Participant Rights and Responsibilities Upon Transfer or Termination
IU Retiree Status
Medical Plan Coverage
Indiana University sponsors medical care coverage options for employees with IU Retiree status. Retirees may elect to enroll in one of the following:
- Under age 65 – IU PPO Healthcare Retiree Plan, or
- Age 65 or older – the Anthem Blue Retiree Plan (Medicare supplement without prescription coverage), or
- COBRA temporary continuation of active medical and/or dental coverage.
Indiana University does not contribute to the cost of Retiree coverage; the participant pays the full cost of these plans. If the Retiree enrolls in COBRA temporary continuation coverage, the Retiree and eligible dependents may elect one of the IU-sponsored Retiree health plans after COBRA eligibility ends.
All employees with IU Retiree status are eligible to enroll in IU-sponsored Retiree group health care coverage if they are covered by an IU-sponsored health care plan at the time of termination from the university (or when COBRA continuation coverage eligibility ends).
Dependents that are eligible for medical and dental care coverage are:
- The employee's spouse as defined by Indiana law; registered domestic partners* and/or
- Children who meet all of the following criteria:
- The child has one of the following relationships to the employee, spouse, or registered domestic partner:
- A biological child; or
- A lawfully adopted child; or
- A stepchild of the employee; or
- A child for whom the employee or spouse has been legally appointed sole guardian for an indefinite period of time; and
- The child is age 25 or under (eligibility ends at the end of the month in which the child reaches age 26), or qualifies for Disabled Child Eligibility.
- The child has one of the following relationships to the employee, spouse, or registered domestic partner:
- A child for whom the employee is legally required to provide health care coverage under a Qualified Medical Support Order, as defined by ERISA or an applicable Indiana state law.
- When an adoption is in the legal process, coverage for such child may begin from the point the child is placed with the employee (granted custody) for the purpose of adoption.
- Surviving dependent(s) of an employee is eligible if the employee has Retiree status at the time of death or the employee's death occurs while the dependents are covered under the Retiree's IU-sponsored Retiree health care plan.
Proof that an individual is a qualified dependent (marriage or birth certificate, guardianship orders, as applicable) is required at the time of initial enrollment and periodically thereafter. Failure to provide proof of dependent eligibility within 30 days of the university's written request for such proof may result in termination of health plan coverage.
* The IRS does not recognize the employee's domestic partners and children for preferential tax treatment. Domestic partners and their tax-exempt children are eligible for IU-sponsored coverage, but the value of benefits provided to these individuals is added to the employee's taxable income, unless they can also be claimed as a tax exemption by the employee.
The eligible individual must submit a retiree health plan enrollment form to the university no later than 60 days from the termination date of their IU-sponsored employee coverage, or for those who have elected COBRA, 60 days from the date continuation coverage ends. Enrollment forms are mailed to Retirees upon termination of employment and are available by contacting the IU Retiree Specialist.
Once enrolled in an IU-sponsored Retiree health care plan, the Retiree cannot add dependents. Other plan enrollment changes are limited to certain circumstances:
- The Retiree may terminate coverage altogether at any time by notifying Anthem, or Indiana University in the case of IU-sponsored PPO plan.
- The Retiree or covered spouse may elect the Blue Retiree Plan upon reaching age 65 by contacting the IU Retiree Specialist within 60 days of his or her 65th birthday.
- During Open Enrollment each year, participants in COBRA continuation coverage may switch enrollment to a different plan.
- The Retiree must notify Anthem and Indiana University of any "change in status" that terminates dependent eligibility (e.g., divorce of a spouse).
- A Retiree enrolled in the Anthem Blue Retiree Plan may add a new spouse within 31 days of the date of marriage.
Participation as an active employee in an IU-sponsored health care plan ends on the day in which the Retiree terminates from the university.
The Retiree's coverage ends on the first of the month for which the individual has not made the required contribution.
Dependent coverage under an IU-sponsored Retiree health care plan ends when:
- the Retiree's coverage ends for a reason other than death of the Retiree;
- the dependent ceases to meet the definition of an eligible dependent;
- all dependent coverage under the plan is discontinued; or
- the dependent becomes eligible for employee coverage.
It is also important to note the following conditions of participation in IU-sponsored Retiree health coverage:
- If the Retiree and dependents do not elect an IU-sponsored health care plan at the time of retirement, they cannot participate at a later time.
- After dropping IU-sponsored Retiree health care coverage, participants cannot re-enroll at a later time.
- Dependents of a participating Retiree may continue coverage should the Retiree die.
Anthem PPO $900 Deductible Plan. Effective January 1, 2017, the Anthem PPO $900 Deductible plan will be discontinued. Participants enrolled in this plan will be automatically enrolled in the Anthem PPO HDHP plan effective January 1, 2017. Through December 31, 2016, the Anthem PPO $900 Deductible Plan is available to all eligible Indiana University employees and retirees under age 65, regardless of the area of residence. When network providers are used, participants receive full benefits. Partial benefits are received from non-network providers, except in the case of an emergency. Network providers include Anthem Blue Access PPO providers in Indiana, Ohio, and Kentucky and BCBS Blue Card providers in other states. Prescription coverage is the same as for active employees in this plan.
