Health Benefits

Health coverage for employees who are currently working in state and local government is provided by the employee's current employer. Members of the Teachers' and State Employees' Retirement System can visit the State Health Plan's website for more information.

State Health Plan Enrollment Process for Eligible Retiring Employees

If you are retiring under TSERS and are eligible for State Health Plan retiree group coverage, you will be auto enrolled into a health plan after you have submitted, and the Retirement System has processed, your online retirement application or have submitted a Form 6E, Choosing Your Retirement Payment Option. Health coverage options may be limited if you wait too close to your retirement date to submit your retirement paperwork.

State Health Plan retiree group coverage begins on the first day of the month after your effective date of retirement.

• If you are under 65 (and not Medicare-eligible), you will be automatically enrolled in the health plan you were enrolled in as an active employee along with any covered dependents.
  • If you did not have coverage in the State Health Plan as an active employee, you will be automatically enrolled in the Base PPO Plan (70/30) Plan retiree-only coverage.
  • You can change your auto-enrollment plan or coverage (or opt out of coverage) up to 30 days after your coverage effective date.
  • You will have up to 30 days before your coverage effective date to change plans.
  • If no action is taken, you will remain in your assigned Medicare Advantage Base Plan until the next Open Enrollment, and your non-Medicare eligible dependents will be enrolled into the health plan they were enrolled in while you were an active employee.
  • You and any Medicare-eligible dependents need to have Medicare Part B in place and made effective as of your retirement effective date.
  • You will have up to the day before your coverage effective date to elect a Medicare Advantage Plan.
  • If you do not elect a Medicare Advantage Base Plan, you will remain in the Base PPO Plan (70/30) until next Open Enrollment, and your non-Medicare eligible dependents will be enrolled into the health plan they were enrolled in while you were an active employee.
  • You and any Medicare-eligible dependents need to have Medicare Part B in place and made effective as of your retirement effective date.

  NOTE: If you do not take action within the specified time period to change coverage, you (and your covered dependents) will remain, unless you drop coverage, in the assigned auto-enrolled retiree group health plan and pay the applicable premiums until the next State Health Plan Open Enrollment (or qualifying event). You do not need a qualifying event or to be within the open enrollment period to drop coverage for yourself and/or your covered dependents.

  If you have questions about your health plan options, please visit the State Health Plan website or contact Customer Service at (855) 859-0966.

  • Guidance on State Health Plan changes for Teachers' and State Employee's Retirement System (TSERS)
  Tab/Accordion Items

  Guidance on State Health Plan changes for Teachers' and State Employee's Retirement System (TSERS)

  When you retire under TSERS, you may be eligible for health coverage under the State Health Plan (Plan) if you have at least five years of TSERS membership service earned as a teacher or state employee. Credit for unused sick leave or credit transferred from the Local Governmental Employees’ Retirement System (LGERS) does not count toward this five-year requirement. As a retiree, your cost, if any, for your individual Plan coverage depends upon:

  • when you were “first hired,
  • the type of coverage you select, and
  • whether you are eligible for Medicare.

  NOTE: You must meet TSERS retirement eligibility requirements in order to retire under TSERS, and you must be receiving your TSERS monthly benefit to be eligible for Plan retiree coverage. Members hired on or after Jan. 1, 2021 are not eligible to receive retiree medical benefits.

  All of the conditions described below are based upon current law .

  SHP Coverage at Retirement for Members “First Hired” Before October 1, 2006

  If you were “first hired” before Oct. 1, 2006, and you have five or more years of TSERS membership service, and have not withdrawn that service or taken a refund, the state will pay all of the cost for your individual coverage under the Base PPO Plan (70/30) or the Medicare Advantage Base Plan as a TSERS retiree.

  Individual coverage under other plans is available for an additional fee. In all cases, the full cost of dependent coverage, if elected, must be paid by you.

  SHP Coverage at Retirement for Members Hired On or After Oct. 1, 2006

  If you were first hired on or after Oct. 1, 2006, your cost at retirement for individual coverage under the Base PPO Plan (70/30) or the Medicare Advantage Base Plan is based upon the following retirement service credit requirements:

  • You must retire with 20 or more years of creditable service to receive individual coverage under the Base PPO Plan (70/30) or the Medicare Advantage Base Plan at no charge.
  • If you retire with 10 years or more, but less than 20 years, of creditable service, you will have to pay 50 percent of the cost for your Base PPO Plan (70/30) or the Medicare Advantage Base Plan coverage.
  • If you retire with five years of membership service, but less than 10 years of creditable service, you will have to pay the full cost for your Base PPO Plan (70/30) or the Medicare Advantage Base Plan coverage.

  Individual coverage under other plans is available for an additional monthly fee. In all cases, the full cost of dependent coverage, if elected, must be paid by you.

  If you were “first hired” by the state on or after October 1, 2006, the required 20 years of creditable service must include at least five years of TSERS membership service in order to receive free SHP coverage under the Base PPO Plan (70/30) or the Medicare Advantage Base Plan. The remaining years of creditable service may include any combination of the following types of service:

  • Membership
  • Prior
  • Noncontributory
  • Eligible unused sick leave
  • Purchased

  NOTE: When a member transfers service from LGERS to TSERS, the LGERS service is reclassified as TSERS creditable service.

  State Health Plan Coverage at Retirement for Members Hired on or after Jan. 1, 2021

  If you were first hired on or after Jan. 1, 2021, you are not eligible to receive retiree

  TSERS Withdrawn Service Purchased in TSERS

  Eligible TSERS withdrawn service that is purchased by the member only counts as creditable service, not membership service. Also, any TSERS withdrawn service that is purchased does not count toward the five-year TSERS membership service requirement for SHP coverage at retirement.

  Definitions of Membership Service, Creditable Service, and “First Hired”

  In this guidance, the following definitions apply:

  • Membership Service – service credit earned in TSERS while working as an active teacher or state employee.
  • Creditable Service – any type of service credit that counts toward a retirement benefit in TSERS, including prior service, membership service, non-contributory service, and purchased service. Creditable service (other than actual membership service) cannot be counted as membership service for the purpose of determining eligibility for SHP benefits.
  • First Hired – your first day as a permanent full-time or permanent part-time state employee. To confirm your “first hired” date, check with your human resources office. If all of your state service prior to October 1, 2006, was in a contract or temporary capacity, you are not considered to be “first hired” prior to October 1, 2006, because you did not work in a SHP-eligible position. If you withdraw your service (receive a refund of your contributions) in TSERS and, at a later date, become re-employed under a TSERS employer, this new start date will be considered your “first hired” date.