Planning for Your Insurance Needs at Retirement
Continuing Health, Dental, Life, and/or Vision Coverage

What is Your Status?

• Vested – You worked long enough to keep benefits and you contributed to a retirement system, but you are not ready to retire (leave active employment) or draw retirement benefits.
• Non-Vest – You worked long enough to keep benefits, but you did not contribute to a retirement system.
• Retire – You worked long enough to retire (leave active employment), keep benefits, and draw a retirement check.
• Defer – You are retiring or vesting and you elect to transfer your medical, dental, and/or vision insurance to your spouse’s current insurance through the Office of Management and Enterprise Services Employees Group Insurance Division (EGID).
• COBRA – You are not eligible to vest or retire, but you are eligible to continue coverage after leaving employment under the Consolidated Omnibus Budget Reconciliation Act (COBRA). You can continue health, dental, and/or vision coverage for up to 18 months if you lose coverage because of a reduction in hours of employment or your employment is terminated for reasons other than gross misconduct.

Years of Service Needed to Continue Benefits at Retirement

• • Teachers’ Retirement System (TRS): 10 years of eligible service to retire or vest.
  • Oklahoma Public Employees Retirement System (OPERS): 8 years of eligible service to retire or vest.
  • Other Retirement System: Employment years may qualify as eligible service to retire or vest. Please contact your retirement system directly for more information.

You Can Begin, Continue, or Drop Coverage When Leaving Active Employment

Keep all the coverage you think you will need in retirement. You can drop or reduce benefits later, but you cannot add health, dental, or life insurance after you leave active employment.

OSEEGIB Rule 360:10-3-20 states that you must return to work for an OSEEGIB participating employer for three years in order to qualify to retain benefits not previously elected upon ceasing current employment.

If your employer offers these benefits through OSEEGIB, the following rules apply:

• Health Insurance – You can begin, continue, or drop coverage within 30 days of leaving active employment.
• Dental Insurance – You can begin, continue, or drop coverage within 30 days of leaving active employment.
• Vision Insurance – You can begin, continue, or drop coverage within 30 days of leaving active employment or during the annual Option Period. Note: Vision insurance is the only benefit that can be added during the annual Option Period.
• Life Insurance – Life coverage must be in effect before you leave active employment. You can reduce or drop life coverage within 30 days of leaving active employment; however, you cannot add life insurance at retirement. Life insurance continued at retirement does not include Accidental Death and Dismemberment benefits.

Plan Changes are not Allowed at Retirement

Retirement is not a qualifying event that allows you to make plan changes; however, you can change plans during the annual Option Period.

The Enrollment Process

You must complete the Application for Retiree/Vested/Non-Vest/Defer Insurance Coverage which is included in this packet. Be sure to sign your application and mail it to EGID at least 30 days before the date you leave active employment.

If you are not eligible for Medicare:

You can continue your current coverage, add coverage, or drop coverage. For example, you can choose to continue your health coverage, add vision coverage, or drop your dental coverage.

If you are Medicare eligible:

You must enroll in a Medicare supplement plan with Part D benefits or a Medicare Advantage Prescription Drug plan for your health coverage.

1. To enroll in one of the Medicare supplement plans with Part D prescription drug benefits, either HealthChoice Employer PDP Medicare Supplement Plan With Part D or UnitedHealthcare Senior Supplement Plan, you must complete and return the Application for Medicare Supplement With Part D which is included in the packet. Be sure to return your completed application at least 30 days before you leave active employment.
2. To enroll in one of the Medicare Advantage Prescription Drug Plans (MA-PD), CommunityCare Senior, Generations Healthcare, or UnitedHealthcare Group Medicare Advantage Plan, you must complete a separate enrollment form. Contact the plan directly to request an enrollment form. You must return your completed form to the plan at least 30 days before you leave active employment.

Enrollment Deadline

EGID Rules state that you have 30 days from the date you leave active employment to elect to continue your insurance.

If you do not elect to add or continue coverage within 30 days of leaving active employment, your eligibility in the plans offered through EGID is cancelled.

Return Your Application Before Leaving Active Employment

If you are Medicare eligible:

It is critical that your application is received the month before you leave active employment. If your application is not received before your employment termination date and you are enrolled in a HealthChoice plan, you will be enrolled in one of the HealthChoice Medicare Supplement Plans Without Part D until the first of the following month*. While the plans With and Without Part D provide identical coverage, the premiums for the plans Without Part D are higher. You must pay the higher premium for one month before you can be changed to a plan With Part D. See Medicare Advantage Prescription Drug Plans later in this packet.

