Human Resource Services
Benefits - Retiree Health Insurance FAQ
When do I become eligible for Retirees’ Health Insurance?
If you are a participant with the State Retirement System, you are eligible for Retirees’ Health Insurance coverage beginning on your retirement date if you contributed to the Retirement System for at least five years while actively employed.
If you are an ORP participant, please remember that you must be receiving annuity payments to be eligible for health insurance coverage. Please contact your annuity representative to find out the minimum amount you will be required to annuitize.
When do I apply for Retirees’ Health Insurance Coverage?
The State Retirement System will send you your application for health insurance after they have received your Application for Retirement (Form 6).
Will the State pay for my health insurance coverage after I retire?
When you retire, you are eligible for coverage under the State Health Plan if you have at least 5 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 5-year requirement.)
Under current law, if you were first hired prior to 10/1/06, and retire with 5 or more years of State System membership service, the State will pay either all or most of the cost, depending on the plan chosen, 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 5 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.
When do I become eligible for Medicare?
You become eligible for Medicare parts A and B when you reach age 65; however, participation is not automatic unless you are receiving Social Security benefits. You must contact the Social Security Administration to ensure that you are covered when you become eligible. In order to avoid late enrollment penalties, you should contact the Social Security Administration at 800-772-1213 about three months prior to your retirement date. Medicare Part A is free; Part B premiums for 2008 are $96.40 per month.
Will I need both Medicare Part A and Part B coverage?
In order to maintain your current level of coverage, you will need both Part A and Part B when you retire. The reason for this is that as soon as you become eligible for Medicare, it will become your primary coverage. The State Health Plan will therefore become your secondary coverage. As your secondary carrier, the State Health Plan will make its payments assuming that you have elected both Medicare Parts A and B, even if you have not. For further information, contact the Seniors’ Health Insurance Information Program in Greensboro at 373-4816; High Point 884-4816 (ask for SHIP help).
Can I cover my spouse by my State-sponsored Health Plan when I retire?
Yes, your spouse and children under age 19 (or age 26 if still full-time students) are eligible for dependent coverage under your plan at an additional premium. You must add your spouse and any other dependents to your health insurance plan when you complete your retirement forms. If you do not, you will need to wait until the next annual enrollment period to add them (unless they experience a loss of their existing coverage), at which time they may be subject to a 12-month waiting period for pre-existing conditions.
Anyone covered by your plan will enjoy rights to survivorship should you precede them in death. This means that if you die, your eligible dependents may continue their coverage through the State at their own cost at the rate for a same-age single person for the rest of their lives.
How much will it cost to cover my spouse after retirement?
The answer to this question depends on the age of your spouse: if he or she is 65 or older (or meets the Social Security definition of “disabled”), then he or she is eligible for Medicare Parts A and B. Since Medicare is the primary coverage for anyone who is eligible, you will pay lower rates to cover a Medicare-eligible spouse. If your spouse is not eligible for Medicare, you will continue to pay the full rates as you did when you were actively employed.
Can I make changes to my coverage as a retiree?
As a member of the retired group, you will receive annual enrollment materials every August just as active employees do. At that time, you may change plans or levels of coverage without penalty. Further, if you select an HMO, but decide to move out of the service area, you will be allowed to switch your coverage to the State Health Plan.
For further information and current rates for coverage, please consult the It’s Your Choice booklet published by the State. Booklets can be obtained by calling the UNCG Benefits Office at 334-5009.
Who can I call for further assistance?
The North Carolina Department of Insurance has established an agency dedicated to helping seniors get all the facts to make the right health insurance decisions and to get the insurance they need without overspending or duplicating coverages. Please contact the Seniors’ Health Insurance Information Program (SHIIP) for free assistance in Greensboro at 373-4816; High Point 884-4816 (ask for SHIP help).
