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Enroll in Part A & B
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Be sure to enroll in Medicare Parts A and B when you're first eligible, and to notify ORS if that happens before you are age 65.
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The Employee Benefits Division of the Michigan Civil Service Commission negotiates the carriers, coverage, and rates for retirees just as it does for active employees. In addition to the State Health Plan PPO administered by Blue Cross Blue Shield of Michigan, some of the HMOs that offer plans for active employees also offer coverage for retirees. Because these things change fairly frequently, the best way to find out which providers participate, compare coverage, and check premium rates is by going to the Employee Benefits section of the Civil Service website. We also provide up-to-date information in the retirement application packet.
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 active employee 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 payments. If your
insurance premiums exceed your pension payments, ORS will create a monthly
payment plan for you.
You will be notified in advance of any rate changes, which
typically occur in October. Premium rates for each carrier are published in the Forms and Publications
of our website.
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.
In addition, you cannot enroll your spouse as an insurance dependent if he or
she is enrolled separately as an eligible state employee or retiree.
Enrolling or changing your enrollment after retirement.
As an active state employee, you could only change your
insurance enrollments during the annual open enrollment period. As a retiree, you
can change your insurance enrollments 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 (R0452G) form and your HMO
enrollment form (if applicable) with the necessary proofs of eligibility on February 10, your coverage would begin August 1.
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 (R0452G) form. To enroll in an HMO,
also request the enrollment form directly from the HMO. Send your completed HMO form to ORS
along with your completed Insurance Enrollment/Change Request (R0452G).
Your enrollment will be subject to a six-month waiting period in
any of the following situations:
- You are enrolled in a HMO and wish to switch to the State
Health Plan PPO.
- You do not notify us within 30 days of a qualifying event
such as marriage, death, divorce, or involuntary loss of coverage in another
group plan.
- You currently are not enrolled in any insurance plan.
The six-month waiting period can be waived if:
- You are enrolled in the State Health Plan PPO and want to
enroll in a HMO.
- You are currently enrolled in a HMO and want to transfer
to a different HMO.
- You are enrolled in an HMO and moving out of the service
area.
- You notify us within 30 days of a qualifying event such as
marriage, death, divorce, or involuntary loss of coverage in another group
plan.
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.
If you have a qualifying event.
The following are considered qualifying events for the purpose of adding or deleting a dependent. ORS must receive
your application and the supporting documentation for a qualifying event by mail within 30 days of the qualifying event to waive the 6-month waiting period. Photocopies are
acceptable.
- Adoption: Acceptable proof is adoption papers, a sworn statement with the date of placement, or a court order verifying placement. In a legal adoption, a child is eligible for coverage as of the date of placement.
Placement occurs when you become legally obligated for the total or partial support of the child in anticipation of adoption.
- Birth: Acceptable proof is a birth certificate.
- Death: Acceptable proof is original death certificate.
- Divorce: Acceptable proof is divorce papers.
- Marriage: Acceptable proof is a marriage certificate.
- Involuntary loss of coverage in another group plan: Provide a statement
on letterhead from the terminating group insurance plan explaining who was
covered, why coverage is ending, and the date coverage ends.
ORS can waive the 6-month waiting period if you complete your
insurance change request through miAccount and we receive, by mail, your
confirmation page and required proofs, or an
Insurance Enrollment/Change Request (R0452G) and required proofs within 30
days of the qualifying event. Coverage can begin the first of the month
following the month in which we receive your completed application and required
proofs.
If you are changing insurance coverage, ORS will adjust your premiums, if
needed, the month your insurance becomes effective. We cannot refund premiums
withheld before or in the month you report the change. If you are adding a
spouse or dependent, there is a 6-month waiting period unless you have a
qualifying event. The 6-month waiting period may be waived if you submit the Insurance Enrollment/Change Request (R0452G) and required proofs within 30 days of the qualifying event.
 How Medicare affects your coverage.
Be
sure to apply for Medicare about three months before you or any of your covered
dependents become eligible for Medicare. For most, eligibility occurs at age 65
or after two years of social security disability eligibility. You must enroll in
both Part A (hospital) and Part B (medical).
If Medicare eligibility happens before age 65, immediately enter
the Medicare information online thru miAccount or send ORS the
Insurance Enrollment/Change Request (R0452G) to enroll in the Medicare Advantage plan (called the Medicare Plus Blue Group,
administered by Blue Cross Blue Shield of Michigan). When your Medicare coverage
begins, you will likely see a decrease in the amount of your health insurance
premiums.
ORS cannot enroll you retroactively in the Medicare Advantage
plan, nor can we make adjustments for premiums paid before your application is
processed.
As soon as you become eligible for Medicare, your health plan
automatically becomes a supplement to Medicare and will no longer pay any
expenses covered by Medicare. If you don't enroll in Medicare Parts A and B, you
will be responsible for any medical expenses covered by Medicare.
Medicare D, a prescription drug program, was introduced by the
federal government in 2006. Do not sign up for Medicare D. Your State Health
Plan includes prescription drug coverage.
Have a question about insurance?
For questions about a pending insurance claim or to find out if a particular service is covered, contact the carrier directly. The Employee Benefits Division can also help with claims or coverage problems; phone (800) 505-5011 or
(517) 373-7977.
If you have questions or a problem with insurance enrollment,
need to add or remove a dependent, or change your insurance carrier, contact
ORS. The quickest way to do this is through miAccount. You can also complete the
Insurance Enrollment/Change Request (R0452G)
form found on our website.
Your medical records are private.
The Health Insurance Portability and Accountability Act (HIPAA) and related rules require group health plans to protect the privacy of its members' health information. If you have state-sponsored health insurance, the Michigan Civil Service Commission website explains how your medical information may be disclosed and how you can get access to this information.
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