Health Benefit Coverage for Retirees Under TSERS, LRS and CJRS

The information below pertains to members of the Teachers' and State Employees' Retirement System, Legislative Retirement System and Consolidated Judicial Retirement System. For a member of the Legislative Retirement System to be eligible for health benefit coverage, you must have a "first hired" date prior to February 1, 2007, and have five or more years of service. All other eligibility requirements are listed below.

When you retire, you are eligible for State Health Plan retiree group coverage if you contributed to TSERS for at least 5 years (not including credit for unused sick leave or credit transferred from the Local Governmental Employees’ Retirement System) while employed as a teacher or state employee. The cost, if any, is determined by when you began state employment and which health plan option you select. TSERS withdrawn service purchased in TSERS does not count toward the 5-year membership service requirement for eligibility for State Health Plan coverage as a TSERS retiree.

2018 Non-Medicare Plans:

  • 80/20 PPO Plan
  • 70/30 PPO Plan

2018 Medicare-Eligible Plans:

  • UnitedHealthcare Group Medicare Advantage PPO Base Plan
  • UnitedHealthcare Group Medicare Advantage PPO Enhanced Plan
  • 70/30 PPO Plan for Medicare Retirees

As a retiree, when you or covered dependents become eligible for Medicare, you must elect both Part A (Hospital) and B (Medical) in order to maintain the same level of coverage provided before retirement. If awarded Medicare retroactively due to a disability, you should elect to have Medicare Part B to be made retroactively effective and pay any applicable back premiums.

If first hired prior to October 1, 2006:

  • If you were first hired prior to October 1, 2006, and retire with five or more years of TSERS membership service, under current law, the state will pay for your individual coverage under the non-contributory plan (currently 70/30 or Medicare Advantage Base).*

If first hired on or after October 1, 2006:

  • You will need 20 years of retirement service credit in order to have the state-paid health coverage (individual coverage) at retirement under the 70/30 Plan or Medicare Advantage Base Plan*
  • If 5 years but less than 10 years, you will have to pay the full cost for the individual coverage
  • If 10 years but less than 20 years, you will have to pay 50% of the cost for the 70/30 or Medicare Advantage Base Plan individual coverage*

*You can choose one of the other plans offered for an additional cost

All costs for dependent coverage must be paid by you.

For additional information regarding State Health Plan changes for employees first hired on or after October 1, 2006, please see Guidance on State Health Plan Changes for Teachers' and State Employees' Retirement System.

When you retire, your State Health Plan (SHP) coverage will change from the active group to the retiree group. Retiree group coverage begins on the first day of the month following your effective date of retirement. If you are eligible for the Plan's retiree group coverage upon retirement, you will be automatically enrolled into a health plan after you have submitted, and the Retirement System has processed, your Form 6E, Choosing Your Retirement Payment Option. You are encouraged to act quickly in returning your Form 6E.

  • If under 65 (and not Medicare-eligible), you will be automatically enrolled in the health plan you were enrolled in as an active employee along with any covered dependents. If you did not have coverage in the State Health Plan as an active employee, you will be automatically enrolled in the 70/30 PPO Plan retiree-only coverage. You can change your plan or opt out of health coverage up to 30 days after your coverage effective date.
  • If Medicare-eligible and your retirement process is completed 60 days or more prior to your coverage effective date, you will be automatically enrolled into the Group Medicare Advantage Base Plan with UnitedHealthcare. You will have up to 30 days prior to your retiree group health coverage effective date to change plans. If no action is taken, you will remain in your assigned Medicare Advantage Plan until next Open Enrollment. Your non-Medicare eligible dependents will be enrolled into the health plan they were enrolled in while you were an active employee.
  • If Medicare-eligible and your retirement process is completed less than 60 days prior to your coverage effective date, you will be automatically enrolled in the 70/30 PPO Plan, but you will have up to the day before your retiree group health coverage effective date to elect a Medicare Advantage Plan. If you do not elect a Medicare Advantage Plan, you will remain in the 70/30 PPO Plan until next Open Enrollment. Your non-Medicare eligible dependents will be enrolled into the health plan they were enrolled in while you were an active employee.
NOTE: If you do not take action within the specified time period to change coverage, you (and your covered dependents) will remain, unless you drop coverage, in the assigned auto-enrolled retiree group health plan and pay the applicable premiums until the next State Health Plan Open Enrollment (or qualifying event). You do not need a Qualifying Life Event or to be within the Open Enrollment period to drop coverage for yourself and/or your covered dependents.

If you have questions about your options, coverage, and premiums under the State Health Plan, please visit the State Health Plan Web site or contact Customer Service at 855-859-0966.