• Eligibility to continue coverage.• Retirement terms.• Premium payment options. • Continuing insurance when leaving active employment.• Dependent coverage.• Working past 65.• Deferring coverage.• Medicare eligibility.• Decreasing/dropping coverage.• Additional information. • Retiree checklist.
Eligibility to continue coverage
Eligibility to continue coverage through EGID as a former employee is defined by Oklahoma statutes, and certain requirements must be met, including:
- The employer must continue to participate in the plans offered through EGID.
- The employee must have the required years of creditable service to continue coverage.
The minimum years of creditable service required to continue coverage as a former employee:
- Teachers’ Retirement System – Education employees need 10 years of service.
- Oklahoma Public Employees Retirement System – State and local government employees need eight years of service.
- Oklahoma Law Enforcement Retirement System – Law enforcement employees need eight years of service.
- Other or no retirement system – Employment years may qualify as creditable service to continue coverage.
Employees can continue coverage under one of the following former employee status categories:
- Retiree – An employee who has worked long enough to retire, draw a retirement check and keep insurance benefits.
- Vested – An employee who has worked long enough to keep benefits and has contributed to a retirement system, but is not ready to draw a retirement check.
- Non-vested – An employee who has worked long enough to keep benefits, but did not contribute to a retirement system that participates with EGID, or has withdrawn all retirement contributions and no longer qualifies for retiree or vested status.
- Defer – A retiree or vested employee who chooses to transfer health, dental and/or vision coverage to their spouse’s account through EGID. Life insurance must be kept in the member’s account; it cannot be deferred to a spouse’s account.
Discourage employees who qualify for any of the above status categories from electing COBRA, which is temporary coverage. If the employee elects COBRA, coverage through EGID ends at the same time their COBRA continuation period ends.
NOTE: There is no individual conversion COBRA option through EGID.
Premium payment options
- Retirement check deduction – Monthly premiums are automatically deducted from the member’s retirement check.
- Direct bill – Monthly premiums are billed directly to the member.
- Automatic draft – Monthly premiums are automatically drafted from the member’s checking account.
To elect either the retirement check deduction or direct bill option, the employee must check the appropriate box in the Certification Signatures section of the retirement application.
If the employee wants automatic draft, they must elect the direct bill option and complete an Electronic Fund Transfer Authorization form.
Regardless of the payment option selected, any retirement system contribution toward health insurance premiums applies.
Continuing insurance when leaving active employment
An employee with the required years of creditable service can add, keep, drop or defer the health, dental and vision coverage offered by their employer within 30 days of active coverage ending. Life insurance must be in effect 30 days before the employee leaves active employment. Life insurance cannot be added or increased at retirement; however, it can be reduced or dropped during the annual Option Period. Retirement is not a qualifying event that allows an individual to make health plan changes unless the member or covered dependent is Medicare eligible. All covered dependents must enroll in the same plan. If the member moves out of the health plan’s service area, they are allowed to change health plans within 30 days of their move.
An employee can elect to add, keep or drop coverage for their spouse and other eligible dependents within 30 days of termination of employment.
If an employee elects to continue coverage for their eligible dependent children, all eligible dependents up to age 26 must be covered. The employee can exclude dependents from the relative coverage if the dependents have other health coverage or other group dental, vision or life coverage or are eligible for Indian or military benefits. An employee can also exclude dependents who do not reside with them, are married or are not financially dependent on them for support.
An employee can exclude a spouse while covering other dependents. The spouse must sign the Spouse Exclusion Certification on the Application for Retiree/Vested/Non-Vested/Defer Insurance Coverage.
A new spouse or dependent child can be added within 30 days of one of the following qualifying events:
- Birth of a child.
- The member’s spouse or dependents under age 26 lose other health or group dental, vision or life coverage.
- The member marries.
- The member adopts or gains legal guardianship of a child under age 26.
Working past 65
- If an employee works past age 65, they may contact Social Security to delay enrollment in Medicare Part B. Their employer insurance will be primary payer while working. Since all insurance offered through EGID is creditable coverage, they will not be assessed a penalty once employer insurance ends.
- If an employee’s spouse works for an EGID participating employer and carries coverage through EGID, the employee can defer (transfer) their health, dental and/or vision coverage to the spouse’s account as a dependent. The spouse must complete an Insurance Change Form through their employer to add the employee to their account.
- An employee cannot defer life insurance; it must be carried in their own member account.
- The former employee can transfer to retiree status when their spouse retires, with another qualifying event, during the annual Option Period, or when they become eligible for Medicare. Coverage through EGID must be continuous. The former employee must complete another Application for Retiree/Vested/Non-Vested/Defer Insurance Coverage. If they are eligible for Medicare, they must also complete either the Application for Medicare Supplement With Prescription Drug Plan or Application for Medicare Advantage Prescription Drug (MAPD) Plan.
