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Eligibility


Behavioral Health

Services are available to all employees and their dependents who are enrolled in any of the state-sponsored health care plans. There is no need to enroll separately for these benefits. Employees who are not enrolled in a health care plan are not eligible. Health plan providers will not provide mental health and substance abuse services.

Coverage is effective on the same date that your health care plan becomes effective, which is the first day of the month following the month in which you enroll in a health care plan, or the first day of the new benefit period.

Child Care Voucher Program

To be considered for the Child Care Voucher Program, you must have worked for the state in the current year and in the previous year and you must have met all of the following eligibility requirements for the previous year:
 

  • Your family’s adjusted gross income did not exceed the income ceiling set by your collective bargaining unit. To determine your adjusted gross income you must complete your federal IRS income tax form 1040. The last line on the front of the form 1040 states, "This is your adjusted gross income." You must provide a copy of your form 1040 with your application to show your adjusted gross income.
  • If you were married as of December 31 of the previous year, you must include your spouse’s income tax form 1040. If you are separated you may file taxes independently for the IRS, but for the purposes of this program, you and your spouse’s income are combined to determine your family adjusted gross income. The IRS 1040 is not to determine marital status, but rather to verify income.
  • You were an exempt employee or represented by either OCSEA/AFSCME Local 11 or District 1199.
  • You were a full-time permanent or part-time permanent employee.
  • Your qualifying child care expenses were greater than or equal to the amount set by your collective bargaining agreement. If you worked less than 2,080 hours the previous year, your expenses must be greater than or equal to the prorated amount based on the number of hours and pay periods actually worked.

COBRA

For Spouse
If you are the spouse of an employee covered by a state of Ohio group health plan, you have the right to choose continuation coverage for yourself for up to 18 months* if you lose group health coverage for any of the following reasons:

Death of employee, or
Divorce or legal separation from employee.
For Dependents
If you are a dependent child of an employee covered by a state of Ohio group health plan, you have the right to choose continuation coverage for yourself for up to 18 months* if you lose group health coverage for any of the following reasons:

Death of employee,
Parents’ divorce or legal separation, or
Dependent child losing eligibility (such as reaching a limiting age, getting married, dropping out of college, etc.).
*COBRA also provides for further extensions of coverage, up to 36 months, under certain circumstances.

For example, an individual who is determined by the Social Security Administration to be disabled while on COBRA may be eligible for an additional 11 months of coverage (for a total of 29 months). When a “secondary event,” such as the death of an employee, occurs while the individual is on COBRA, the 18-month original coverage period may be extended to 36 months for survivors who are on the plan. All COBRA extension requests and questions should be directed to Benefits Administration Services through HCM Customer Service at 614.466.8857, or toll-free at 1.800.409.1205.

Important Employee, Spouse and Dependent Notifications Required
Under the federal law, the employee, spouse or other family member has the responsibility to notify the state of Ohio of a divorce, a legal separation or a child losing dependent status under the group health plan. This notice must be made within 60 days of the event or the date coverage ends in order to be eligible for COBRA continuation.

If this notification is not completed within the required 60-day notification period, rights to continuation coverage will be forfeited.

Notification should be made by contacting your agency's payroll/personnel officer. You may also request additional information from Benefits Administration Services by calling HCM Customer Service at 614.466.8857, or toll-free at 1.800.409.1205.

Commuter Choice Program

The majority of costs you incur from your residence to work or from work to your residence, for public transportation (i.e. mass transit) or vanpools and for parking are considered eligible commuting expenses under IRS regulations. Commuting expenses must represent your normal commute between your residence and your work location.

Dental

You are eligible for dental coverage after you have completed one year of continuous state service, and you are a permanent full-time or permanent part-time employee.

Service time for employees classified as student help, college interns or whose appointments are temporary, seasonal or intermittent may count toward one year of continuous state service if such employees are hired on a permanent, full-time basis or permanent part-time basis with no break in service. Please contact your payroll/personnel officer to confirm your eligibility.

Dependents
If you are eligible for dental benefits, your dependents may also be eligible to receive dental benefits under your coverage.

Disability

To be eligible for disability benefits, all of the following must apply:
 

  • You must be disabled and unable to perform the duties of your position for more than 14* consecutive calendar days.
  • *Contract exceptions for length of waiting period - Attorney General, FOP 46 and FOP 48 - please refer to your contract.
  • You must be a full-time permanent employee or a part-time permanent employee who has worked 1500 hours or more in the 12 months immediately prior to the disability.
  • You must have completed one year of continuous state service immediately prior to the date of the disabling injury, illness or condition.


