Enrollment Basics for Health Care, Dental, and Vision Coverage

Enrolling Yourself in Health Care

You are eligible for SERS coverage if you have at least 10 years of qualified service credit. You can enroll in SERS’ coverage:

  • When you retire or begin receiving a disability benefit
  • Within 90 days of becoming eligible for Medicare
  • Within 31 days of involuntary termination of other health care coverage or termination of Medicaid
    • Failing to pay the premium or ending coverage because of plan changes does not count as involuntary termination.

Enrolling Family Members in Health Care

When you enroll in SERS coverage, you may cover your spouse, and children up to age 26, as dependents.

A child includes:

  • A biological, or legally adopted, child, stepchild, or child for whom you have legal custody, who is under age 26
  • A child who is permanently and totally disabled, provided the disability existed prior to the child reaching age 26

If you do not enroll your spouse or children during your initial enrollment period, you can enroll them under the following circumstances:

  • Within 31 days of marriage
  • Within 31 days of the birth or adoption of a child
  • Within 90 days your spouse becoming eligible for Medicare
  • Within 31 days of involuntary termination of other health care coverage or termination of Medicaid
    • Failing to pay the premium or ending coverage because of plan changes does not count as involuntary termination.

For more information about health care eligibility, please refer to the Member Health Care Guide.

 

Coverage Under More Than One Ohio Retirement System

When you retire from SERS, you cannot waive SERS’ health care coverage in order to enroll in coverage through another Ohio public retirement system. Your primary coverage must be through the retirement system from which you retire. This also applies to spouses and dependents.

 

Dental and Vision Enrollment

To sign up for dental and vision coverage, you have to be eligible for, but you do not have to be enrolled in, SERS’ health care coverage. You must be enrolled in dental and/or vision coverage in order to enroll your dependents.

SERS offers coverage through Delta Dental of Ohio and VSP Vision Care.

You can enroll in dental and vision coverage at the following times:

  • When you retire or begin receiving a disability benefit
  • During the annual open enrollment period

Health Care Coverage During Reemployment

If you retire and then go back to work for a public or private employer, you temporarily may lose eligibility for SERS’ health care coverage while you are reemployed. Once reemployment ends, your eligibility is restored.

Individuals affected are those:

  • Under age 65 not yet eligible for Medicare
  • Eligible for Medicare but not enrolled in Part B

Individuals not affected are those:

  • Enrolled in Medicare Part A and B
  • Enrolled in Medicare Part B only

SERS’ health care eligibility is lost when:

  • You are eligible for medical and prescription coverage through your new employer.
  • You are not eligible for medical and prescription coverage through your new employer, but other employees in comparable positions are eligible for coverage. The coverage available to employees in comparable positions must be at the same cost as full-time employees.

You will not lose your eligibility for SERS’ coverage if you do not have access to the employer coverage, or if it costs employees in comparable positions more than full-time employees pay.

Termination of Eligibility

If you are affected by this rule, you will be notified of the termination date of your SERS health care coverage. Because you must be enrolled in SERS’ coverage in order to enroll your spouse and dependents, termination of your eligibility may affect their coverage.

Regaining Eligibility

Your eligibility for SERS’ health care coverage will be restored after you stop working. Because losing employer coverage is considered an involuntary termination of coverage, you will regain eligibility for SERS’ coverage. You will have 31 days after you lose employer coverage to re-enroll.

Dependent Coverage

This rule also applies to your spouse. If your spouse has SERS’ health care coverage and takes a new job, your spouse loses eligibility for SERS’ coverage. Your eligibility will not be affected by your spouse’s loss of coverage.

If your child has SERS’ coverage and takes a job, that child will not lose SERS’ coverage. Federal law provides that coverage may continue to age 26, regardless of the child’s employment or eligibility for employer coverage.

Please notify SERS if you or your spouse become employed.

Health Care Waiver and Cancellation

You can waive coverage at any time by submitting a Waiver and Cancellation of Health Care Coverage form. If you choose to waive coverage, dependent coverage for your spouse and children automatically ends.

If you waive coverage, you can only re-enroll under the following qualifying events:

  • Within 90 days of becoming eligible for Medicare
  • Within 31 days of an involuntary termination of other health care coverage or termination of Medicaid
    • Failing to pay the premium or ending coverage because of plan changes does not count as involuntary termination.

Cancellation of Health Care Coverage for Your Spouse and/or Children

To cancel health care coverage for a spouse or a child, you must send a written request to SERS. Both you and your spouse must sign the request if the cancellation is for your spouse.