*Please note: This action is taken so you do not experience a break in prescription drug coverage and become subject to a late enrollment penalty.

Defer (Transfer) Your Coverage to Your Spouse’s Plan

If your spouse works and they are currently enrolled in coverage through EGID, you can defer, or transfer, your health, dental, and/or vision coverage to your spouse’s coverage as a dependent.

Life insurance cannot be deferred and must be kept in your retirement account.

To transfer your coverage to your spouse’s plan:

1. Mark “defer” on your Application for Retiree/Vested/Non-Vest/Defer Insurance Coverage.
2. Your spouse MUST contact their employer to add you to their coverage as a dependent.
3. Any retirement system contribution paid toward your health insurance premium will not be paid during the deferral period.

As long as your former employer group continues to participate with EGID, you can transfer your coverage back to your own account at any time by completing a new Application for Retiree/Vested/Non-Vest/Defer Insurance Coverage.

Coverage for Your Dependents

You can elect to begin or continue coverage for your spouse or other eligible dependents at retirement.

You can also exclude your spouse. Your spouse must sign the Spouse Exclusion Certification section of your Application for Retiree/Vested/Non-Vest/Defer Insurance Coverage.

If you elect to continue coverage for your eligible dependent children, all of your eligible dependents up to age 26 must be covered; however, you can elect to exclude dependents from coverage if they have other group coverage or are eligible for Indian or military health benefits. You can also exclude eligible dependents who do not reside with you, are married, or are not financially dependent on you for support.

You cannot add dependents after retirement unless one of the following qualifying events occurs:

• Birth of a child
• Your spouse or dependents under age 26 lose other group coverage
• You marry
• You adopt or gain legal guardianship of a child (under age 26)

A new spouse and any eligible dependents must be added within 30 days of the date of the qualifying event.

A spouse or other dependents can never be added at a later date unless a qualifying event occurs.

Life Insurance

You can keep all or part of the life insurance you carried while you were a current employee. Life insurance must be kept in $5,000 units.

• Premium – $1.88 per $1,000 of coverage, up to $40,000.
• Coverage amounts over $40,000 – Premiums are age-rated. For age-rated life premiums, see the premium rate charts included in this packet.

Dependent Life

You can keep any life insurance in force on eligible dependents at your retirement. Dependent Life must be kept in $500 units. Premiums are per dependent and are $0.94 per $500 unit of coverage.

• For your spouse  – You can keep any amount of the coverage that was in effect prior to your termination date.
• For your dependents – The amount you keep must be the same for each covered dependent

Life Insurance Beneficiaries

If you choose to keep life insurance at retirement, it’s a good idea to complete a new Beneficiary Designation Form at the same time you complete your retirement insurance application. It is very important that you keep your beneficiary information current.

You can request a beneficiary change at any time by completing a new Beneficiary Designation Form and returning it to HealthChoice. This form is included in the packet and is also available on this website.

Please complete a new Beneficiary Designation Form* when:  

• • A beneficiary changes their name
  • A beneficiary changes their address
  • A beneficiary pre-deceases you

*Please note: This beneficiary form is for HealthChoice Life Insurance only. It will not affect the beneficiary designation you may have made for any other life policy, or any death benefits you may have through your retirement system.

In the Event of Your Death

Your surviving spouse and eligible dependents have 60 days following your death to notify EGID they wish to continue health, dental, life, and/or vision insurance coverage.

Your surviving spouse can continue insurance coverage as long as premiums are paid. A surviving spouse pays the primary member rate and there is no retirement system contribution paid toward their premium.

Your surviving dependent children can continue coverage until they reach age 26.

Surviving dependent children who elect self-coverage will be set up as a primary member, but will continue to pay the child premium rate.

Medicare Coverage

You should be notified by the Social Security Administration when you are eligible for Medicare Part A and Part B.

• Medicare Part A pays for hospital services. Typically, this coverage is free.
• Medicare Part B pays for doctor and outpatient medical services. Call Social Security for information on your Part B premiums. See the Contact Information section page.
• Medicare Part D pays for prescription drug coverage. All the plans offered through EGID provide Part D prescription drug coverage or creditable prescription drug coverage. This means the plans all meet the benefit guidelines set by Medicare.

Enrollment in Medicare

Enrollment in Medicare is handled in two ways. You are either automatically enrolled or you must apply.

If you are a disabled beneficiary under Social Security or Railroad Retirement prior to turning age 65, you are automatically enrolled, and your Medicare ID card will be mailed to you about three months before your Medicare eligibility date.

If you are not already enrolled in Medicare, you must apply. Contact the Social Security Administration, or if appropriate, the Railroad Retirement Board for more information. You should apply three months before your 65th birthday to avoid a possible delay in the start of your coverage.

