Georgia Health Insurance Retirees & Employees Near Retirement

Provisions for Eligible Retirees & Considerations for Employees Near Retirement

Plan Membership
This section includes Plan membership and coordination of benefits information for eligible Retirees, as well as important points to consider if you are near retirement. Effective January 1, 2006, SHBP implemented a new Medicare policy. SHBP will pay primary benefits for non-enrolled Medicare eligible Retirees, as well as Retirees who are not entitled to Medicare because they did not participate in Social Security or pay Medicare taxes.

Eligibility
You may be able to continue Plan coverage if you are enrolled in the Plan when you retire and are immediately eligible to draw a retirement annuity from any of these systems:

• Employee' Retirement System
• Teachers Retirement System
• Public School Employees Retirement System
• Local School System Teachers Retirement Systems
• Fulton County Retirement System (eligible Employees)
• Legislative Retirement System
• Superior Court Judges or District Attorney's Retirement System

Important Note: Individuals who have withdrawn money from their respective retirement system will not be able to continue health coverage as a Retiree. Eligibility for temporary extended coverage under COBRA provisions would apply.

Applying for Coverage Continuation
If you are an eligible Retiree, you must apply for continued coverage for yourself and Covered Dependents within 60 days of the date your active coverage ends. Application can be made on a Retirement/Surviving Spouse Form, available through your personnel/payroll office or by contacting the Plan's eligibility section. Failure to apply timely or make the appropriate premium payments terminates your eligibility for Retiree coverage.

When Coverage Begins
If you are eligible for a monthly annuity at the time you retire, your coverage starts immediately at retirement, provided that you make proper premium payments or have them deducted from your annuity check. Coverage for your Dependents (if you elect to continue Dependent coverage) starts on the same day that your Retiree coverage begins. A change from single to family coverage as a Retiree is allowed only when you have a qualifying event.

When Coverage Ends

For you
Coverage will end when you discontinue coverage or fail to pay premiums on time.

For Your Dependents
Coverage for your Dependents will end when:

• They are no longer eligible
• You change from family to single coverage
• You do not pay premiums on time
• Your coverage as a Participant ends.

Keep in mind that if you drop Dependents from your coverage, you will not be able to enroll them again - unless you have a qualifying event.

Continuing Dependent Coverage at Your Death
In the event of your death, your surviving Spouse or eligible Dependents should contact the applicable retirement system (ERS, TRS, PSERS, etc.) and the Plan as soon as possible. To continue coverage, surviving Spouses or eligible children must complete a Retirement/Surviving Spouse From and send it to the Plan within 31 days of your death.

Plan provisions vary for survivors:
Surviving Spouse receives annuity:

• Plan coverage may continue after your death
• Premiums will be deducted from annuity
• Spouse sends payments directly to Plan if annuity is not large enough to cover premium
• New Dependents or Spouses cannot be added to survivor's coverage

Surviving Spouse does not receive annuity:

• Plan coverage may continue after your death when Spouse was married to you at least one year before death
• Spouse sends payments directly to the Plan
• Coverage ends if surviving Spouse remarries

Surviving Child does not receive annuity and there is no surviving Spouse:

• Plan coverage may continue under COBRA provisions

Making Changes to Your Retiree Coverage
You can make changes to your coverage only at these times:

• When you have a qualifying event
• During the annual Retiree option change period
• You may change your Plan option only
• Adding Dependents is not permitted, unless you have a qualifying event as described in the section below.

Qualifying Events
If you have this event...	You may...
Within 31 days of eligibility for Retiree coverage Annuity no longer covers premium amount Become eligible for Medicare	Change to an available option
Acquire Dependent because of marriage, birth, adoption or Qualified Medical Child Support Order (QMCSO) Within 31 days of loss of a Dependent's health benefit coverage through Spouse's or former Spouse's Medicaid, Medicare, group coverage through active employment or COBRA coverage	Add in your eligible Dependent(s) - Proper documentation is required *Surviving Spouse and Dependents cannot change from single to family coverage
Spouse or enrolled Dependent's employment status changes, affecting coverage eligibility under a qualified health plan	Change coverage tier within 31 days of the qualifying event - proper documentation is required
You and Spouse are both Retirees who both have sufficient benefits from a covered retirement system to have Plan premiums deducted New Dependents or Spouses cannot be added to survivor's coverage	Change at any time from family coverage to each having single coverage; a request to change from family to single for you and the request for single coverage for your Spouse must be filed at the same time

You must request a coverage change within 31 days of the qualifying event by:

• Contacting the Plan directly
• Returning the necessary form(s) with any requested documentation to the Plan by the deadline. Fill out the form(s) completely.

If you miss the deadline, you will not have another chance to make the desired change. If the deadline is met, your change will take effect on the first day of the month following the receipt of your request, unless indicated above.

Changes Permitted Without A Qualifying Event
Retirees may change from family to single coverage, or discontinue coverage at any time by submitting the appropriate Plan form. However, if you change from family to single coverage, you cannot increase your coverage later without a qualifying event. Also, if you discontinued coverage, you may not enroll later.

Important Note On Coverage Changes:
If your current Plan option is not offered in the upcoming Plan year and you do not elect a different option available to you during the Retiree option change period, your coverage will be transferred automatically to the PPO option effective January 1 of the subsequent Plan year.

Retiree Option Change Period
During the 30-day Retiree option change period - generally from mid-October to mid-November each Plan year - you can make these changes to your coverage:

• Select a new coverage option
• Change from family to single coverage
• Discontinue coverage (Note that re-enrollments are not allowed.)

Changes will take effect the following January 1.

Before the Retiree option change period begins, the Plan will send you a Retiree information packet. The packet will include:

• Information on the Plan options
• Steps for notifying the Plan about coverage selections for the new Plan year
• Forms you may need to complete
• Informational resources

To ensure that you receive the information packet, make sure the Plan always has your most up-to-date mailing address.