Health, Dental, and Vision Insurance
The Employee Benefits Division of the Civil Service Commission negotiates the carriers, coverage, and rates for retirees just as it does for enlisted officers. In addition to the State Health Plan PPO administered by Blue Cross Blue Shield of Michigan, some HMOs that offer plans for active employees also offer coverage for retirees. Because these 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 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.
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 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 6-month delay in your coverage. (See Enrolling or changing your enrollment after retirement, below.)
The state pays most of your premium for health, dental, and vision insurances; your portion is deducted from your pension payments.
You will be notified in advance of any rate changes, which typically occur in October. Premium rates for each carrier are published on the Employee Benefits section of the Civil Service Commission website.
How Medicare affects your coverage
If you or any of your covered dependents qualify for Medicare, be sure to apply for it about three months before reaching Medicare eligibility. Usually, eligibility occurs the first day of the month in which you turn age 65 or after 2 years of social security disability eligibility. You must enroll in both Part A (hospital) and Part B (medical).
If your eligibility happens before age 65 and you enroll sooner, notify ORS and provide your Medicare number and effective date. You can enter this Medicare information in miAccount or send us a completed Insurance Enrollment/Change Request (R0452H). When your Medicare coverage begins, you will likely see a decrease in the amount of your health insurance premiums charged by ORS.
When you become eligible for Medicare, your plan’s health insurance automatically acts as a supplement to Medicare and will no longer pay expenses normally paid by Medicare, even if you’re not enrolled in Medicare. This is important: Make sure you’re enrolled in Parts A and B of Medicare to avoid higher out-of-pocket expenses. For example, Medicare Part B pays for 80 percent of outpatient expenses like knee and hip surgeries. Without Medicare, you will be responsible for that extra out-of-pocket expense.
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 request.
Note: In 1986, federal law required mandatory Medicare 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.
Aging in to Medicare
If you are enrolled in the State Police retiree insurance plan through ORS, at age 65, ORS will automatically switch you to the Medicare Supplemental retiree health plan and Medicare Part D prescription drug plan. For most customers, this is a seamless transition and no action is needed on their part other than signing up for Medicare Parts A & B in a timely manner. If you do not have enough credits to qualify for either Social Security or Medicare benefits, technically known as quarters of coverage (QCs), you may not be eligible for Medicare. In this case, you can continue your enrollment in Non-Medicare retiree insurance but you must take action to do so.
If you are not eligible for Medicare either on your own or through your spouse, you must submit a letter to ORS from the Centers for Medicare and Medicaid Services (CMS) or the Social Security Administration (SSA) indicating you do not have the necessary QCs to enroll in Medicare. Upon receipt and acceptance, ORS will maintain your enrollment in the non-Medicare health and prescription drug retiree insurance plans. For more information about Medicare eligibility, please refer to the Original Medicare (Part A and B) Eligibility and Enrollment section of the CMS website. If you decline insurance at retirement and decide after age 65 to enroll, you will be enrolled in the non-Medicare plans and the letter from CMS or the SSA will be required along with your enrollment application.
If you are married and your spouse has enough QCs to be eligible for Medicare, you must enroll in Medicare when first eligible through your spouse. If your spouse is not eligible for Medicare either, you must submit proof from CMS or the SSA indicating your spouse does not have the necessary QCs to enroll in Medicare.
Effects of other group insurance
The state's health, dental, and vision insurance plans contain a coordination of benefits (COB) provision, which states that you cannot 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 inform ORS 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.
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 (R0452H).
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 the required forms and proofs. For example, if we receive your Insurance Enrollment/Change Request (R0452H) with the necessary proofs of eligibility on February 10, your coverage would begin August 1.
We can waive the waiting period if you or a dependent has an involuntary loss of other group coverage or a change in your family status. If we receive your Insurance Enrollment/Change Request (R0452H) along with proof of your loss of coverage within 30 days of the event, there will be no gap in your coverage.
Changing plans. To change your insurance plan, log in to miAccount and click on Insurance Coverage, or complete the Insurance Enrollment/Change Request (R0452G) and return it to ORS along with all required proofs. If you are currently enrolled in an HMO, 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.
Coverage in the new plan will begin the first day of the second month after ORS receives your materials.
If you have a qualifying event
The following are considered qualifying events for adding a dependent. You must submit proofs with the application within 30 days of the qualifying event. Photocopies are acceptable.
- Involuntary loss of coverage in another group plan: Provide a statement on letterhead from the terminating group insurance plan explaining who was covered, what type of coverage it was, why coverage is ending, and the date coverage ends.
- 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: For enrollment, provide a statement on letterhead from the terminating group insurance plan explaining who was covered, what type of coverage it was, why coverage is ending, and the date coverage ends. For disenrollment, no proof is needed.
- Marriage: Acceptable proof is government issued marriage certificate and spouse’s birth certificate-both are needed.
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 the Employee Benefits section of the Civil Service Commission website, 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 (R0452H).
Adjustments to premiums
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 this form and required proofs within 30 days of the qualifying event.
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.