Health, Dental, and Vision Insurance

The Employee Benefits Division of the Michigan Civil Service Commission negotiates the carriers, coverage, and rates for retirees just as it does for active employees. In addition to the State Health Plan PPO administered by Blue Cross Blue Shield of Michigan, some of the HMOs that offer plans for active employees also offer coverage for retirees. Because these things 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 Michigan 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 gap in your coverage.

Your insurance protection as a retiree begins on your retirement effective date. Since your coverage as an active employee 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 six-month delay in your coverage. (See Enrolling or changing your enrollment after retirement, below.)

Insurance premiums.

The state pays most of your premiums for health, dental, and vision insurances; your portion is deducted from your pension payments. If your insurance premiums exceed your pension payments, ORS will create a monthly payment plan for you.

You will be notified in advance of any rate changes, which typically occur in October. Premium rates for each carrier are available on the Employee Benefits section of the Civil Service Commission website.

How Medicare affects your coverage. 

Be sure to apply for Medicare about three months before you or any of your covered dependents become eligible for Medicare. For most, eligibility occurs at age 65 or after two years of social security disability eligibility. You must enroll in both Part A (hospital) and Part B (medical).

If Medicare eligibility happens before age 65, immediately enter the Medicare information online through miAccount or send us the Insurance Enrollment/Change Request (R0452G) 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 health plan automatically becomes a supplement to Medicare and will no longer pay any expenses covered by Medicare. If you don't enroll in Medicare Parts A and B, you will be responsible for any medical expenses covered by Medicare.

It's important to act promptly because 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 Insurance Enrollment/Change Request (R0452G) .

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.

Effects of other group insurance.

The state's health, dental, and vision insurance 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 expenses for your care or service. Be sure to keep us informed if anyone on your insurance is covered under another insurance, including Medicare.

In addition, you cannot enroll your spouse as an insurance dependent if he or she is separately enrolled as an eligible state employee or retiree.

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 (R0452G) 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 (R0452G) and/or HMO enrollment form with 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 (R0452G) 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 (R0452G) and return it to ORS along with all required proofs.

To switch from on 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 (R0452G) 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.

If you have a qualifying event.

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

• 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: 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 six-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 (R0452G) 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 6-month waiting period unless you have a qualifying event. The 6-month waiting period may be waived if you submit the Insurance Enrollment/Change Request (R0452G) and required proofs within 30 days of the qualifying event.

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 Employee Benefits section of their website at www.michigan.gov/mdcs , 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 (R0452G) form found on our website.

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.