All eligibile retirees - those officially retiring from the County within 120 days of separation - are eligible to participate in County medical insurance. If you retire after 120 days of separation, you will not be eligible to enroll in County medical insurance upon retirement. 

• Retirees who enroll in County medical insurance can only make changes during the annual open enrollment period or when you have a qualifying event.
• All retirees can participate in dental and vision insurance.

IMPORTANT NOTE: If you terminate enrollment in the retiree medical insurance, you and your dependents will not have another opportunity to participate again in the future until you turn age 65. You will have a final opportunity to opt in to County medical when you turn age 65 and enroll in Medicare.

Survivor Spouse Benefits

A spouse or domestic partner survivor of a deceased retiree may be eligible for health coverage if they are both:

• Enrolled OR eligible to enroll as a dependent at the time of death AND
• Qualify for a monthly survivor retirement benefit

As a survivor, you may request health enrollment from the County within 60 days from the date of death. Contact San Luis Obispo County Pension Trust (SLOCPT) at (805)781-5465 to setup survivor spouse benefits. Subsequent spouses and children are ineligible for County retiree benefits. 

You can enroll the following family members in County medical, dental, and vision plans:

• Spouse (the person who you are legally married to under state law, including a same-sex spouse)
• Registered Domestic Partner (must be recognized by state law and confirmed by registration with the sate)
• Children up to age 26 (including your domestic partner's children). Married children are eligible for benefits too.
• Children over age 26 ONLY if they are incapacitated due to a disability and primarily dependent on your for support. You must request a Disabled Dependent Certification form from Blue Shield.
• Dependents named in a Qualified Medical Child Support Order (QMCSO) as defined by federal law.

Dependent Verification 

Adding dependents is subject to eligibility verification in order to ensure only eligible individuals are participating in our plans. You will be required to provide legal documentation within 31 days of their eligibility. If you do not supply the proper documentation to add dependents within the 31-day period, you will not be able to add the dependent(s) until the next open enrollment period. 

Who is not eligible?

Family members who are not eligible for coverage include (but are not limited to):

• Parents, grandparents, and siblings
• Former spouses and stepchildren are ineligible dependents and will be removed from County insurance plans effective the date of the divorce decree. Medical claims and premiums incurred due to late notification to the County are the responsibility of the retiree.

Please review the County Medicare Transition webpage for more information: slocounty.ca.gov/medicaretransition. 

Turning 65 years old and becoming eligible for Medicare is a special qualifying event only for the member turning age 65. This qualifying event is only to enroll in a County Medicare plan (or waive County medical) and does not allow you to make any changes to dental/vision enrollments. 

• If you (the retiree) waived County medical upon retirement, your Medicare Transition is the last opportunity for you to rejoin County medical insurance. 
• If you (the retiree) waived County medical upon retirement and your spouse turns 65 first, your spouse is not eligible to be enrolled in County medical by themselves. 

If you are newly eligible for Medicare, please review the Medicare Transition webpage at slocounty.ca.gov/medicaretransition.

Purchasing a plan (Medicare supplemental, dental, vision, etc.) from an insurance broker or out in the marketplace is not considered other group coverage and cannot be used to waive County benefits in this qualifying life event. Other group coverage is considered employer-sponsored coverage. See the FAQs section for examples of how you may obtain other group coverage.  

New Eligibility for Other Group Coverage Qualifying Event

Qualifying Event Date	Coverage Effective Date	Required Documentation
Date County Coverage should Terminate	First of the month following event date Example: County coverage termaintes 08/31 New coverage starts 09/01	Proof of Other Group Coverage containing: Carrier Name Group/Employer Name Member name and all covered dependents Plan Name Plan Effective Date Copy of your new insurance card Proof needed individually for medical, dental, and vision if making changes to all lines of coverage

 

IMPORTANT: If you are currently enrolled in County medical insurance, under age 65, and drop County medical insurance with this qualifying event, you will have one final opportunity to elect County medical coverage once you turn 65 with your Medicare Transition. You will only be allowed to add medical with your Medicare Transition qualifying event and you cannot re-add medical during any subsequent Open Enrollment periods. If you are over age 65 and drop your County medical plan, you will not be allowed to rejoin County medical again.

