The Tennessee Consolidated Retirement Systems (TCRS) advises that it can take approximately 60-90 days on average to process a pension application. Benefits Administration cannot process an Application to Continue Insurance at Retirement until the retiree is in an approved status as an active retiree with TCRS. There are situations that arise where the members insurance coverage as an active employee has already terminated but the TCRS pension application has not been approved yet. This results in Benefits Administration having to pend the Application to Continue Insurance at Retirement until TCRS has approved the member as an active retiree.
When a member’s active insurance coverage has been terminated, if they member expresses concern regarding the status of their insurance coverage, they have two options while waiting for their pension to be approved by TCRS.
- The member may “go bare” and pay for any insurance related claims expenses out of pocket and save their receipts. When their pension has been approved and it has been confirmed that they meet all eligibility criteria to continue coverage as a retiree and they will be retroactively enrolled in retirement insurance. They may submit a request to the applicable vendors to have their claims reprocessed to receive reimbursement from the vendors for any applicable out of pocket expenses.
- *** Please note for prescription drug claims, if the pharmacy is unable to reprocess the claim for the member, the member will have to submit a paper claim form directly to Caremark to be reimbursed for their out of pocket prescription expenses. Caremark will provide the member with the necessary claim form; it is on the Caremark website. The member may also call Caremark and request the form.
- The member may enroll in COBRA while waiting for their TCRS pension to be approved. When an employee has separated employment and their active insurance terminates for a reason other than Gross Misconduct, they are offered the opportunity to continue coverage under the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA). COBRA is a federal law that allows eligible employees and/or dependents (spouse and children) who are losing their health, dental or vision benefits to continue coverage in certain circumstances where coverage might otherwise end.
When a person enrolls in COBRA, they are covered under the exact same plan that they had as an active employee. They may continue to use the same insurance cards and their insurance ID numbers remain the same. A member has a 60-day window to apply for COBRA.
If the member enrolls in COBRA and it is later confirmed that they meet all eligibility criteria to continue coverage as a retiree and they will be retroactively enrolled in coverage on the retiree medical plan, they will receive credit for the difference between COBRA premiums paid and retiree premium due.
A Zendesk ticket must be submitted to the COBRA Specialist to cancel the COBRA enrollment back to the effective date of retiree coverage and to leave the premiums paid toward COBRA coverage in open credit to be applied towards the retiree premiums due.
A Zendesk ticket must also be sent to the Retirement Billing Specialist to request that the retiree be enrolled in direct bill on their retiree record to absorb the COBRA payment(s) that will be in open credit on their account. The timeframe that the retiree should be enrolled in direct bill to absorb the COBRA payment(s) will vary depending on the amount in open credit and timing of the RET payroll cycle.