Health, Dental, Vision

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.)

Insurance premiums.

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 at age 65 or after 2 years of social security disability eligibility. You must enroll in both Part A (hospital) and Part B (medical).

Enter the Medicare information in miAccount or send us a completed Insurance Enrollment/Change Request (R0452H) to enroll. When your Medicare coverage begins, you will likely see a decrease in the amount of your health insurance premiums.

As soon as you become eligible for Medicare, your plan health automatically becomes a supplement to Medicare and will no longer pay any expenses normally paid by Medicare. If you don't enroll in Medicare Parts A and B, you will be personally responsible for any medical expenses covered by Medicare.

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.

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.

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.

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.

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 (R0452H) 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 (R0452H) and/or HMO enrollment form 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) and HMO enrollment form, if needed, along with proof of your loss of coverage within 30 days of the event, there will be no gap in your coverage.

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, complete the Insurance Enrollment/Change Request (R0452H) 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 (R0452H) and all necessary proofs. DO NOT return your application to the HMO.

Coverage in the new plan will begin the first day of the second month after ORS receives your materials.