Permitted Benefits Changes

Benefit Type	Permitted Change
Medical	Drop self from County medical and waive Dropping yourself from medical will drop any enrolled dependents Drop dependent(s) from County medical
Dental	Drop self from dental and waive Dropping yourself from dental will drop any enrolled dependents Drop dependent(s) from dental
Vision	Drop self from vision and waive Dropping yourself from vision will drop any enrolled dependents Drop dependent(s) from vision

Choosing to cancel a marketplace plan, like cancelling a non-County Medicare supplemental is not considered losing other group coverage and would not make you eligible to enroll in County benefits. See the FAQs section for examples of how you may lose other group coverage.

Loss of Eligibility for Other Group Coverage Qualifying Event

Qualifying Event Date	Coverage Effective Date	Required Documentation
Date Other Group Coverage Ended	First of the month following event date Example: Other Group Coverage termaintes 08/31 County Coverage starts 09/01	Termination notice from carrier or group stating: Member Name and all covered dependents names Group/Employer Name Plan Name Plan Effective Date COBRA Paperwork If adding a new dependent, dependent documentation required too Birth certificate for children Marriage certificate for spouse

Permitted Benefits Changes

Benefit Type	Permitted Change
Medical	Add eligible dependents to existing medical plan enrollment See Retiree and Survivor Spouse Benefits section for medical eligibility rules
Dental	Add self to County dental (if you lost your other group coverage) Add eligible dependents to existing dental plan Cannot enroll dependents in dental if you waive
Vision	Add self to County vision (if you lost your other group coverage) Add eligible dependents to existing vision plan Cannot enroll dependents in vision if you waive

If you get married or enter into a domestic partnership, this is considered a qualifying event for you to add your new spouse/partner (and any eligible stepchildren) to benefits. 

Marriage/Domestic Partnership Qualifying Event

Qualifying Event Date	Coverage Effective Date	Required Documentation
Date of Marriage or Domestic Partnership	First of the month following event date	Marriage Certificage or Domestic Partnership Affidavit Official Birth Certificate for stepchildren

It is your responsibility to provide San Luis Obispo County Pension Trust (SLOCPT) a copy of your marriage certificate/domestic partnership affidavit. Contact SLOCPT at (805) 781-5465 or email [email protected].

Permitted Benefits Changes

Benefit Type	Permitted Change
Medical	Add spouse/partner and/or stepchildren to existing medical plan. Change medical plan and add spouse/partner and/or stepchildren
Dental	Add spouse/partner and/or stepchildren to existing dental plan.
Vision	Add spouse/partner and/or stepchildren to existing vision plan.

If you get divorced, this a mandatory qualifying event to remove spouse and stepchildren from all enrolled plans.

• Former spouses and stepchildren are not eligible for the County's insurance plans.
• For late notifications, retirees are personally responsible for claims incurred by ineligible dependents and premium costs incurred after coverage effective date.

Divorce Qualifying Event

Qualifying Event Date	Coverage Effective Date	Required Documentation
Date of Divorce	Benefits for spouse and stepchildren will terminate at the end of the divorce month	Divorce Decree or Legal Separation Termination of Domestic Partnership Proof of Coverage Terminating for Dependents

It is your responsibility to provide San Luis Obispo County Pension Trust (SLOCPT) a copy of your divorce paperwork. Contact SLOCPT at (805) 781-5465 or email [email protected].

Permitted Benefits Changes

Benefit Type	Permitted Change
Medical	Must drop ex-spouse and stepchildren You may change your existing medical plan
Dental	Must drop ex-souse and stepchildren
Vision	Must drop ex-spouse and stepchildren

If you have a newborn child, newly adopt a child, or obtain new legal guardianship, this is considered a qualifying event for you to add your new dependent child to County benefits. 

