Health, Dental, Vision

The state-sponsored health, dental, and vision plans are essentially the same for active members and retirees. That is, services that are covered while you are active will, for the most part, continue to be covered in retirement.

No break in your coverage.

Your insurance protection as a retiree begins on your retirement effective date. Since your coverage as an enlisted officer continues through the end of the month in which you terminate employment, there should be no break in coverage as you go from active to retired status. However, if you file your application after the month in which you terminate employment, or if you waive coverage when you're first eligible, there could be a 6-month delay in your coverage. (See Enrolling or changing your enrollment after retirement, below.)

Insurance premiums.

The state pays most of your premiums for health, dental, and vision insurances; your portion is deducted from your pension.

You will be notified in advance of any rate changes, which typically occur in October. Premium rates for each carrier are published on the Department of Civil Service-Employee Benefits Division website.

How Medicare affects your coverage.

If you or any of your covered dependents become eligible for Medicare, you must enroll in both Part A and Part B. If that happens before the age of 65, you need to notify ORS. You can do this by entering your Medicare number in miAccount, and navigating to the insurance button on the left, or submit a completed Insurance Enrollment/Change Request (R0452H) including your Medicare numbers. (Medicare begins at age 65; after 24 months of social security disability eligibility; or in cases of end-stage renal disease.)

Your plan health coverage automatically becomes a supplement to Medicare and will no longer pay any expenses normally paid by Medicare. If you don't enroll in Medicare Part B, you will be personally responsible for any medical expenses that would be covered by Medicare. Your retirement system health plan will continue to pay for any of the plan's covered benefits that are not covered by Medicare.

When your Medicare coverage begins, you will likely see a decrease in the amount of your health insurance premiums.

Medicare D is a prescription drug program introduced by the federal government in 2006. Do not sign up for Medicare D. Your State Health Plan includes prescription drug benefits as part of your health care coverage.

Note: In 1986, federal law required mandatory coverage for state and local government employees even if they do not pay social security taxes. If you were hired (or rehired) after March 31, 1986, you may have mandatory Medicare coverage. However, the Social Security Administration is the final authority for determining your Medicare eligibility.

Effects of other group insurance.

The state's health, dental, and vision insurance plans contain a coordination of benefits (COB) provision, which says you can't be reimbursed for more than the allowed cost of your care or service. If you or your dependents are covered under another group plan, the plans coordinate their reimbursement so that their combined payments don't exceed the allowed expenses for your care or service. Be sure to keep ORS informed if anyone on your insurance is covered under another insurance.

In addition, you cannot enroll your spouse as an insurance dependent if he or she is separately enrolled in any state health plan.

Enrolling or changing your enrollment after retirement.

As an enlisted officer, you could only change your insurance enrollments during the annual open enrollment period. As a retiree, you can do this at any time during the year. However, your request won't take effect until the first day of the sixth month after ORS receives all required forms and proofs. For example, if we receive your Insurance Enrollment/Change Request (R0452H) and/or HMO enrollment form with the necessary proofs of eligibility on February 10, your coverage would begin August 1.

We can waive the waiting period if there has been an involuntary loss of other group coverage or a change in your family status, provided you enroll and furnish proofs within 30 days of the event.

If you decide not to enroll in the health, dental, or vision insurances within 30 days of your retirement effective date but then want to enroll later, or if you want to change your enrollment, use the Insurance Enrollment/Change Request (R0452H)  form. To enroll in an HMO, request the enrollment form directly from the HMO. Send your completed form to ORS.

After making sure your enrollment application is complete we will take action to adjust your premiums if necessary, and then we will enroll you with the insurance carrier you have selected. If you do not receive your insurance card(s) by your insurance effective date, please contact the insurance carrier directly.