Flexible Spending Account

HEALTH CARE SPENDING ACCOUNT (HCSA)

Employee must be a permanent part time or permanent full time employee.
1) May enroll within 60 days of the hire date, if no probationary period.
2) May enroll within 60 days of completing probation, if there is a probationary period.

DEPENDENT CARE SPENDING ACCOUNT (DCSA)
Employee may enroll within 60 days of the hire date if:
1) Employee is a permanent part time or permanent full time employee.
2) Employee has a qualifying dependent(s).

If an employee does not enroll within the timeframes noted above, other opportunities to enroll are as follows:
1) During annual open enrollment period.
2) Upon experiencing an IRS qualifying status change

Medical

You are eligible for health care benefits if you are a permanent full-time or permanent part-time employee, which includes established-term regular, established-term irregular, a judge or other elected or appointed official.

State of Ohio employee health plans do not contain pre-existing condition exclusions; therefore, coverage is available to you and your eligible dependents regardless of current health or health history.

Employees classified as student help or college interns, or whose appointments are temporary, seasonal, interim or intermittent are not eligible for health coverage.

Married State Employees

When a husband and wife are both employed by the state, both employees cannot carry family coverage for medical, dental or vision.

  • You have the following options:
  • Both may carry single coverage;
  • Both may be covered by one family plan; or
  • One employee may carry family coverage and the other single, but the spouse with single coverage may not be listed as a dependent under the family plan.

Employees NOT Eligible for Coverage:
 

  • Full-time temporary, appointment types 2, 3, 5
  • Part-time seasonal, appointment type 6
  • Intermittent, appointment type 7
  • Full-time interim internal, appointment type 11, unless eligible prior to interim appointment
  • Part-time interim internal, appointment types 13
  • Part-time interim external, appointment type 14
  • Student or college intern classifications
  • Eligible Dependents


The following people are eligible to enroll as dependents:
 

  • Your current legal spouse.
  • You and your legal spouse's unmarried children (including legally adopted children, children for whom either has been appointed legal guardian and dependent stepchildren and foster children who normally reside with you until the end of the month in which they reach age 19).
  • Your unmarried children age 19 or older, who are attending an accredited school and are primarily dependent on you for maintenance and support, are eligible until the end of the month in which they either reach age 23 or cease being a student - whichever occurs first.
  • Student coverage is not automatic. Your health plan will periodically request proof of school enrollment. When you provide this proof, your dependent will continue to be covered. If the requested proof is not provided to your health plan, coverage ends on the last day of the birthday month.
  • To be considered primarily dependent, the dependent must receive the majority of his/her essentials such as food, clothing and shelter from the employee and must be enrolled in an accredited school. Attendance at an accredited school may be either full-time or part-time. Students are permitted to miss one quarter/semester per school year and still retain their coverage.
  • Children of divorced or separated parents who are not residing with you but who you are required by law to support.
  • Unmarried children of any age who are incapable of self-support due to mental retardation, severe mental illness, or physical handicap, whose disability began before age 23 and who are primarily dependent upon you. When there is an unsuccessful attempt at independent living, a child covered pursuant to this provision may be re-enrolled for coverage, provided that the application is submitted within five (5) years following loss of coverage.
  • This coverage is not automatic. You must complete an Affidavit of Dependent Status (ADM 4729) and a Request to Extend Limiting Age for Mentally Retarded, Severely Mentally Ill, or Physically Handicapped Dependent Child (ADM 4730) and give these to your payroll or personnel officer. The forms must be completed and returned no later than 31 days prior to the dependent’s 19th birthday, or upon being diagnosed with a disabling condition between the ages of 19 and 23. Periodically, but not more than once a year, proof of continued incapacity and dependence must be provided upon request.
  • Adopted children have the same coverage as children born to you or your spouse, whether or not the adoption has been finalized. Coverage begins upon placement/custody.
  • Current stepchildren living in the employee’s home more than 50 percent of the time.
  • Under all health plans, coverage for your dependents ends no later than the last day of the month in which they turn 23, unless they have been granted an extension as described above.
  • In cases of two state employees who are married and who have legally separate dependents, the employee who has coverage as a spouse may be included as a covered dependent as well as children not residing with the employee, but for whom the spouse is required by law to provide health insurance.
  • Dependents of divorced employees may be enrolled on both parents’ family plan pursuant to a court order or joint custody agreement. However, health plans do not allow duplicate payments for services and may not coordinate benefits. Check details with your plan(s).


