Health, Dental, and Vision Insurance
Enroll in Part A & B
Be sure to enroll in Medicare Parts A and B when you're first eligible, and to notify ORS if that happens before you are age 65.
If you are enrolled in Part A but not Part B because you are actively working, enroll in Part B at least two months before your retirement effective date to ensure continuous coverage into retirement.
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.
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 wait to begin your coverage. (See Enrolling or changing your enrollment after retirement, below.)
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. Your insurance cards will arrive a few weeks after your retirement effective date. If you need health services after you retire but before your cards arrive, contact the insurance carrier directly to get your policy number or to verify coverage.
When you meet age and service requirements, the state will subsidize your health insurance premiums. 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.
Insurance coverage always begins on the first day of a calendar month. We must have your completed insurance application and all required proofs before we can enroll you, and we cannot enroll you retroactively.
If you don't have Medicare, and you submit your application and proofs before your retirement effective date, your insurance will begin on your retirement effective date.
If you have Medicare, we need the application and proofs by the 15th of the month for your insurance to start on your retirement effective date. If we get the request and proofs after the 15th but before the end of the month, you will not be enrolled until a month later. For example, if you submit your application and proofs on July 25, for a retirement effective date of August 1, your actual insurance effective date will be September 1.
We must receive a complete application and proofs for everyone you want to enroll no later than 30 calendar days after your retirement effective date, or those with missing information will be subject to a six-month wait to enroll, starting from the date we received the new enrollment request and proofs.
How Medicare affects your coverage.
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 the 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 will be canceled for that person 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 eligibility. If that happens before age 65, send ORS a completed Insurance Enrollment/Change Request (R0452G).
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. Don't sign up for a Medicare Part D prescription drug plan or any other supplemental prescription plan. Doing so will result in a loss of medical and prescription coverage through the retirement system's plan.
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 completed online insurance enrollment (in miAccount) or Insurance Enrollment/Change Request (R0452G).
Effects of other group 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 plan.
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.
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).
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 the required forms and proofs. For example, if we receive your Insurance Enrollment/Change Request (R0452G) with necessary proofs of eligibility on February 10, your coverage would begin August 1.
If you have a qualifying event, such as an involuntary loss of other group coverage or a change in family status, and you submit the required documents (see below) within 30 days, the six-month waiting period does not apply.
For retirees who do not have Medicare, coverage can begin the first of the month after we receive your completed application and required proofs.
For retirees with Medicare, if we receive 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 in later, but within the 30 days of the qualifying event, you will not be enrolled until a month later.
If you are changing insurance coverage, ORS will adjust your premiums, if needed, the month the insurance becomes effective. We cannot refund premiums withheld before or in the month you report the change, and there is a 6-month waiting period unless you have a qualifying event.
Changing Plans. To change your insurance plan, log in to miAccount and click on Insurance Coverage, or complete the Insurance Enrollment/Change Request (R0452G) and return it to ORS along with all required proofs. 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 you have moved out of the coverage area..
Coverage in the new plan will begin the first day of the month after ORS receives your materials if you are enrolling in BCBSM or moving out of an HMO coverage area. Coverage will begin the first day of the second month if you are voluntarily changing HMOs.
The six-month 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. Photocopies are acceptable.
- Involuntary loss of coverage in another group plan: Provide a statement on letterhead from the terminating group insurance plan explaining who was covered, what type of coverage it was, why coverage is ending, and the date coverage ends.
- 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 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.
- Marriage: Acceptable proof is a marriage certificate.
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.