If an employee or their covered dependents are Medicare eligible, an additional form is required based on the plan chosen.
NOTE: Health plan changes can be made at retirement if the employee or the covered dependent is Medicare eligible.
If the application is not received prior to the effective date, the former employee or covered dependent will be enrolled in a Medicare supplement plan without Part D. To prevent late enrollment, EGID requests the application be submitted at least 30 days before active insurance coverage ends.
Former employees who are already drawing Social Security when they become Medicare eligible are automatically enrolled in Part A and Part B. Otherwise, they must contact Social Security before turning 65 to enroll in Part A and Part B.
EGID recommends Medicare-eligible former employees enroll in Medicare Part B. The benefits of all Medicare plans offered through EGID are based on enrollment in Part A and Part B.
About two months before they turn 65, EGID notifies each former employee of their options, including how to enroll in a Medicare supplement or MAPD plan.
If a former employee is under age 65 and becomes Medicare eligible, they must immediately notify EGID. At that time, EGID provides information about how to enroll in a Medicare supplement or MAPD plan.
If an employee chooses to decrease or drop coverage, inform them they cannot regain that coverage in the future. If they drop health coverage, any retirement system contribution paid toward their health insurance premium will be lost.
Pre-retirement insurance seminars
ICs and members are strongly encouraged to attend one of the EGID pre-retirement insurance seminars. Designed to provide important information about insurance in retirement, these seminars are available online or by location throughout Oklahoma. You are encouraged to attend for useful information to assist retirees. You can access the schedule on the EGID website.
Retirement is not a qualifying event that allows the member to make health plan changes unless they or the covered dependent is Medicare eligible. All covered dependents must enroll in the same plan. If the member moves out of their health plan’s service area, they are allowed to change health plans within 30 days of their move.
In the event your employer terminates coverage through EGID, Oklahoma statutes dictate whether a retiree can continue coverage through EGID or must follow your employer to its new insurance carrier.
- Common school or career tech employees who retired before May 1, 1993, can continue coverage with EGID if their former employer elects another insurance carrier. If the retirement date was on or after May 1, 1993, all eligible former employees must follow their former employer to its new insurance carrier.
- County and local government employees who retired before Jan. 1, 2002, can continue coverage with EGID if their former employer elects another insurance carrier. If the retirement date was on or after Jan. 1, 2002, all eligible former employees must follow their former employer to its new insurance carrier.
- Higher education and charter school employees must follow their most recent former employer to its new insurance carrier regardless of the retirement date.
- Groups that joined EGID after the dates listed above must take all retirees with them if they terminate coverage through EGID in the future.
A retiring employee is only eligible to add or continue the benefits that their former employer offered through EGID.
- Have the employee review the information on the Planning for Insurance Needs at Retirement guide on the EGID webpage and encourage them to attend an insurance seminar.
- Confirm the employee has the required number of years of creditable service to continue insurance.
- Give the employee an Application for Retiree/Vested/Non-Vested/Defer Insurance Coverage.
- Inform the employee they can add, keep, drop or defer health, dental and/or vision coverage at retirement (based on benefits available through their employer). Employees cannot change health plans until the next annual Option Period unless they move out of their HMO ZIP code service area or the employee or covered dependent is Medicare eligible.
- Inform the employee of the option to continue life insurance.
- Life insurance cannot be added or increased at retirement.
- Premiums are different for former employees.
- Remind the employee to review their beneficiary information and that a new Beneficiary Designation Form can be completed at any time.
- If the employee is enrolled in HealthChoice, remind them that they must continue to complete the tobacco-free attestation each Option Period until they and their covered dependents are on Medicare.
- If the employee or covered dependents are Medicare eligible and elect to continue health coverage, give each eligible individual an Application for Medicare Supplement with Prescription Drug Plan or Application for Medicare Advantage Prescription Drug (MAPD) Plan as appropriate.
- If the employee or covered dependents have delayed enrollment in Part B, they must call Social Security toll-free at 800-772-1213 to begin Part B coverage.
- Instruct the employee to complete and return all necessary forms to EGID at least 30 days before their active insurance coverage ends. To expedite, fax all forms to Attn: Member Accounts Retirement at 405-717-8939 or 405-717-8942. Confirmation statements are mailed to new retirees electing coverage within seven to 10 days of receipt of completed retirement application. Former employees should contact EGID immediately if a confirmation statement is not received within this time period.
- Inform the employee that you are required by law to send a COBRA packet and to disregard it if they elect to continue coverage as a former employee.