Section 13 - STATE SPONSORED GROUP INSURANCE PLANS
QUESTIONS AND ANSWERS
Q#1: When is the enrollment period?
A: The Open Enrollment Period begins on August 8, 2011 for fiscal year 2011-12. All changes must be entered in your online Self-Service account by midnight on August 26, 2011. Instructions for accessing your Self-Service account are at the Online Help link, on the MI HR Gateway. If you have questions, do not have access to the Internet, or need assistance, please contact the MI HR Service Center at (877) 766-6447.
Q#2: What is the effective date of coverage?
A: The effective date of coverage is October 2, 2011 for FY 2011-2012 insurances.
Q#3: Is my 19 to 26 year-old child still eligible if not enrolled in school?
A: Eligible children up to age 26 may be enrolled in your health coverage, regardless of marital or student status or dependency upon you for support. Coverage does not extend to dental or vision plans or to his or her spouse or children. To be eligible for health coverage, one of the following criteria must be met:
Your child(ren) by birth, legal adoption, or legal guardianship.
Step-child(ren).
Foster child(ren) placed in your home by a State agency or the court.
Dependent of an Other Eligible Adult Individual (OEAI)
Dependent children of employees hired before 4/1/2010 may not have access to other employer provided health insurance. This does not apply to those employees hired on or after 4/1/2010.
Q#4: I made a change and enrolled into a different plan, when will I get my new insurance cards?
A: Insurance cards will be mailed to individuals prior to the coverage starting on October 2, 2011. If you will require additional copies, contact the number on the back of the cards.
Q#5: When is required supporting documentation due?
A: When adding a new or previously removed individual, you must submit eligibility documentation to the MI HR Service Center by September 30, 2011 for the enrollments to be valid.
If you work for the Attorney General, Auditor General, Secretary of State, Legislative Service Branch or Judicial, please submit your required supporting documentation to your HR Office by September 30, 2011.
If adding an Other Eligible Adult Individual (OEAI) to your health insurance coverage, all required documentation is due to the MI HR Service Center by September 9, 2011 otherwise the OEAI and their dependents will not be added for coverage.
Q#6: What is the Other Eligible Adult Individual (OEAI) Coverage?
A: NERE's, UAW, and SEIU Local 517M negotiated this benefit which allows those employees who do not have a spouse eligible to enroll in the State-Sponsored Group Insurance Health Plans, to enroll one OEAI if the individual meets all of the eligibility criteria. Dependent children of an OEAI may also enroll in health insurance only, under the same conditions that apply to dependent children of employees, if dependent eligibility criteria are met.
Employees who wish to enroll an OEAI will need to submit the required documentation to MI HR Service Center (or their HR Agency for non-participating agencies) by September 9, 2011.
In accordance with IRS regulations, State of Michigan employees are responsible for paying taxes associated with the fair-market value of enrolling an OEAI and the OEAI's dependents. Additional information on OEAI tax implications is available on the Employee Benefits Division website.
You may access additional details to the OEAI enrollment process in the Open Enrollment Brochure.
Q#7: Can I add an Other Eligible Adult Individual (OEAI) after the open enrollment period?
A: You may add an OEAI and their dependents only during the open enrollment period each year. If the criteria for enrollment of an OEAI or the OEAI's dependent child(ren) are no longer met, the employee must notify the MI HR Service Center within 14 calendar days. Coverage will be ended effective the date that eligibility criteria were no longer met.
Q#8: What if my coverage needs change after the open enrollment period?
A: After open enrollment, changes in coverage will only be allowed for a "family status change" or "life event". The coverage change must be consistent with the life event and each event requires documentation. Some examples of a family status change are:
You move outside of your HMOs or DMOs service area: You may enroll in health and dental insurance plans authorized for your area; the effective date will be the first day of the pay period after your move.
You get married or divorced:
You may enroll a new spouse within 31 days of your marriage; the effective date of the insurance is the first day of the next pay period after the MI HR Service Center receives notification.
Or you may newly enroll in health coverage if you lose insurance coverage as a result of a divorce. (Note: a former spouse's eligibility for State sponsored insurance coverage will end on the date of your divorce).
Your spouse dies and you are covered under that spouse's insurance plans: You may newly enroll in the State-sponsored group insurance plans.
An eligible child is born, adopted or moves into your home in a parent-child relationship: You may add a new dependent to your insurance coverage within 31 days of acquiring that dependent through birth, adoption, or legal guardianship. The effective date will be the date of birth, adoption, legal guardianship or move.
Your spouse begins or ends employment:
You and your eligible dependents may enroll in State-sponsored group insurance coverages if your insurance coverage is lost as a result of a change in your spouse's employment;
Or you may cancel your state-sponsored insurance (or opt out) if you enroll in your spouse's plans. See Q#3 below regarding "opt-out".
