<- Section 12

• 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".

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.


Q#6: If I'm enrolled in an HMO, DMO 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#7: 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#8: Is my 19-year-old child, who still lives at home, still eligible?

A: Generally, your unmarried children can only remain on your coverage through the day before the 19th birthday, if all other dependency criteria are met. However, an unmarried child may remain on your health, dental and vision coverage at and after age 19 if he or she is still regularly attending an accredited education institution and depending on you for support as defined by IRS regulations OR if he or she is totally incapacitated prior to age 19 and remains permanently disabled. See Section 11, Dependent Eligibility for details. Unmarried dependents may be covered on the dependent life insurance plan until age 23 if they are dependent on you for support as defined by IRS regulations (even if they are no longer students).


Q#9: 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#10: 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#11: 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#12: Can I enroll my dependent parent(s) who live with me and rely solely on me for support?

A: No, parents cannot be enrolled. The criteria for eligible dependents under the state sponsored group insurance plans do not include parents.


Q#13: If I still have questions, whom can I call?

A: To verify your eligibility (or the eligibility of a family member), call the MI HR Service Center at (877) 766-6447.


To get answers about available benefits , contact the Insurance Plan Administrators listed in Section 14.


Benefit booklets are available from this website and from each Insurance Plan Administrator.

*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).