Coverage for an employee who has already retired will terminate at the end of the calendar month in which the retiree elects no longer to participate, provided that the retired employee has experienced a qualifying event that allows such termination. In the absence of a qualifying event, coverage cannot be terminated until the next Open Enrollment period.
For retiring employees, coverage will terminate at the end of the month in which the employee ceases active employment, unless forms have been completed to continue coverage. If you are not yet eligible for Medicare, then your retirement does not qualify you to change health care plans. If you are enrolled in a managed care plan as an active employee, then you must remain in that managed care plan upon retirement until the next open enrollment, when you may choose any plan for which you are eligible. If Medicare becomes the primary coverage for you or your dependents while enrolled in a managed care plan, you must transfer to PEIA’s Medicare Advantage plan or the Special Medicare Plan.
For Direct Pay Non-Medicare Retired Employees
If payment is not received by June 5, a late notice will be sent to the policyholder. If payment is not received by PEIA within 30 days following the due date, a termination notice containing the termination date will be mailed to the policyholder. All claims incurred following the termination date will be the policyholder’s personal responsibility. The policyholder has the right to appeal the termination in writing within 60 days following the termination date. If the terminated policyholder appeals the termination in writing within 60 days from the date of termination, he or she may pay the past-due premiums, apply to pay premiums by direct draft from a bank account, and may be granted uninterrupted coverage at PEIA’s discretion.
If the terminated policyholder appeals the termination in writing more than 60 days following the date of termination, PEIA may only allow re-enrollment during the open enrollment period, and only if the policyholder enrolls as a new enrollee and agrees to pay premiums by direct draft from a bank account. In no event will an appeal and re-instatement due to termination for failure to pay occur more than once in a 12-month period.
At PEIA’s discretion, a policyholder who has been terminated for failure to pay may revoke the right to ever re-enroll with PEIA. In this case, the policyholder will be required to reimburse PEIA for the claim costs incurred by plan after last premium payment as a final settlement of the debt. The policyholder will be required to sign an agreement accepting the settlement arrangement and permanently revoking the right to re-enroll in the PEIA plan.
If extenuating circumstances prevent the policyholder from appealing within 60 days of the termination, the policyholder may appeal for and the PEIA director may grant, at his or her discretion, a waiver of the 60-day requirement.
Extending Employer-Paid Insurance Upon Retirement
You may be eligible to extend your employer-paid insurance upon retirement, but how you do that depends upon your employer. To take advantage of this benefit, you must move directly from active public employment into your respective retirement system. If you choose to defer your retirement, you cannot defer your sick and annual leave for use later. Elected public officials are not eligible for this benefit. This benefit terminates when the policyholder dies; it cannot be used by surviving dependents, who may continue coverage by paying the monthly premium.
You may also have the option to use your accrued leave to increase your retirement benefits from your retirement system. You must choose between additional retirement benefits and extended employer-paid insurance coverage. You may not use some of your accrued leave to increase your retirement benefit and the rest to extend your employer-paid insurance coverage. Once this election is made, you may not revoke the selection.
Using Accrued Sick and Annual Leave to Extend Coverage
If you are an employee of a State agency or a county board of education (or an eligible employee of a local agency) with coverage through a PEIA plan and have accrued sick and/or annual leave when you retire, you may use that accrued leave to extend your employer-paid insurance coverage. You must be enrolled in a PEIA plan or a PEIA-sponsored managed care plan or a group life insurance plan offered by PEIA prior to your retirement to qualify. This extended coverage must be for full months. Employees hired on or after July 1, 2001, are not eligible for this benefit.
If the policyholder dies, the accrued leave benefit terminates, even if the surviving dependent continues coverage.
If you and your spouse are both public employees eligible for extended employer-paid insurance coverage, you may combine your accrued leave to extend your family coverage provided each of your respective employers agrees. Certain restrictions apply. See your benefit coordinator for details.
The amount of this benefit depends on when you came into the PEIA plan as follows:
Before July 1, 1988
If you are an employee who has been continuously covered by PEIA since before July 1, 1988, then your additional coverage is calculated as follows:
Between July 1, 1988 and June 30, 2001
- 2 days of accrued leave = 100% of the premium for one month of single coverage
- 3 days of accrued leave = 100% of the premium for one month of family coverage
If you were hired after July 1, 1988 and before July 1, 2001, or if you had a lapse in coverage during this period then your additional coverage is calculated as follows:
On or After July 1, 2001
- 2 days of accrued leave = 50% of the premium for one month of single coverage
- 3 days of accrued leave = 50% of the premium for one month of family coverage
If you were hired on or after July 1, 2001, or if you had a lapse in coverage during this period, you are not eligible for extended employer-paid insurance upon retirement.
Extending Coverage for Higher Education Faculty
If you are a full-time faculty member employed on an annual contract basis for a period other than 12 months, you may extend your employer-paid insurance coverage based on your years of teaching service. Your benefit is calculated as follows:
- 3 1/3 years of teaching service = 1 year of single coverage
- 5 years of teaching service = 1 year of family coverage
This benefit is not available to faculty hired on or after July 1, 2009.