Eligibility And Enrollment

for Non-TCRS Participants

 

Continuing Group Health Coverage

Detailed information on the rules to continue health insurance as a retiree can be found in the 2026 Local Education Medical Plan Document. This document is available on the publications webpage of the Partners for Health website.

To continue health insurance benefits, the agency from which you retire must continue to participate in the state plan. If your former agency leaves the State Group Insurance Program, your and your dependent’s health coverage will be canceled.

If your spouse is an employee enrolled in state group health insurance, you may continue coverage as a dependent on his/her contract instead of choosing retiree coverage. When your spouse ends employment, you may be eligible to apply via the special enrollment provision under your own eligibility as a retiree.

Retiree health coverage is only available to employees hired before July 1, 2015. If you started working for a participating local education agency or the state of Tennessee for the first time on or after July 1, 2015, you are not eligible to continue or enroll in insurance at retirement.  If you started working for the state of Tennessee or a participating local education agency for the first time before July 1, 2015, you will not be prohibited from continuing or enrolling in insurance at retirement, provided you did not accept a lump sum payment from the TCRS before July 1, 2015 and that you satisfy all other eligibility requirements.

 The eligibility guidelines are:

  • Ten years (120 months) of creditable service, must be age 55 at the time employment ends with the participating agency and at least three years of continuous insurance coverage in the plan immediately prior to final termination or employment for retirement. The date retirement insurance benefits start must immediately follow active coverage ending. This requirement for immediate commencement of insurance benefits will be waived if you become insured by a state, local education or local government agency that participates in the State Group Insurance Program.
  • Twenty years (240 months) of creditable service, must be age 55 and have at least one year of continuous insurance coverage in the plan immediately prior to final termination or employment for retirement. The period of time between your final termination date and  the date retiree coverage begins may be up to five years. This requirement for commencement of insurance benefits will be waived if you become insured by a state, local education or local government agency that participates in the State Group Insurance Program with no lapse in coverage.
  • Twenty-five years (300 months) of creditable service and one year of continuous insurance coverage in the plan immediately prior to final termination of employment for retirement. The period of time between your final termination date and commencement of retirement insurance may be up to five years. This requirement for commencement of insurance benefits will be waived if you become insured by a state, local education or local government agency that participates in the State Group Insurance Program with no lapse in coverage.

Creditable Service:

  • You can count employment with the state of Tennessee, a state higher education institution or a local education agency that participates on the state group health plan to calculate total employment.  Unused sick leave may also be counted. Military service that did not interrupt employment, educational leave, leave of absence or service with a local government agency cannot be counted.
  • Only creditable service will count. Years of service applies to the minimum length of service required to continue coverage at retirement. It does not necessarily count toward premium reduction. State premium support is provided on teaching service only.
  •  If you are eligible to combine creditable state and local education service, you will be classified as a retiree under the plan from which you ended employment prior to retirement. 
  • If you are eligible for retiree coverage without combining creditable service under more than one plan, you may choose to be classified as a retiree in the plan in which you first satisfied eligibility criteria, or in the plan from which your employment ended immediately preceding retirement.

 

Application to Continue Group Health Coverage

You must submit an Application to Continue Insurance at Retirement to Benefits Administration within one full calendar month of the end of active insurance. If enrollment is approved, you will continue in the same health insurance option in which you are currently enrolled.

If you have 20 or more years of service and there is an allowed gap between your date of termination and the date insurance benefits start, you must submit the application to Benefits Administration within one full calendar month of meeting conditions to enroll in coverage.

 

Effective Date of Retiree Group Health Coverage

Subject to timely submission of an enrollment application, the effective date of coverage will be the first of the month following attainment of conditions for continuing coverage.

 

Individuals Eligible for Medicare

If you are enrolled in health insurance and meet the service requirements, you may continue coverage at retirement until you become eligible for Medicare due to age. You may also continue coverage on covered dependents until they become eligible for Medicare due to age or no longer qualify as eligible dependents.

You and your dependents who become entitled to Medicare prior to age 65 must enroll in Medicare parts A and B to continue group health coverage until becoming entitled to Medicare due to age, or for covered children, until they turn 26 or meet plan provisions for incapacitated dependents.

Retirees who are Medicare eligible due to age are no longer eligible for the group health plan and are not eligible to apply to cover their dependents on the state group health plan via the special enrollment provision. The Tennessee Plan is not available to you if you are a non-TCRS local government member.

 

End-stage Renal Disease

If you are eligible for Medicare as a result of end-stage renal disease, you may be eligible for extended group health benefits. Contact Benefits Administration for information on the eligibility criteria.

 

Dental Coverage 

Continuation of dental insurance is NOT automatic at retirement.  If you are enrolled in a state-sponsored dental plan, but are not vested in TCRS, you have two options for continuing coverage:

COBRA Dental

You can continue your coverage for 18 months under COBRA. A notice will be mailed to your home once your active coverage ends. The COBRA enrollment form is separate from the Application to Continue Insurance at Retirement. If you choose to continue dental through COBRA, you must submit the enrollment form to Benefits Administration within 60 calendar days after the later of the following dates:

 1. The date after active coverage ends; or 

2. The date notice of a right to elect COBRA continuation coverage is sent. You will be billed directly for the premiums due.

Retiree Dental

You may also choose to enroll in retiree dental coverage. Just select dental on your Application to Continue Insurance at Retirement. To enroll you must have been hired prior to July 1, 2015, be at least age 55 at the time of termination with 10 or more years of service with a participating local education agency or 10 or more years of combined service with a participating LEA and the state.  If you do not select dental coverage at retirement, you can enroll during the annual enrollment period. Dependent-only coverage is not available.   Effective Jan. 1, 2026, and thereafter, eligibility to participate in the state retiree dental plan is only open to retirees of an LEA that is participating in the state dental plan at the time of retirement. If the LEA subsequently terminates participation in the state dental plan, its retirees are no longer eligible to continue retiree dental coverage.

 

Vision Coverage

Continuation of vision insurance is NOT automatic at retirement.  If you are enrolled in the state-sponsored vision plan, but are not vested in TCRS, you have two options for continuing coverage:

COBRA Vision

You can continue your coverage for 18 months under COBRA. A notice will be mailed to your home once your active coverage ends. The COBRA enrollment form is separate from the Application to Continue Insurance at Retirement. If you choose to continue vision through COBRA, you must submit the enrollment form to Benefits Administration within 60 calendar days after the later of the following dates: 

(1) The date after active coverage ends; or

(2) The date notice of a right to elect COBRA continuation coverage is sent. You will be billed directly for the premiums due.

Retiree Vision 

If you were hired prior to July 1, 2015, are at least age 55 at the time of termination with 10 or more years of service with a participating local education agency or 10 or more years of combined service with a participating local education agency and the state.  If you do not select vision coverage at retirement, you can enroll during the annual enrollment period.  Effective Jan. 1, 2026, and thereafter, eligibility to participate in the state retiree vision plan is only open to retirees of an LEA that is participating in the state vision plan at the time of retirement. If the LEA subsequently terminates participation in the state vision plan, its retirees are no longer eligible to continue retiree vision coverage.