If you are a disability pension recipient, Insurance coverage will begin on your retirement effective date or the first of the month following approval of your disability, whichever is later.

Coverage begins on retirement effective date. If you submit your completed retirement application before your retirement effective date, and required insurance documents (applications and proofs) are submitted before the end of the month of your retirement effective date, coverage can begin on your retirement effective date. It takes 45 days after your pension eligibility determination for your insurance enrollment to be processed, so we recommend you apply 3 months before your retirement effective date.

If we receive required proofs and/or insurance applications after the end of the month of your retirement effective date, you will be subject to a six-month delay in coverage.

Coverage with retroactive retirement effective date. If you apply for retirement in the month of your retirement effective date or later (retroactively), you have until the end of the month in which you apply for retirement to submit your required insurance documents, including applications and proofs. Your insurance would begin the first of the month after the date you submitted your insurance documents.

If we receive required proofs and/or insurance applications after the end of the month in which you applied for retirement, you will be subject to a six-month delay in coverage.

Delayed insurance coverage. You may choose to delay your insurance coverage up to 90 days after your retirement effective date. Your insurance documents must still be submitted based on when you applied for retirement (see above). We suggest you 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 that were withheld from your pension.

New enrollment after your retirement effective date. If you initiate a new enrollment for yourself, your spouse, or another dependent in the retirement system's insurance after your retirement effective date, that coverage will begin on the first day of the sixth month after ORS receives all required forms and proofs.

The waiting period does not apply if you or a dependent has an involuntary loss of other group coverage or a qualifying event such as a change in your family status. If we receive your enrollment along with all required proofs within 30 days of your loss of coverage or qualifying event, there will be no gap in your coverage.

Note: If you purchased service credit on or after July 1, 2008, the effective date of your insurance eligibility follows the rules described above. However, the date you are eligible for a premium subsidy may be delayed. See Premium Subsidies for details.

If you have a qualifying event.

The following are considered qualifying events for the purpose of adding or deleting a dependent. ORS must receive the supporting documentation for a qualifying event by mail within 30 days of the qualifying event to waive the 6-month waiting period. 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.
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.

ORS can waive the 6-month waiting period if you complete your insurance change request through miAccount and we receive, by mail, your confirmation page and required proofs, or an Insurance Enrollment/Change Request (R0452C)  and required proofs within 30 days of the qualifying event. Coverage can begin the first of the month following the month in which we receive your completed application and required proofs.

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 six-month waiting period unless you have a qualifying event. The six-month waiting period may be waived if you complete your insurance change request through miAccount and we receive, by mail, your confirmation page and required proofs, or an Insurance Enrollment/Change Request (R0452C)  and required proofs within 30 days of the qualifying event.

If you enrolled in insurances before your insurance premium subsidy effective date and are paying the full premium, ORS will automatically reduce your insurance premium on your premium subsidy effective date.

If you have other health insurance.

The health, drug, dental, and vision plans contain a coordination of benefits (COB) provision, which says you can't 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 costs.

It is your responsibility to keep ORS informed of any changes that may affect your own and your family'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, your spouse, or anyone covered by your health plan insurance become eligible for Medicare, that person must enroll in both Parts A and B. If this happens before age 65, send ORS a completed Insurance Enrollment/Change Request (R0452C) form. About three months before you turn age 65, we will take steps to enroll you in the retirement system Medicare Advantage programs.

Your health coverage coordinates with Medicare. Medicare parts A and B are requirements for enrollment in the Medicare Advantage programs (health care and prescription drug). Your retirement system health plan will continue to pay for any of the plan's covered benefits that are not covered by Medicare.

If you don't enroll in Medicare Part B, you will not be eligible to participate in the Medicare Advantage programs and you will be personally responsible for any Part B medical expenses that would be covered by Medicare. When your Medicare coverage begins, you will likely see a decrease in the amount of your health insurance premiums.

Medicare D is a prescription drug program introduced by the federal government in 2006. Your insurance carrier will automatically enroll you in Medicare Part D if appropriate. Be sure your carrier knows your Medicare number.

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.