Eligibility and Enrollment

Continuing Group Health Coverage

Detailed information on the rules to continue health insurance as a retiree can be found in the 2026 State Medical Plan Document. This document is available on the publications webpage of the Benefits Administration website located here: www.tn.gov/ partnersforhealth/publications/publications.

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 cancelled.

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 the State of Tennessee, University of Tennessee, other State of Tennessee Public Institutions of Higher Education. any agency of the State of Tennessee, which is authorized by statute to participate in the plan or a participating local education agency 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 one of those employers for the first time before July 1, 2015, you will not be prohibited from continuing or enrolling in insurance at retirement, provided 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 of 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 of employment for retirement. The period of time between your final termination date and he 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. If combining service to include local education employment, 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 Coverage 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 are enrolled in the CDHP/HSA plan , you will not be eligible for new seed money at retirement. You will be able to make changes to your insurance during the annual enrollment period each fall.

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.

If your initial date of employment with the state or other qualifying employer is prior to July 1, 2015, you may be eligible for the state’s Supplemental Medical Insurance for Retirees with Medicare program called The Tennessee Plan.

 

Application for The Tennessee Plan Coverage

Higher Education Optional Retirement Plan employees who are eligible for Medicare at retirement can select The Tennessee Plan coverage on the application to continue insurance at retirement.

The Tennessee Plan is a supplemental medical insurance program designed to cover certain expenses not fully paid by your Medicare parts A and B coverage. It does not cover prescription drugs. If you participate in The Tennessee Plan, you will need a separate Part D plan for your prescription drug needs. The Tennessee Plan will not coordinate benefits if you are currently enrolled in or join a Medicare Advantage plan. This means if you have a Medicare Advantage plan, The Tennessee Plan will not pay out any benefits.

If you are enrolled in at least Medicare Part A at retirement, you can select The Tennessee Plan coverage on the Application to Continue Insurance at Retirement. You may also apply to cover your dependents who are eligible for Medicare when you enroll in The Tennessee Plan.  You have 60 days from the initial eligibility date to enroll. If you qualify and enroll within 60 days of initial eligibility, you cannot be turned down for coverage due to age or health. The initial eligibility date is the date active state group health coverage ends or the date of Medicare eligibility, whichever is later.

Coverage is effective the first of the month following the end of your active insurance coverage or the date of your Medicare entitlement, whichever is later.  If the date of retirement is the later date and falls on the first of the month, your coverage may be effective on that date.

If you become eligible for Medicare due to age after retirement and you are covered on the state retiree group health plan, you will be sent an application approximately three months before your 65th birthday. The application must be submitted within 60 days of Medicare eligibility. Coverage will become effective on your date of Medicare entitlement provided the application is received timely. If you enroll in The Tennessee Plan and your spouse becomes entitled to Medicare at a later date, you have 60 days from the date of your spouse’s eligibility to apply to add him or her to coverage.

If enrollment is not selected within 60 days of initial eligibility, you and your eligible dependent may apply through medical underwriting. Enrollment is subject to approval and may be denied. Benefits Administration will submit the application for review to the vendor. You must be enrolled in The Tennessee Plan to cover a dependent.

Once approved, you will receive an ID card from the vendor. It will show your name and identification number. If you are not satisfied with The Tennessee Plan, you can cancel it within 30 days after receipt. You will receive a refund of premiums paid in advance. Any claims paid during this period will be recovered.

 

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, 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

If you are an ORP participant, you may also choose to enroll in retiree dental coverage if hired prior to July 1, 2015. Just select dental on your application to continue insurance at retirement. If you do not select dental coverage at retirement, you can enroll during the annual enrollment period. Dependent-only coverage is not available.

 

Vision Coverage

Continuation of vision insurance is NOT automatic at retirement.  If you are enrolled in the state-sponsored vision plan, 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 are an ORP retiree, you are eligible for retiree vision coverage if hired prior to July 1, 2015. If you do not select vision coverage at retirement, you can enroll during the annual enrollment period. You may also cover dependents.