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Health, Prescription Drug, and Dental/Vision Insurance

Glossary of Terms

Insurance carriers

When you retire, you and your eligible dependents can enroll in the plan's group insurance offerings. You can enroll in the Master Health Care Plan (MHCP) or one of several Health maintenance Organizations (HMOs). For provider information and details about coverage, refer to the Insurance Options Summary (R0379C). You can also download vendor brochures from links in the table below.

Check out the Insurance Information (R0058C) document for information on enrollment, coverage, and eligibility for retirees.

The insurance carrier answers any questions about insurance claims or if you want to know if a particular service is covered. If you have enrollment questions or problems, contact ORS.  If you apply at least 3 months before your insurance effective date, your cards will usually arrive by your retirement effective date. If you need health services before your cards arrive, contact the insurance carrier directly to get your policy number or to verify coverage.

 

 

PLAN

 

WEBSITE

 

PHONE NUMBER

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Blue Cross Blue Shield of Michigan (BCBSM)

www.bcbsm.com/mpsers

(800) 422-9146

Catamaran Rx

www.mycatamaranrx.com

(855) 577-6517

Blue Care Network

www.MiBCN.com/mpsers

(866) 966-2583

Health Alliance Plan (HAP)

www.hap.org/medicaresolutions

(800) 801-1770

HealthPlus

www.healthplus.org/mpsers.aspx

(800) 332-9161

Priority Health

www.priorityhealth.com/mpsers

(888) 389-6648

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Blue Cross Blue Shield of Michigan

www.bcbsm.com/mpsers

(800) 422-9146

Catamaran Rx

www.mycatamaranrx.com

(866) 288-5209

Blue Care Network

www.MiBCN.com

(800) 662-6667

Health Alliance Plan (HAP)

www.hap.org

(800) 422-4641

HealthPlus

www.healthplus.org/mpsers.aspx

(800) 332-9161

Priority Health

www.priorityhealth.com/mpsers

(888) 389-6648

Dental/

Vision

Delta Dental

www.deltadentalmi.com/MPSERS

(800) 345-8756

BlueVision (supported by VSP)

www.vsp.com/advantage

(877) 478-7558

Insurance premium subsidies.

Whether or not the state helps cover insurance premium costs depends on when membership with the Michigan Public School Employees Retirement System began as well as other factors. See Premium Subsidies for details.

When your coverage begins.

Insurance coverage always begins on the first day of a month.

If you enroll at retirement. Retiree coverage for you and your dependents can begin on your retirement effective date or up to 90 days past your retirement date if you will have insurance coverage with your school employer after you retire. Check with your school employer to find out when your present insurance(s) will terminate. That way there won't be any break in your coverage and you won't be duplicating coverage. Determining the correct effective date is very important because we can't refund any premiums once they have been withheld from your pension.

If you have a retroactive retirement date. If you apply for retirement in the month of your retirement effective date or later (retroactively), insurance coverage can begin no earlier than the first day of the month after the enrollment request and required proofs are received, even if your retirement effective date is earlier than that.

For disability retirees. If you are a disability pension recipient with the Premium Subsidy benefit, insurance coverage will begin (after you apply) on your retirement effective date or the first of the month following approval of your disability, whichever is later.

Timely application and proofs. For retirees who do not have Medicare, coverage can begin the first of the month after we receive your completed application and proofs. For retirees with Medicare, if we get your request and proofs by the 15th of the month, we will enroll you the first of the following month. If we get the request and proofs later, but within 30 days of the qualifying event, you may not be enrolled until a month later.

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 may be September 1.

Enrolling after retirement. If you have the Premium Subsidy benefit and you are enrolling yourself, your spouse, or a dependent in insurance after retirement, 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 and/or HMO enrollment form with proofs on February 10, your coverage would begin August 1.

The waiting period does not apply if you or a dependent has a qualifying event and ORS gets the request and proofs within 30 days of the qualifying event. For retirees who do not have Medicare, coverage can begin the first of the month after the month we receive your completed application and proofs. For retirees with Medicare, if we get your request and proofs by the 15th of the month, we will enroll you the following month. If we get the request and proofs later, but within 30 days of the qualifying event, you may not be enrolled until a month later.

If you have the Personal Healthcare fund, you cannot enroll in insurances after your retirement effective date.

If you have a qualifying event.

The waiting period does not apply if you, a spouse, or an eligible dependent has an involuntary loss of other group coverage or a qualifying event such as a change in your family status and you have the Premium Subsidy benefit.

ORS must receive required proofs, and the enrollment request through miAccount or by using the Insurance Enrollment/Change Request (R0452C), within 30 days of the qualifying event or you will be subject to a 6-month wait. If we receive the application and proofs within 30 days, 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.

The following are considered qualifying events for the purpose of adding or deleting a dependent. Photocopies are acceptable.

Adoption.  Acceptable proof is adoption papers. In the case of 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. A sworn statement with the date of placement or a court order verifying placement is required.
Birth. Acceptable proof is a birth certificate.
Death. Acceptable proof is a death certificate.
Divorce. Acceptable proof is divorce papers.
Marriage. Acceptable proof is a marriage certificate and spouse's birth certificate-both are needed.
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.

If you're 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 due to marriage, birth, or adoption, be sure to submit the request and proofs within 30 days of the event or they will be subject to a 6-month waiting period before they can enroll.

If you have a delayed subsidy, you're enrolled in insurances before your subsidy effective date, and you're paying the entire premium, ORS will automatically reduce your insurance premium on your subsidy effective date.

If you have other health insurance.

It is your responsibility to keep ORS informed of any changes that may affect your own and your dependent's eligibility and/or coverage, so be sure to notify ORS when anyone on your insurance has coverage under another insurance plan.

If you and your spouse are both Michigan public school retirees, you will be covered together under one contract.

Sign up for Medicare.

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). You must have Medicare Parts A and B to enroll in retiree insurance and prescription drug programs. If you, your spouse, or your dependents don't enroll in Medicare Part B when first eligible, the insurance for that person will be canceled and there is a six month wait to re-enroll.

For most people, Medicare begins at age 65 or after 24 months of social security disability. If that happens before age 65, send ORS your completed Insurance Enrollment/Change Request (R0452C), and make sure ORS has your Medicare number.

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 Part D (prescription drug) is a federal program that is administered by your group insurance plan. When you enroll in a retiree prescription drug plan, we will automatically enroll you in Medicare Part D if appropriate.

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 are concerned that your privacy rights have been compromised, or you need further information, please contact ORS.


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The retirement plan information that appears on this website is intended to summarize basic provisions of Public Act 300 of 1980, as amended.
Current laws, rates, and factors are subject to change. Should there be discrepancies between the information reflected here and the actual law,
the provisions of the law govern.



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