Health, Dental, and Vision Insurance
Enroll in Part A & B
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.
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 Michigan Civil Service Commission website.
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.
gap 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
gap 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
six-month wait to begin your coverage. (See Enrolling or changing your enrollment after retirement, below.)
The state pays most of your premiums for health, prescription drug, 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 available on the
Employee Benefits section of the Civil Service Commission website.
Timely application and proofs.
We must receive your application and proofs for everyone you want to enroll by the 15th of the month before the requested retirement effective date. If you submit the application and proofs after the 15th but before the end of the month, your insurance effective date will be one month later than requested.
For example, if you submit your application and proofs on July 25th, for a retirement effective date of August 1, your actual insurance effective date will be September 1.
Regardless of when you want your coverage to start, we must receive your application and proofs for everyone you want to enroll no later than 30 calendar days after your retirement effective date, or those with missing information will be subject to a 6-month wait to enroll, starting from the date we received the new enrollment request and proofs.
How Medicare affects your coverage.
As soon as you or anyone else covered by your health insurance becomes eligible for Medicare, that person must enroll in both Part A (hospital) and Part B (medical). For most people, Medicare begins at age 65 or after 24 months of social security disability eligibility. If that happens before age 65, send ORS a completed Insurance Enrollment/Change Request (R0452G).
Once you sign up for Medicare, we will enroll you in a Medicare Advantage plan. A Medicare Advantage plan is a private health plan that coordinates with Medicare and supplements Medicare coverage. Medicare Parts A and B are requirements for enrollment in the Medicare advantage and Part D prescription drug programs. If you don't enroll in Medicare Part B, you will not be eligible to enroll in the Medicare Advantage or Part D programs offered by ORS and you will be responsible for any medical expenses covered by Medicare.
Medicare Part D (prescription drug) is a federal program that is administered by your group insurance plan. When you enroll in an ORS-offered prescription drug plan, ORS will automatically enroll you in Medicare Part D if appropriate. Be sure ORS has your Medicare number.
It's important to act promptly because ORS cannot enroll you retroactively in the state health plan once you're eligible for Medicare. Further, we cannot make adjustments for premiums paid before we receive your
Insurance Enrollment/Change Request (R0452G).
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.
Effects of other group insurance.
The state's health, prescription drug, 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 their combined payments don't exceed the allowed expenses for your care or service. Be sure to keep us 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 as an eligible state employee or retiree.
Enrolling or changing your enrollment after retirement.
While you're actively employed, you can 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
using miAccount, or by submitting an
Insurance Enrollment/Change Request (R0452G) or HMO enrollment form.
Enrolling for the first time. If you are enrolling
in the retirement system's insurance after your retirement effective date, your
coverage will begin on 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) and/or HMO enrollment form
with necessary proofs of eligibility on February 10, your coverage would begin
The waiting period does not apply if you, your spouse, or an eligible dependent has an
involuntary loss of other group coverage or a change in your family status. If
we receive your
Insurance Enrollment/Change Request (R0452G) and HMO enrollment form, if
needed, along with proof of your loss of coverage within 30 days of the event and you meet all other eligibility requirements, we will process the enrollment the first day of the month after we receive the request and proofs.
Changing Plans. If you are currently enrolled in an HMO and
wish to change to the State Health Plan, you must remain in the HMO for at least
six months, unless the coverage is no longer available because you have moved
out of the coverage area. To change from an HMO to the State Health Plan,
Insurance Enrollment/Change Request (R0452G) and return it to ORS along
with all required proofs.
To switch from one HMO to another HMO or change from the State Health Plan to
an HMO, request an application from the HMO and return it to ORS along with the
Insurance Enrollment/Change Request (R0452G) and all necessary proofs.
Do not return your application to the HMO.
Coverage in the new plan will begin the first day of the month after
ORS receives your materials if you are enrolling in BCBSM or moving out of an HMO coverage area. Coverage will begin the first day of the second month if you are voluntarily changing HMOs.
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 six-month waiting period. Photocopies are acceptable.
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.
Acceptable proof is a birth certificate.
Acceptable proof is original death certificate.
Acceptable proof is divorce papers.
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 six-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.
Have a question about insurance?
The insurance carrier is your best resource for answers about insurance cards, claims, or if you want to know if a particular service is covered. The Employee Benefits Division can also help with claims or coverage problems-navigate to Employee Benefits section of their website at
or call (800) 505-5011.
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.