Enrollment: When Your Coverage Begins

calendar

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

Your timelines and enrollment process will depend on whether you, your spouse, and eligible dependents are:

Enrolling at retirement

Retiree coverage for yourself, your spouse, and 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. Make sure you determine the correct effective date and submit your application and proofs timely so you don't have a break in your coverage, and you won't be duplicating coverage. Check with your school employer to find out when your present insurance plan(s) will terminate, and review the timely application and proofs section. Determining the correct effective date is very important because we can't refund any premiums once they have been withheld from your pension.

Timeline for your enrollment effective date at retirement:

timeline

To ensure your coverage begins on your requested insurance enrollment date, follow these guidelines for submitting your insurance enrollment and required proofs.

Non-Medicare: For retirees who do not have Medicare, coverage can begin the first of the month after we receive your completed application and proofs.

Medicare: 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 your retirement effective date, you will not be enrolled until the first of the second month. Learn more about how Medicare works with your coverage here.

For example, if you apply to retire July 1 and you submit your retirement application and proofs on July 25, your insurance effective date will be September 1.

If you have a retroactive retirement date

Insurance enrollments are not retroactive. 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, 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.

Enrolling after retirement

Personal Healthcare Fund or Premium Subsidy?

If you aren't sure whether you have the Personal Healthcare Fund or the Premium subsidy, log in to miAccount and refer to your Account Summary.

If you have the Premium Subsidy and are enrolling yourself, your spouse, or dependents in insurance after retirement, your coverage will begin on the first day of the sixth month after ORS receives all required forms and proofs (unless you have a qualifying event). For example, if we receive your Insurance Enrollment/Change Request (R0452C) form with proofs on February 10, your coverage would begin August 1 (see timeline below).

If you have the Personal Healthcare Fund, you cannot enroll in any insurance plan after your retirement effective date.

Timeline for enrollment without a qualifying event:

timeline

If you have a qualifying event

If you, a spouse, or an eligible dependent have a qualifying event (such as change in family status or involuntary loss of other group coverage), and you have the premium subsidy benefit, your coverage can begin as early as the first of the month after you apply and we receive the required proofs. Refer to the timely application and proofs section for more details on required time frames.

If you have the Personal Healthcare Fund, you cannot enroll in any insurance plan after your retirement effective date.

ORS must receive your completed application and proofs within 30 days of the qualifying event. If you do not meet this timeframe your insurance enrollment period will begin 6 months from the date we received your completed application and proofs.

If ORS receives your completed application and proofs within 30 days of the qualifying event, and you meet other eligibility requirements, your start date depends on whether or not you have Medicare, and when you submit your request and proofs.

Non-Medicare: For retirees who do not have Medicare, coverage can begin the first of the month after we receive your completed application and proofs.

Medicare: 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 will not be enrolled until a month later. Learn more about how Medicare works with your coverage here.

Qualifying Event Examples

The following are considered qualifying events for the purpose of adding or removing a dependent. You will need to provide proof of the qualifying event. Photocopies of proofs are acceptable. See the Proofs Required for Insurance Coverage table below for more details.

  • Involuntary loss of coverage in another group plan. Provide a statement on letterhead (certificate of creditable coverage) from the terminating group insurance plan.
  • Marriage. Acceptable proof is a government issued marriage certificate and spouse's birth certificate-both are needed.
  • Birth. Acceptable proof is a birth certificate.
  • Adoption. Acceptable proof is adoption papers. See Dependent Coverage for more information.
  • Death. Acceptable proof is a death certificate.
  • Divorce. Acceptable proof is an insurance change request. For enrollment, request must also include proof of loss of coverage from the previous benefit administrator which includes who is being terminated, when, and why.

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 their coverage will begin on the first day of the sixth month after ORS receives the required forms and proofs.

Non-qualifying Events

The following examples are not considered qualifying events for the purpose of adding or removing a dependent.

  • Dropping other coverage because rates increase
  • Receiving a stipend in lieu of coverage
  • Termination of coverage for failure to pay your premiums
  • Lapse of coverage due to late enrollment in Medicare

Changing plans

  • 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 of a move. To change plans, log in to miAccount and click on Insurance Coverage, or complete the Insurance Enrollment/Change Request (R0452C) and return it to ORS along with all required proofs.
  • Coverage will begin the first day of the month after ORS receives your materials if you are enrolling in BCBSM (with or without OptumRx prescription drug) or moving out of an HMO coverage area. Coverage will begin the first day of the second month if you are voluntarily changing HMOs.

Required Proofs for Enrollment

If you want to…

 

Enroll your spouse in insurance

If enrolled in Medicare or other insurance plan

  • Insurance plan information, including
    • Policy number
    • Type of coverage (health, dental, vision, prescription drug)
    • Who is enrolled
 

Enroll your dependent in insurance
(under age 19)

Must have:

Birth certificate for each dependent

If you are the adoptive parent

  • Sworn statement with the date of placement or a court order verifying placement is required

If enrolled in Medicare or other insurance plan

  • Insurance plan information, including
    • Policy number
    • Type of coverage (health, dental, vision, prescription drug)
    • Who is enrolled
 

Enroll your dependent in insurance
(age 19 or older)

Must have:

  1. Birth certificate for each dependent
  2. School records as proof of full-time attendance, which must include
    • Dependent's name
    • Dates enrolled
    • Name of institution
    • Number of credit hours, or that student is deemed full time
  3. IRS form 1040 that identifies the child as your dependent or a letter from your tax preparer (on letterhead) declaring your dependent is eligible but files their own taxes. 

If you are the legal guardian

  • Court orders to prove guardianship

If you are the adoptive parent

  • Sworn statement with the date of placement or a court order verifying placement is required

If enrolled in Medicare or other insurance plan

  • Insurance plan information, including
    • Policy number
    • Type of coverage (health, dental, vision, prescription drug)
    • Who is enrolled
 

Enroll your disabled dependent in insurance

Must have:

  1. Birth certificate for each dependent
  2. Current letter from the attending physician detailing the disability, stating the child is
    • Totally and permanently disabled, and
    • Incapable of self-sustaining employment
  3. IRS form 1040 that identifies the child as your dependent

If you are the legal guardian

  • Court orders to prove guardianship

If you are the adoptive parent

  • Sworn statement with the date of placement or a court order verifying placement is required

If enrolled in Medicare or other insurance plan

  • Insurance plan information, including
    • Policy number
    • Type of coverage (health, dental, vision, prescription drug)
    • Who is enrolled
 

Prove your involuntary loss of coverage, verifying your qualifying event

Must have:

Statement on letterhead from the terminating group insurance plan explaining

  • Who was covered
  • Why coverage is ending
  • Date the coverage ends
 

Enroll your dependent parent(s) or parent(s)-in-law in insurance

Must have:

  1. Birth certificate for each dependent
  2. Proof of residency, in the parent or parent-in-laws name:
    (only one of the following is required)
    • 1099/1098 tax form for previous year, OR
    • Current voter registration card, OR
    • State driver's license, OR
    • State issued ID