Frequently Asked Questions

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Will the state pay for my health insurance coverage after I retire?

When you retire under the Teachers' and State Employees' Retirement System (TSERS), you are eligible for coverage under the State Health Plan if you have at least five years of retirement membership service earned as a teacher or state employee. (Credit for unused sick leave or credit transferred from the Local Governmental Employees’ Retirement System does not count toward this five-year requirement.)

Under current law, if you were first hired prior to 10/1/06, and retire with five or more years of TSERS membership service, the State will pay for your individual coverage under one of the Preferred Provider Organization (PPO) plans. Based on the conditions described above, if you were first hired on or after 10/1/06, in order to receive individual coverage at no cost, you must retire with 20 or more years of retirement service credit; if you have 10 but less than 20 years of retirement service credit, you will have to pay 50% of the cost for your coverage, and with five but less than 10 years, you will have to pay the full cost for your coverage. In all cases, the full cost of dependent coverage, if elected, must be paid by you.

The Guidance on State Health Plan Changes Effective October 2006 goes into greater detail about this question.

May I continue to cover my spouse as a dependent on my health insurance policy?

Yes. Dependent coverage is available provided you pay the appropriate cost. In the event of your death, your surviving spouse and/or dependent children may continue coverage by paying the appropriate cost of the coverage, provided you are covering your spouse as a dependent at the time of your death. The surviving spouse and/or dependent children will be contacted by the State Health Plan for enrollment for full contributory coverage as a survivor's benefit, should they choose to continue coverage.

Must I complete an application form for health insurance coverage when I apply for retirement even though I have been covered and am not changing insurance carriers?

Yes. Changing your coverage from the active group to the retiree group is not automatic. You must complete an health coverage form (Form HM) to enroll in the retired group. Also, please note that the retiree group coverage begins on the first day of the month following the effective date of retirement. For example, if your effective date of retirement is January 1, 2008, your retiree group health coverage will begin on February 1, 2008. If you work through the end of the month prior to your effective date of retirement, generally your employer will pay (under current law) for your individual coverage during your first month of retirement.

Why should I elect Part B of Medicare?

As a retiree, when you or a covered dependent become eligible for Medicare, both parts A and B must be elected in order to maintain the same level of coverage you had before becoming Medicare eligible.

I am having difficulty getting my health insurance carrier to pay some of my medical bills.  Can the Retirement System help me with this problem?

Although the Retirement Systems Division has been designated as the Health Benefits Representative (HBR) for retired teachers and state employees, our duties do not include claims processing or appeals. As the HBR, the Retirement Systems Division is responsible for processing the enrollment forms of new retirees, reporting type-of-contract changes, determining premium amounts, making premium deductions from retirement benefits checks, reconciling group billings, and remitting premiums to the claims processing contractor. Claims disputes should be resolved in accordance with the procedures outlined in the booklet provided by the claims processing contractor.

The 1997 session of the General Assembly created a long-term care program for retired employees who receive monthly benefits from the Teachers' and State Employees' Retirement System and the Local Governmental Employees' Retirement System. Can you give me information about this plan?

This program is administered by the State Health Plan. Information about this program is available through the State Health Plan, the coverage provider, and the Retired Governmental Employees’ Association.