Understanding Premium Subsidy Eligibility

When you retire, you and your eligible dependents can enroll in the plan's health, prescription drug, dental, and vision insurances. The cost of coverage and conditions of enrollment will vary depending on several factors, which are covered below in detail.

If you enroll in insurance, your share of the premium is deducted from your monthly pension payments. If your pension is less than the premium amount, we will bill you for the remainder of the premium and send you payment coupons to submit with your monthly payments.

Click here to see current rates. These rates apply to all public school retirees who retire after January 1, 2013 or to previous retirees who were not yet eligible for Medicare coverage as of January 1, 2013. Annual rate sheets are mailed out each year to members before the January 1 effective date.

As an active member, you may be eligible for the Premium Subsidy, or the Personal Healthcare Fund, not both. If you’re not sure whether you have the Personal Healthcare Fund or the Premium Subsidy, login to miAccount and refer to your account summary. You are responsible for paying the balance of the premium amount. 

If you have the Personal Healthcare Fund, you are not eligible for subsidized health, prescription drug, dental, or vision insurance through the retirement system.

Premium Subsidy

The Premium Subsidy is where the retirement system pays a percentage of your monthly insurance premiums (or a percentage of the maximum subsidy for some deferred members). The cost of coverage and conditions of enrollment will vary depending on several factors, which are covered below in detail. 

Qualifying for Premium Subsidy.

First, we'll cover the basics and define some terms.

Premium: The amount paid monthly in order to have health insurance.

Subsidy: The amount of the premium that is paid for by the retirement system.

If you named a new spouse as beneficiary after retirement

Subsidized insurance coverage for a spouse named as a survivor beneficiary after retirement will end upon the death of the retiree. Coverage for the surviving spouse can continue by paying the full premium.

Factors that may affect your subsidy

Answer these guiding questions to learn more about how your insurance subsidy is calculated.

  1. Did you initiate a service credit purchase on or after July 1, 2008?

    Yes. If your answer is "Yes", your premium subsidy will be delayed if the service credit purchase allows you to qualify for your pension earlier than if you did not make the purchase. Here are some examples of delayed subsidy situations.

    If a delayed subsidy applies, your subsidy will begin at age 60 or the age you would have been eligible to retire if you had not made the service credit purchase, whichever happens first. You can still enroll in the health, prescription drug, dental, and vision insurance before your subsidy is available; however, you will have to pay the entire premium until the subsidy begins.

    If you have a delayed subsidy, you're enrolled in insurances before your subsidy effective date, and you're paying the entire premium, ORS will automatically reduce your insurance premium on your subsidy effective date.

    A delayed premium subsidy does not apply if you become eligible for a pension under a duty or nonduty related death or disability provision.
    (Continue to #2)

    No. If your answer is "No", you can skip to #2. The delayed insurance subsidy does NOT apply.

    View this short e-learning module to learn more about qualifying for your pension and Premium Subsidy. 

  2. When did you first begin working for a Michigan public school reporting unit?

    Before July 1, 2008

    On or after July 1, 2008