children (as provided by COBRA).
(1) The surviving spouse and/or dependent child/children
of a deceased employee/retiree who are not eligible to continue coverage
under the provisions of the Act or subsection (e) of this section,
who are not entitled to benefits under the Social Security Act, Title
XVIII, and who are not covered under any other group health plan,
may continue for up to 36 months the GBP health, dental and vision
coverage only that were in effect immediately prior to the date of
death of the employee/retiree. A formal election must be made to continue
coverage by the surviving spouse and/or the dependent child/children.
The formal election must be postmarked or received by ERS within 60
days of the date of notice contained in the notice of right to continue
coverage form or by the date coverage terminated, whichever is later.
(2) An employee whose employment has been terminated
voluntarily or involuntarily (other than for gross misconduct), whose
work hours have been reduced such that the employee is no longer eligible
for the GBP as an employee, or whose coverage has ended following
the maximum period of LWOP as provided for in §81.7(g)(2)(A)
of this chapter, except for those persons not eligible pursuant to §81.11(f)
of this chapter (relating to Cancellation of Coverage and Sanctions)
and/or his/her spouse and/or dependent child/children who are not
eligible to continue coverage under the provisions of the Act or subsection
(f), (g) or (h) of this section, who are not entitled to benefits
under the Social Security Act, Title XVIII, who are not covered under
any other group health plan, may continue for up to 18 months the
GBP health, dental and vision coverage only without the basic term
life that were in effect immediately prior to the date of the loss
of coverage. A formal election must be made to continue coverage by
the employee and/or his/her spouse and/or dependent child/children.
The formal election must be postmarked or received by ERS within 60
days of the date of notice contained in the notice of right to continue
coverage form or by the date coverage terminated, whichever is later.
(3) If an employee, spouse, or dependent child is determined
by the Social Security Administration to have been disabled before
or during the first 60 days of continuation coverage, all covered
individuals may continue GBP health, dental and vision coverage extended
up to an additional 11 months, for a total of 29 months. Notification
of the Social Security Administration's determination must be received
by ERS before the end of the original 18 months of continuation coverage.
Continuation coverage will be canceled the month that begins more
than 30 days after the date the Social Security Administration determines
that the participant is no longer disabled.
(4) A spouse who is divorced from an employee/retiree
and/or the spouse's dependent child/children who are not otherwise
eligible to continue coverage under the provisions of the Act or subsection
(c) of this section, who are not entitled to benefits under the Social
Security Act, Title XVIII, who are not covered under any other group
health plan, may continue for up to 36 months the GBP health, dental
and vision coverage only that were in effect immediately prior to
the date the divorce decree is signed. The employee/retiree or the
divorced spouse or the divorced spouse's dependent child/children
must notify ERS through the benefits coordinator of the divorce within
60 days from the date the divorce decree is signed. A formal election
must be made to continue coverage by the divorced spouse and/or the
dependent child/children. The formal election must be postmarked or
received by ERS within 60 days of the date of notice contained in
the notice of right to continue coverage form or by the date coverage
is terminated, whichever is later.
(5) A dependent child who has attained 26 years of
age, who is not otherwise eligible to continue coverage indefinitely
under the provisions of the Act or subsection (c) of this section,
who is not entitled to benefits under the Social Security Act, Title
XVIII, who is not covered under any other group health plan, may continue
for up to 36 months the GBP health, dental and vision coverage only
that were in effect immediately prior to the date of the child's 26th
birthday. The child or employee/retiree must notify ERS through the
benefits coordinator within 60 days of the child's 26th birthday.
A formal election must be made by the 26-year-old child to continue
coverage. The formal election must be postmarked or received by ERS
within 60 days of the date of notice contained in the notice of right
to continue coverage form or by the date coverage is terminated, whichever
is later.
(6) Extension of continuation of coverage for certain
spouses and/or dependent child/children of former employees who are
continuing coverage under the provisions of paragraph (2) of this
subsection is governed by the following provisions.
(A) The surviving spouse and/or dependent child/children
of a deceased former employee whose death occurred during the period
of continuation coverage, who satisfy the provisions of paragraph
(1) of this subsection and who notify ERS within 60 days of the date
of death of the former employee are entitled to a total of 36 months
of continuation coverage.
Cont'd... |