Always notify EGID in the event you become Medicare eligible due to a disability.

All the Medicare supplement plans offered through EGID pay benefits as if you are enrolled in both Medicare Part A and Part B.

Delaying Medicare Part B and Medicare Part D Coverage

Medicare Part B

If you work past age 65 and choose to delay your enrollment in Medicare Part B, contact Social Security to make arrangements.

Medicare Part D Late Enrollment Penalty

If you choose to work past age 65 and delay your enrollment in Medicare Part D, you will not have to pay a Medicare late enrollment penalty if you are enrolled in a health plan through EGID since all plans provide creditable prescription drug coverage.

Medicare Supplement Plans Offered Through EGID

HealthChoice High and Low Option Medicare Supplement Plans With and Without Part D

The HealthChoice Plans provide supplemental benefits for Medicare Parts A and B covered services, as well as Part D prescription drug benefits.

UnitedHealthcare Senior Supplement Plans High and Low Option

The UnitedHealthcare Plans provide supplemental benefits to Medicare Parts A and B covered services, as well as Medicare Part D prescription drug benefits.

Medicare Advantage Prescription Drug (MA-PD) Plans

You must be enrolled in Medicare Parts A and B to be eligible for enrollment. When you enroll in a Medicare Advantage Prescription Drug (MA-PD) plan, the plan replaces Medicare as your primary insurer.

The plans provide benefits for Medicare Part A and B covered services, as well as Part D prescription drug benefits.

You must live in the MA-PD plan’s approved ZIP Code service area to be eligible to enroll in an MA-PD plan.

MA-PD Plan offerings for 2012 include:  

• CommunityCare Senior Health Plan
• Generations Healthcare by GlobalHealth
• UnitedHealthcare Group Medicare Advantage

If you want to enroll in an MA-PD plan, you must contact the plan directly to request an enrollment form and also notify EGID.

Your Medicare ID Number

When you complete the Application for Retiree/Vested/Non-Vest/Defer Insurance Coverage, be sure to fill in your Medicare ID number (HICN). HealthChoice must have your Medicare ID number in order to coordinate your benefits with Medicare.

Moving Outside a Plan’s Service Area

If you are not eligible for Medicare:

If you are enrolled in an HMO plan and move outside your plan’s ZIP Code service area, you must notify EGID in writing of your new address. Your health coverage will be changed to the HealthChoice High Plan.

The HealthChoice USA Plan is an option if you move outside of Oklahoma and Arkansas. You must enroll within 30 days of your move or wait until the next annual Option Period.

To enroll in the HealthChoice USA Plan, send a written request to EGID and include your new address.

If you are eligible for Medicare:

If you are enrolled in an MA-PD plan and move outside your plan’s ZIP Code service area, you must contact both EGID and the MA-PD plan to disenroll. Your coverage will be changed to the HealthChoice Medicare Supplement Plan Without Part D.

To change your coverage to a plan that includes Part D prescription drug benefits, you must also complete the proper application.

Your coverage will be effective the first of the month following receipt of your form.

Plan Premiums

See the premium charts in the packet.

Three Premium Payment Options

1. Retirement check – Monthly premiums are automatically deducted from your retirement check.
2. Direct bill – You are billed directly for your monthly premium, and your premium is due on the 20th of each month.
3. Automatic draft – Your monthly premium is automatically drafted from your checking account on or around the 20th of each month. If you elect this option, provide EGID with an Electronic Fund Transfer Authorization Form and a voided check. This form is available on the EGID website or contact Member Services. See the Contact Information section included in this packet.

Retirement System Contribution to Your Monthly Insurance Premium

• OPERS – $105 monthly
• TRS – $100 to $105 monthly

HealthChoice ID Cards

Members have two ID cards, one card for health and/or dental benefits, and one for pharmacy benefits.

• Pre-Medicare retirees should keep their current ID cards. New cards are not issued.
• Medicare eligible members should keep their current health ID card, but new pharmacy ID cards are issued.

HMO and MA-PD Plans ID Cards

HMOs and MA-PD plans generally issue new ID cards. Do not destroy your current cards until you receive your new ones.

Address Information

It’s important for you to keep your address information up-to-date. You run the risk of delaying claims processing or missing important communications when there is incorrect information in our files.

Medicare requires that any change in your home address be reported to your insurance plan.

Option Period

After you leave active employment, your Option Period materials will be mailed directly to you. To make plan changes, complete your enrollment form and return it directly to EGID.

For more information about plan benefits, please contact each plan directly or visit their website.