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 enlisted officers. 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 pays most of your premium for health, dental, and vision insurances; your portion is deducted from your pension payments.
You will be notified in advance of any rate changes, which typically occur in October. Premium rates for each carrier are published on the Employee Benefits section of the Michigan Civil Service Commission website.
Timely application and proofs
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 more than one month prior to your retirement effective date. If your last day of work is in December and you want your insurance coverage to start January 1, your retirement effective date, we need your required proofs before December 1. If we get the request and proofs after the first of the month one month prior to your retirement, 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 December 1, for a retirement effective date of January 1, your actual insurance effective date will be February 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. For any received later, coverage will not begin until the first day of the sixth month after we receive the complete enrollment request including required proofs.
How Medicare affects your coverage
What you need to know
Medicare is the federal health insurance program for people who are 65 or older, or otherwise receiving Social Security Disability benefits.
Medicare is divided into four parts, which cover specific services. You will only need to focus on these three if you enroll in a state-sponsored retiree insurance plan:
- Part A (Hospital)
- Part B (Medical)
- Part D (Prescription Drug)
Medicare Part D (Prescription Drug) is a federal program 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 drug plan. Doing so will result in a loss of medical and prescription drug coverage through the retirement system's plan.
You can learn more about Medicare and sign up for Medicare here.
Aging in to Medicare
Eligibility for social security and Medicare is based on the accumulated credits, technically known as quarters of coverage (QCs). If you don't have enough credits to qualify for Medicare, you can continue your enrollment in non-Medicare retiree insurance, but you must act to do so.
If you are not eligible for Medicare either on your own or through your spouse, you must submit a letter to ORS from the Centers for Medicare and Medicaid Services (CMS) or the Social Security Administration (SSA) indicating you do not have the necessary QCs to enroll in Medicare. Upon receipt and acceptance, ORS will maintain your enrollment in the non-Medicare health and prescription drug retiree insurance plans. For more information about Medicare eligibility, please refer to the Original Medicare (Part A and B) Eligibility and Enrollment section of the CMS website. If you decline insurance at retirement and decide after age 65 to enroll, you will be enrolled in the non-Medicare plans and the letter from CMS or the SSA will be required along with your enrollment application.
If you are married and your spouse has enough QCs to be eligible for Medicare, you must enroll in Medicare when first eligible through your spouse. If your spouse is not eligible for Medicare either, you must submit proof from CMS or the SSA indicating your spouse does not have the necessary QCs to enroll in Medicare.
What you need to do
Your experience with Medicare and your retirement insurance will vary based on whether you or your dependents are eligible for Medicare when you retire, become eligible for Medicare after your retirement or qualify for Medicare early before age 65.
As soon as you, or anyone else covered by your health insurance, become eligible for Medicare, that person must enroll in both Part A (Hospital) and Part B (Medical). You must have Medicare Part 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. If you want to enroll again, your coverage will begin on the first day of the sixth month after ORS receives all required forms and proofs.
Eligible for Medicare when you apply to retire
- Need to apply for your Medicare card. If you or your dependent will be eligible for Medicare when you apply to retire and haven’t enrolled yet, you should contact Social Security to enroll in both Medicare Part A (Hospital) and Part B (Medical) at least three months before your retirement effective date. You will get a Medicare number once you are enrolled that you will need to provide to ORS when you enroll in an insurance plan.
- Enrolled in Medicare. If you or your dependent are already enrolled in Medicare Part A (Hospital) and Part B (Medical) when you first apply to retire and enroll in one of the retiree insurance plans, you’re already half done.
When you apply to retire, you'll have a chance to enroll in a retiree insurance plan in step two of the online application. Enter your Medicare number and effective dates for Part A and B when prompted. You will pick a carrier from the list of available options in your area. Once you're enrolled in the Medicare plans of your choice, you can expect ID cards and welcome kits from your selected carrier(s). If you apply for your retiree insurance at least 3 months before your insurance effective date, your cards will usually arrive before your coverage begins. If you need health services before your cards arrive, contact the insurance carrier directly to get your policy number or to verify coverage. For more information, go to your insurance carrier’s website.
Become Eligible for Medicare after Enrolling in the Retiree Insurance Plan
If you, or your dependent are enrolled in retiree insurance before becoming eligible for Medicare, the information below will help you understand what you need to do to streamline the process.
Tell ORS your Medicare number and effective date for Part A and B
When you enroll in Medicare you will receive your Medicare card from Social Security. As soon as you receive your card, tell ORS your Medicare number and effective dates for Part A and B. You can submit your Medicare enrollment information one of the following ways:
- Log in to miAccount and send a secure message on Message Board, using the Submit My Medicare Number category. Include the name, Medicare number, and effective dates for Part A and B in your message.
- Update your insurance enrollment information in miAccount to include the new Medicare information and mail or fax the confirmation page to ORS.
- Make a copy of the Medicare card. Write your name, member id, address, and date of birth on the copy and mail or fax it to ORS.
- Mail or fax a completed Insurance Enrollment/Change Request (R0452H) form to ORS with the Medicare information.
- Call ORS and provide the Medicare number and effective dates for Part A and B over the phone.
Your insurance carrier will enroll you in the version of your plan for Medicare eligible members. Your carrier will send you ID cards and welcome kits. If you tell ORS your Medicare number at least two months prior to your Medicare starting date, your insurance cards will usually arrive before your coverage begins. If you need health services before your cards arrive, contact the insurance carrier directly to get your policy number or to verify coverage. For more information, go to your insurance carrier’s website. Waiting to enroll in Medicare could affect your eligibility and coverage.
New Medicare card
Medicare will be removing Social Security numbers from Medicare cards and issuing new Medicare cards to help guard against identity theft. The new Medicare card will show an 11- character identifier that is unique to you. Medicare plans to begin mailing new cards in April 2018. People with Medicare will receive their new Medicare cards between April 2018 and April 2019. Mailing everyone a new Medicare card will take some time. Your card may arrive at a different time than your friend’s and neighbor’s. Go to www.ssa.gov to update your address since your new Medicare card will be mailed to your address on file with the Social Security Administration.
If you are enrolled in Medicare Part A and B before April 2018, you don’t need to take any action. Medicare will provide your health and prescription drug provider and ORS with your new Medicare number.
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 (R0452H).
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 (R0452H).
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 (R0452H) 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 day of the month after we receive your request and any required proofs, including proof of a qualifying event. For retirees with Medicare, coverage can begin the first day of the second month after we receive your request and required proofs, including proof of the qualifying event. For example, if ORS receives your application and proofs on July 10, your coverage will begin September 1. 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.
Changing Plans. To change your insurance plan, log in to miAccount and click on Insurance Coverage, or complete the Insurance Enrollment/Change Request (R0452H) and return it to ORS along with all required proofs. If you are currently enrolled in any health insurance plan with the retirement system, you can change your enrollment to another plan regardless of your Medicare status. Your change in coverage will be the 1st day of the 2nd month after your request and required proofs are received. For example, if ORS receives your change request and any required proofs on January 10, your coverage with the new plan will begin on March 1.
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 following are considered qualifying events for adding a dependent. You must submit proofs with the application 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: For enrollment, 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. For disenrolling a former spouse, no proof is needed.
- Marriage: Acceptable proof is government issued marriage certificate and spouse’s birth certificate-both are needed.
If you have an insurance question
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 (R0452H) 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.