Long-Term Care Eligibility and Enrollment
- Who may be covered – Eligibility
- Enrolling in coverage
- When coverage starts and ends
- Changing your spouse's coverage
- Decreasing your level of coverage
Enrolling in Coverage
You must apply for this coverage before appointment to your first benefit from any retirement system.
To meet this deadline, your Retiree Health Benefits Enrollment/Waiver form must be postmarked or received by the deadline. If you do not apply for coverage at this time, you waive your right to apply for this coverage at a later date.
You can send in the form seperately, but most often this form is completed as part of the retirement packet.
When Coverage Starts
New benefit recipients who are approved will be covered under this Plan on the date of their appointment to receive retirement, disability, or survivor benefits.
When Coverage Ends
Coverage under the LTC Plan ends at the earliest time one of the following occurs:
Failure to Pay Premium
Coverage ends on the last day of the calendar month in which you pay the required monthly premium. If at any time your benefit check is insufficient to pay the monthly premium, you may pay the premium directly to the claims administrator.
Contact the Division for more information.
A person who pays premiums for this coverage directly to the claims administrator will lose coverage if:
- A premium payment is delinquent by more than 60 days; or
- Premium payments are delinquent twice in any one calendar year by more than 31 days.
If your coverage ends due to failure to pay the premium, coverage may be reinstated back to the date it ended without requiring proof of good health; however, within 5 months of the date coverage ended you or your representative must:
- Provide proof acceptable to the Plan that you suffered a severe cognitive impairment or loss of functional capacity at the time your contribution was due, and
- Must pay all past due premiums.
Termination of Retirement Benefits
Coverage ends on the last day of the calendar month in which you cease to be eligible for a benefit from any of the retirement systems. A retiree whose benefit terminates because they return to employment may pay LTC premiums directly to the claims administrator and will remain covered. When re-retired, you may have LTC coverage only if you have continued the premium payments for you and your spouse during your period of re-employment.
Cancellation of Coverage
You may cancel your participation in the Plan at any time by submitting a signed, written request to the Division. Your premium deductions will be stopped the first of the month following receipt of your request. Your coverage will end on the last day of the month in which the last premium is deducted.
You may not cancel your coverage and retain coverage for your spouse. If you cancel participation, you forfeit all rights to future coverage and you are not eligible to re-enroll.
Your spouse’s coverage will end on the same day your coverage ends, unless you divorce. Coverage for your spouse ends on the date the divorce is final, unless your spouse continues coverage as described below. You must notify the Division of your divorce. Premiums for your spouse will stop only after the Division receives your written notification.
If you have selected coverage for your spouse and you divorce or die (and your spouse is not eligible for a continuing benefit), your spouse may continue coverage by paying the premiums directly to the claims administrator. To continue coverage, your spouse must apply for coverage within 60 days following your death or divorce and pay premiums retroactive to the date coverage ended. Contact the Division for more information.
Changing Your Spouse's Coverage
You may terminate coverage for your spouse at any time. To terminate your spouse’s coverage, submit a written request to the Division.
Your termination of spouse coverage will be effective on the first of the month following receipt of your written request by the Division. Once you terminate your spouse’s coverage, you cannot reinstate it except as described below.
If you choose coverage for yourself only because you are not married when you retire or if you remarry following divorce or the death of your spouse, you may request to cover your new spouse. Your request must be postmarked or received by the Division within 120 days after your marriage. Your new spouse will be required to provide information on his or her health and will be subject to approval or denial by the claims administrator. If your spouse’s coverage is approved, he or she will be covered on the first of the month following the approval assuming the premium is paid.
Decreasing Your Level of Coverage
You may decrease the coverage option for yourself or your spouse at any time before you begin a Covered Program of Care by notifying the Division in writing. For example, you may decrease from the Platinum Option to the Gold Option. Changes in your option are effective on the first of the month following receipt of your written request.
The Bronze Option is closed and may not be selected. You may not increase coverage at any time.