Anthem PPO HDHP. Effective January 1, 2017, this plan is available to all eligible Indiana University employees and retirees under age 65, regardless of the area of residence. When network providers are used, participants receive full benefits. Prescription coverage is the same as for active employees in this plan.
This plan is a "Medicare Supplement" or "Medigap" plan that is available only to those age 65 and over who are enrolled in both Medicare Part A and Part B. As a supplement, many services will be fully paid between Medicare and the Blue Retiree Plan.
Basic Benefits are based on paying what Medicare doesn't pay:
- Medicare A deductible
- Medicare B deductible and coinsurance
Major Medical benefits are subject to deductible and copays. This includes covered services that Medicare does not pay in full, for example:
- skilled nursing facility charges beyond 100 days,
- charges over the Medicare allowed amount (up to UCR allowances) for covered services rendered by unassigned providers,
- hospital inpatient after day 150, and
- skilled nursing services provided outside a hospital.
This plan does not include prescription drug coverage. Participants must enroll in a Medicare Part D plan in order to obtain prescription coverage.
Split Coverage. A Retiree and spouse may split coverage between the IU PPO Healthcare Retiree Plan and the Anthem Blue Retiree Plan in cases where one enrollee is eligible for the Blue Retiree Plan and the other is not eligible due to age (under 65). Coverage in the PPO retiree plans ends at age 65, at which time, both may be covered together on the Anthem Blue Retiree Plan.
Other options which may be available to Retirees that are not sponsored by IU, include Medicare Advantage HMO and POS plans which usually include prescription coverage. One such plan is the IU Health Medicare Advantage, which includes IU and Methodist hospitals and physicians. Since these are not IU-Sponsored Plans, individuals who enroll in these plans cannot return to the IU-sponsored Retiree Medicare Supplement plan at a later time. For more information go to iuhealth.org/medicare, or www.medicare.gov.
COBRA continuation of active coverage is available to Retirees and their eligible dependents under age 65 or who are entitled to Medicare at the time of COBRA election. COBRA benefits are described in detail in Section II of this booklet. At the end of COBRA eligibility, the Retiree and eligible dependents may elect the IU PPO Healthcare Retiree Plan or the Blue Retiree Plan. Continuation of coverage under COBRA is generally 18 to 36 months, depending on the circumstances. If the participant reaches age 65 after COBRA coverage begins, COBRA eligibility ends at age 65.
COBRA coverage may be attractive to Retirees because it allows the participant to temporarily:
- maintain medical plan coverage;
- maintain dental coverage; and
- maintain Open Enrollment options (e.g., adding dependents which is not allowed once enrolled in the Retiree plans).
In order to avoid medicare penalities, COBRA participants generally need to enroll in Medicare Part A (hospital benefits), Part B (outpatient benefits), and Part D (prescription benefits) at the time employment terminates (if already age 65 at termination), or when initial Medicare eligibility begins upon reaching age 65. Medicare allows for a "special enrollment period" when employment ends and when a retiree approaches age 65. The special enrollment period is the time during which the retiree can elect Medicare medical and prescription coverage without penalty. Delaying enrollment beyond the special enrollment period can result in a waiting period (gap in coverage) and higher Medicare premiums. There is no special enrollment period at the termination of COBRA coverage.
Summary of actions the participant must take:
For Medical Plans
- Review plan options and rates to select an IU-sponsored Retiree health care plan option.
- Complete an enrollment form for the IU PPO Retiree health plan or the Anthem Blue Retiree Plan, and submit to the IU Retiree Specialist no later than 60 days from the termination date of IU-sponsored coverage.
- Pay premium payments on time.
- Enroll in Medicare Part A, Part B, and Part D (prescription), if the participant is age 65 or over.*
*For those retirees who wish to continue participation in the IU HDHP PPO & Health Savings Account, enrollment in Medicare, i.e. Part A, Part B, or Part D, will disqualify the retiree from making contributions to the Medical Savings benefit.
For those electing COBRA
- Complete an application form for COBRA within 60 days of:
- the date that coverage ended; or
- the date of the COBRA offer letter, whichever is later.
- Pay initial COBRA premiums to-date within 45 days of electing COBRA.
- Pay monthly COBRA premiums on time.
- In order to continue under an IU-sponsored health plan after COBRA eligibility ends, complete a health plan enrollment form.
- If eligible for Medicare at the time COBRA is elected, check with the Social Security office to fully understand how Medicare Part B and Part C enrollment coordinates with the COBRA election. COBRA almost always pays only after Medicare pays first.
- Make any desired plan changes during Open Enrollment.
For All Options
- Provide timely notice to the plan administrator of a "change in status," such as, divorce, change in disability status, or death of a covered individual.
- During coverage, notify the plan administrator of changes that will effect communications or eligibility, including:
- Address changes
- Entitlement under Medicare
- Coverage under another group health plan
The terminating employee may initially contact their Human Resources office for information on retirement.
University Human Resource Services also has two benefit specialists to assist Retirees with IU-sponsored health care programs. This includes name changes and canceling coverage.
Retiree Benefit Specialist (812) 856-4459
COBRA Specialist (812) 855-7833
Anthem is the claim administrator for the IU PPO Healthcare Retiree Plan and the insurer for the Anthem Blue Retiree Plan. Call Anthem's Customer Service Center (800) 345-2460 for:
- Checking the status of claims
- Obtaining ID Cards
- Obtaining claim forms
- Checking eligibility