Examples of Persons NOT Eligible for Coverage as A Dependent:

  • A spouse from whom the employee is legally divorced or separated
  • Dependents age 19 to 23 not enrolled in an accredited school
  • Same sex partners
  • Live-in boyfriends or girlfriends
  • Parents or parents-in-law
  • Grandchildren (unless employee is the court-appointed legal guardian)
  • Married children
  • Children older than age 22 who are not disabled
  • Employee, spouse or child currently in the military service.
  • Adults under guardianship of employee
  • Common law spouse in which the relationship began after October 10, 1991
  • A child who is eligible as an employee of the state or who receives health care coverage through their own employment
  • Current and former stepchildren who do not reside with the employee more than 50 percent of the time
  • Any other members of your household who do not meet the definition of an eligible dependent
     

Life Insurance

Basic life insurance is provided to:
 

  • All permanent exempt employees of the state of Ohio, both full-time and part-time, who have completed one year of continuous service;
  • Established-term regular employees; and
  • Judges and other elected or appointed officials of the state of Ohio serving fixed terms of office.
  • Continuous state service means the uninterrupted service in which an employee is paid directly by warrant of the director of budget and management where no break in service occurs. The following qualifications apply:
  • Reinstatement to state employment within 30 days does not constitute a break in continuous service.
  • Employees on authorized disability leave before the one year of continuous service is complete will be credited with the period of service prior to their leaving once employment resumes (the time spent on disability leave does not count).
  • Re-appointment within one year of the effective date of a layoff will be considered as having satisfied the waiting period.
  •  

Long Term Care

You may be eligible for long term care benefits if you are either a permanent full-time employee or a permanent part-time employee working 20 hours or more per week. If you are eligible for long term care, your spouse, parents, parents-in-law and adult children are also eligible. These eligible individuals may enroll for long term care even if you do not.

Pharmacy

Pharmacy benefits, available to all employees enrolled in a state health plan, are provided through
Catalyst Rx, the state's pharmacy benefit manager. Employees who are enrolled in any of the health plans are automatically enrolled in pharmacy benefits through Catalyst Rx.

Take Charge! Live Well!

You may participate in Take Charge! Live Well! if you are enrolled in a state health plan. Your spouse who is enrolled in a state health plan is also eligible to participate.

This qualifies you for the services, including free health assessment, health coaching, online lifestyle programs, Road Show health screenings, and incentives.

In addition to your spouse, your dependent children may be eligible to participate in some chronic condition management programs, such as asthma or diabetes management. Check with your Take Charge! Live Well! provider for eligibility information. Children, however, are not eligible to earn a Take Charge! Live Well! incentive.

Vision

You are eligible for vision coverage after you have completed one year of continuous state service and you are a permanent full-time or permanent part-time employee. County service time does not count towards eligibility time.

Service time for employees classified as student help, college interns or whose appointments are temporary, seasonal or intermittent may count toward one year of continuous state service if such employees are hired on a permanent, full-time basis or permanent part-time basis with no break in service. Please contact your payroll/personnel officer to confirm your eligibility.

Dependents
If you are eligible for vision benefits, some of your dependents also may be eligible for vision benefits through your plan.

Your dependents eligible for vision benefits are:
 

  • Your spouse;
  • Your unmarried, dependent children who are dependent upon you for primary support. Your children are only eligible:
  • Through the end of the month in which they turn age 19; or
  • Through the end of the month in which they turn 23 if the child is residing with you or attending an accredited school (proof of attendance may be required).
     

Worker’s Compensation

Workers' compensation (or work-related disability) is a ‘no-fault’ system that compensates employees for work-related injuries or illnesses. Benefits are limited to wage loss, medical and rehabilitation expenses and are payable as long as the disability lasts or medical treatment is reasonably necessary. Workers’ compensation provisions can be found in the Ohio Constitution Article II, Section 35; Ohio Revised Code Chapters 4121 and 4123; and Ohio Administrative Code Chapters 4121, 4123 and 4125.