Medicare Eligibility
- You are a retired employee of the State of Alabama who has at least 10 years of creditable coverage in the SEHIP; and
- Receives a monthly benefit from the Employees' Retirement System or Teachers' Retirement System of Alabama or Judicial Retirement Fund.
Members who are eligible for Medicare are automatically enrolled in the Group Medicare Advantage Plan offered by the SEIB. The Medicare Advantage Plan will automatically go into effect unless you complete a Medicare Advantage Opt-Out form and return it to the SEIB within 21 days from the date of the opt-out notice. If you opt-out of the Group Medicare Advantage Plan offered by the SEIB and enroll in another Medicare Advantage Plan, you will not have any medical coverage through the SEIB.
Members enrolled in Medicare Advantage will receive information about the plan’s benefits. A link to the Evidence of Coverage, a current drug formulary, participating pharmacy directory, and a provider finder is available on the SEIB Humana group information page.
A Medicare-eligible member should have both Medicare Parts A and B to have adequate coverage with the State of Alabama.- Your spouse (excludes divorced or common-law spouse);
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Your child(ren) under 26 years old is defined as:
- your son or daughter,
- legally adopted by you or your spouse,
- your stepchild, or
- a dependent for whom you, or your spouse, has legal and physical custody granted by a court of competent jurisdiction.
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An incapacitated dependent child* over age 25 will be considered for coverage provided the dependent is:
- unmarried,
- permanently mentally or physically disabled or incapacitated,
- had the condition prior to the dependent’s 26th birthday,
- incapable of self-sustaining employment,
- dependent on you for 50% or more financial support,
- otherwise eligible for coverage as a dependent except for age,
- covered as a dependent on your Plan immediately prior to the child’s 26th birthday,
- and not eligible for any other group health insurance benefits.
- Your spouse or other dependents if they are independently covered as a state employee unless they are employed as a professional civil engineer trainee with ALDOT and their employment is part of their educational training
- An ex-spouse or ex-stepchildren, regardless of what the divorce decree may state
- Your biological child if the child has been adopted by someone other than your spouse and you have been relieved of your parental rights and responsibilities
- Children age 26 and older
- Incapacitated children age 26 and older who do not meet the Incapacitated Child eligibility requirements listed above under Eligible Dependen
- A child of a dependent child
- A daughter-in-law or son-in-law
- Grandchildren or other children related to the member by blood or marriage for which the member does not have legal and physical custody
- Grandparents
- Parents
- A fiancé(e) or live-in girlfriend or boyfriend
- When a new employee requests coverage for an incapacitated child within 60 days of employment; or
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When an employee’s incapacitated child is covered under a spouse’s employer group health insurance for at least 18 consecutive months and:
- the employee’s spouse loses the other coverage because the employer ceases operations, termination of employment or reduction of hours of employment, or employer stopped contributing to coverage.
- a change form is submitted to the SEIB within 30 days of the incapacitated child’s loss of other coverage, and
- Medical Review approved incapacitation status.
In the event of the death of a retired employee who carried family coverage, the eligible dependents may continue coverage by making appropriate premium payments to the SEIB. The SEIB must be notified within 90 days of the date of death.
Dependents may not be added to coverage after the death of the retired employee. To be eligible to continue coverage under this section, a dependent must be covered under the SEHIP immediately prior to the death of the retired employee.
If a dependent covered under this section cancels coverage for any reason, the dependent is ineligible for survivor coverage at a later date.
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The retiree may have coverage in the SEHIP, until the next Medicare Open Enrollment period, for
benefits that would have been covered by Medicare Part B and for prescription drug coverage. The
retiree will be required to pay the Early Retiree rate, plus the Medicare Part B premium to the SEHIP.
- If the retiree does not pay this amount to the SEHIP, the retiree will not have any coverage in the SEHIP for benefits that would have been covered by Medicare Part B and will not have any prescription drug coverage. The SEHIP will only pay secondary to Medicare Part A.
- The retiree will not have any coverage in the SEHIP for benefits that would have been covered by Medicare Part B and will not have any prescription drug coverage. The SEHIP will only pay secondary to Medicare Part A.
Keep in mind that if you opt-out of Medicare Advantage and do not have or do not enroll in another prescription drug plan, you may have to pay a late enrollment penalty in addition to your premium for Medicare prescription drug coverage in the future.
Re-employed Medicare State retirees who work an average of 10 hours or more per week will be classified as re-employed State retirees for health insurance purposes. That means the SEIB will convert their SEHIP coverage (and the coverage for their Medicare dependents, if applicable) to primary coverage. Medicare will be their secondary coverage as long as they are re-employed State retirees and work at least 10 hours per week. The employing agency will be billed for the retirees’ premiums and the retirees will be billed for their dependent premiums.
Re-employed Medicare State retirees who work less than an average of 10 hours per week, may continue their retiree coverage and will not be classified as re-employed State retirees for health insurance purposes.
- is in a skilled nursing facility, or
- has other Part D prescription drug coverage.