My Pharmacy Benefits

Reduction in Force and Health Coverage

Employees who lose their jobs as a result of a reduction in force (RIF) will continue to have coverage under the State Health Plan for up to 12 months, as long as the employee has 12 or more months of service and the employee was covered by the Plan at the time of separation from service — or completed a contract term of employment of 10 or 11 months as an employee of a local school administrative unit.

Employees may continue coverage for their eligible dependents during this 12-month period. Employees who elect not to continue coverage under RIF immediately following separation from employment may not obtain RIF coverage at a later date. Employees are not eligible for RIF health coverage if the employee is provided health coverage on a non-contributory basis by a subsequent employer.

eEnroll Groups

Termination Process

HBRs should use the Reduction in Force event in the eEnroll system that will allow the HBR to cancel the coverage for the member and their dependents. The system will automatically terminate the coverage the last day of the month of the RIF event date.

Enrollment Process

Benefitfocus will mail eligible members the Reduction in Force Application. Once the member completes and returns the application to the HBR, the HBR should use the Enroll in 12-Month RIF event that has been added to the eEnroll system to enroll the member and dependents in coverage effective the first of the month following the separation date.

If you have employees who are part of a RIF and eligible for Medicare, they will need to purchase Medicare Part B even though your agency will be covering them for 12 months. Medicare becomes primary when a member no longer has employment status. The HBR will need to update the Medicare status to primary in the eEnroll system.

However, an HBR does not need to wait for the RIF'd employee to receive the paperwork. If the HBR prefers, the RIF enrollment process can occur during the exit interview. The HBR and the RIF'd employee can complete the Reduction in Force Application and the 12-month RIF coverage can be entered into the system at that time.

Billing Process

The state monthly contribution amount for the RIF members is included in the active group bill.

The member will be billed directly by COBRAGuard for any dependent premium or if they are enrolled in the 80/20 Standard plan.

If the member is enrolled in the 80/20 Standard plan and the employee portion of the premium is not received within 30 days, COBRAGuard will move the member to the 70/30 Basic plan. If the member has dependent coverage and the dependent premium is not received within 30 days, coverage for their dependents will be terminated as of the last day of the month through which premiums have been paid.

Forever RIF Process

Prior to the end of 12-month RIF health coverage, the member and dependents will be automatically canceled with an end date equal to the end of 12- months of coverage. This cancellation is sent to COBRAGuard to trigger the Forever RIF letter to the member. The member should complete and return the form back to COBRAGuard to enroll in the Forever RIF health coverage. COBRAGuard will then bill the member directly for the full amount of the premium.

For more information on RIF and health coverage, review the RIF Frequently Asked Questions.

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