Birth Qualifying Event

Qualifying Event Date	Coverage Effective Date	Required Documentation
Date of Birth, Adoption, or Legal Guardianship	Date of Birth or Adoption (medical only) First of the month following event date (dental and vision)	Official Birth Certificate, Adoption Paperwork, or Court Documents Social Security Number (SSN) card

Permitted Benefits Changes

Benefit Type	Permitted Change
Medical	Add child only to existing medical plan If you currently waive retiree medical, you cannot enroll in medical with this qualifying event.
Dental	Add child only to exisiting dental plan If you currently waive retiree dental, you cannot enroll in dental with this qualifying event.
Vision	Add child only to existing vision plan If you currently waive retiree vision, you cannot enroll in vision with this qualifying event.

For each Qualifying Event, there is required documentation. Please review the above panels to determine what documentation you need and how to upload it into BenXcel. If you need additional assistance obtaining the required documentation, you can use the resources below:

Birth Certificate for Newborns, Stepchildren, and Legal Guardianship

• County office that issued original birth certificate
• Hospital in which child was born
• U.S. Department of State (for children born outside of the U.S)
• Social Security Administration
• Vitalchek.com

Adoption Paperwork

• State agency that issued final adoption papers
• Adoption agency that issued placement papers
• Social Security Administration

Marriage Certificate, Certificate of Domestic Partnership, Divorce Decree, and Termination of Domestic Partnership

• County office that issued original marriage certificate or certificate of domestic partnership
• Vitalchek.com
• sos.ca.gov/registries/domestic-partners-registry

Proof of Other Group Coverage/Proof of Loss of Other Group Coverage

• Contact new/old employer for paperwork
• Employer can provide a hire letter stating benefits coverage (with dependents listed) 
• Employer can provide a letter stating benefits termination (with dependents listed)
• Request a "Letter of Credible Coverage" or a "Confirmation of Benefits" letter

Retiree pension premium deductions are reviewed on a monthly basis. If you completed all steps necessary for an eligible qualifying event (calling the enrollment line and submitting required documentation), any premiums changes will be automatically reflected in your pension.

Due to timing, some qualifying events may not be processed in time for the following month's pension benefit, which is sent at the beginning of each month.

• Any over deductions in premiums will be reimbursed as needed. You will receive a letter from County HR informing you of the reimbursement.
• If your enrollment increases and it is not deducted, you will be required to pay the difference in premiums. You will receive a mailed communication from County HR with instructions on sending payment.

You may only drop/waive current County benefits enrollments if you newly obtain other group coverage. Below are a few examples of how you could obtain other group coverage:

• You get a new job and are offered employer group coverage (medical/dental/vision).
• Your spouse is hired at a new job and is offered group coverage. Your spouse chooses to cover themself/your dependents/and you on their new benefits.
• Your dependent child receives new coverage through college or a job.

You cannot drop your medical, dental, or vision plan mid-year without a qualifying life event.

You cannot drop your medical, dental, or vision plan mid-year without a qualifying life event. Below are some examples of how you may lose other coverage:

• You had coverage (medical/dental/vision) through an employer, but lose coverage due to retirement or loss of employment.
  • Review the Retiree and Survivor Spouse section for additional eligibility rules for medical. You may not be eligible to enroll in County medical, even if you lose other coverage.
• Your spouse had coverage through an employer, but loses coverage due to retirement or loss of employment.
  • If you waived County medical previously or you are not eligible for County medical, you and your spouse cannot use this qualifying event to newly enroll in County medical insurance. You may add your spouse to your exisiting medical plan if you are enrolled.
  • Your spouse may enroll in County dental/vision.
• Your spouse has covers themself and you on their employer sponsored coverage, but loses the coverage due to retirement or loss of employment.
  • You may enroll in County dental and vision for yourself and spouse.
  • You may not enroll in County medical. See Retiree and Survivor Spouse section for medical eligibility rules.
• Your child is under age 26 and loses their college sponsored healthcare or loses employer sponsored coverage from their job