Your spouse changes from part-time to full-time (or vice versa) or takes an unpaid leave of absence resulting in a significant change in your coverages:
You and your eligible dependents may enroll in State-sponsored group insurance coverages if coverage is lost or significantly reduced as a result of a change in your spouse's employment status;
Or you may cancel your state-sponsored insurance (or opt out) if you enroll in your spouse's plans. See Q#3 below regarding "opt out".
There is a significant change in your coverages (or your spouse's coverages) through your spouse's employer plan:
You and your eligible dependents may enroll in State-sponsored group insurance coverages if coverages through your spouse's employer plan are lost, canceled, or significantly changed;
Or you may cancel your state-sponsored insurance (or opt out) if you enroll in your spouse's plan. See Q#3 below regarding "opt out".
You must notify the MI HR Service Center within 31 days of the family status change or life event. You will be required to complete the necessary forms and will also be required to provide proof of dependent eligibility. Details about family status change and life events are available in Section 15 on the Employee Benefits Division website.
Q#9:
Can I opt out of the health care options completely (that is, forego all health or HMO coverages altogether)?
A: Since it is your employer's intent to ensure that you have at least a basic level of health insurance coverages, safety nets (the Catastrophic Health Plan and the Preventive Dental Plan) are provided.
However, a request to completely opt out of any state-sponsored health and/or dental care plan is allowed. Select Health Waive With Rebate and/or Dental Waive With Rebate. You will still receive the $50 biweekly cash refund under the health option, and the one time only refund of $100 under the dental option. The $50 biweekly will not be paid if you are not in pay status.
Q#10: Why can't I opt out and receive the $50.00 rebate if my spouse is also a State of Michigan employee or retiree?
A: The State does not allow you to carry two enrollments at the same time. Please refer to "employee eligibility".
Q#11: If I am married to another eligible State employee, why can't I enroll both as an employee and as a dependent under two of the same category of coverages (for example, the State Health Plan PPO or the Catastrophic Plan)?
A: Existing eligibility rules do not allow you to carry two enrollments in the same category of State-sponsored coverages. The reason is simple: the State covers 80% to 100% of the premium for each enrolled person.* Two premiums or cash refunds are not payable for the same person. Each eligible person (employee, spouse, child, OEAI, or OEAI dependent) can enroll only once.
You and your spouse can enroll separately (both as employees) OR as a family unit (with one of you enrolling as a dependent). If you enroll separately, either one of you can cover your children, but you both can't enroll the same children.
Divorced employees may cover any eligible child(ren) in either parent's plan, as long as each child is only covered once. In the event employees cannot agree which parent will cover the child(ren), the parent whose birthday falls closest to the first of the calendar year will cover the dependent child(ren). Employees should be aware that one life insurance claim will be paid in the event of a dependent's death, even if both parents paid premiums for the child's life insurance policy.
*Except for those employees in certain bargaining units who were hired on or after 1/1/00 who have a regular work schedule of 40 hours or less per bi-weekly pay period (not permanent-intermittent positions).
Q#12: If I'm enrolled in an HMO or PPO, how do I get emergency care when I'm outside of the plan's service area?
A: All of these plans cover immediate emergency care anywhere in the world. However, there may be certain requirements before benefits are processed, such as reporting the emergency within a reasonable time period. Contact the Benefit Plan Administrators listed in Section 14 for more details and benefit booklets.
Q#13: What if I wish to change "primary care physicians" or what if my physician does not renew his or her contract with the HMO?
A: An HMO's contracted providers have the option of not renewing their contracts by providing advance notice to the HMO. Generally, contracts are not renewed because a physician is retiring or relocating outside of the HMO's service area or is changing the nature of his or her practice (i.e., from "primary care" to "specialty care" only). Because HMOs allow members to select another primary care physician from among those who are available to care for new patients, State employee members will not be allowed to disenroll from an HMO outside of an "open enrollment period" simply because of a need to select another available primary care physician.
Q#14: What coverages are available if I am laid-off or on a leave of absence or if one of my family members is no longer eligible?
A: The Employee Benefits Division (EBD) policy, collective bargaining agreements, and/or federal COBRA law provide options for continuing enrollments in any State-sponsored health care, dental care, vision and life insurance plan. In addition, conversion policies are available from the health, HMO and life insurance plan administrators. Details about continuation of coverage through the Employee Benefits Division are available in Section 12. Details about conversion policies are available from the insurance plan administrators and your HR office. Contact your department's Human Resources Office for applications.
Q#15: If there are no generic drugs available, must I still pay the brand name prescription drug copayment?
A: Yes. If a prescription is filled with a brand name drug, whether or not a generic equivalent is available, the brand name co-payment will be charged. Prescriptions filled by the Mail Order Pharmacy for "maintenance medications" are for 90 days for the same co-pay.
Q#16: Why do I get charged more when I ask for a brand name drug?
A: When you choose to purchase a brand name drug with an FDA approval generic equivalent drug available, you will be charged the difference in price between the brand and generic drug, in addition to the applicable brand co-payment.
Q#17: If I still have questions, whom can I call?
A: Call the MI HR Service Center at (877) 766-6447.
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