Eligibility

Below is a brief overview of eligibility for retirees. You can find a full description of eligibility rules in the Plan of Benefits  .

An employee may be eligible for health, dental and vision coverage in retirement if the employee meets the requirements for such coverage. Your eligibility for retiree group insurance coverage and funding depends upon a number of factors, including your eligibility for a retirement benefit, the date you were hired into an insurance-eligible position, your retirement service credit earned while working for an employer that participates in the State Health Plan and the nature of your last five years of active employment with an employer that participates in the State Health Plan.

Eligibility for retiree group insurance is not the same as eligibility for retirement. Determining retiree insurance eligibility is complicated, and only PEBA can make that determination. It is very important to contact PEBA before making final arrangements for retirement.

Special eligibility situations

A special eligibility situation is an event that allows you, as an eligible retiree, to enroll in or drop coverage for yourself or eligible family members outside of an open enrollment period.1

You can make changes using MyBenefits   if you have a special eligibility situation, such as adding a newborn, marriage, divorce or adoption. MyBenefits will display the documentation required for each change. The required documents can be uploaded through MyBenefits.

To make a change through your benefits administrator, you will need to:

  • Contact your benefits administrator;
  • Complete a Notice of Election   form within 31 days2 of the event; and
  • Upload documentation to MyBenefits   or give documentation to your benefits administrator.

More details about special eligibility situations are available in the Insurance Benefits Guide.  

1 A salary increase or decrease, or transfer does not create a special eligibility situation.
2 Changes related to Medicaid or the Children’s Health Insurance Program (CHIP) must be made within 60 days.