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 was covered by the Plan at the time of separation from service and:
- Has 12 or more months of service
- Completed a contract term of employment of 10 or 11 months as an employee of a local school administrative unit
Coverage for Eligible Dependents
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.
Enrollment and Termination Process
- HBRs should use the Reduction in Force event in eBenefits 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.
- For members who wish to continue coverage under Reduction in Force, the HBR should use the Enroll in 12-Month RIF event in eBenefits to enroll the member and dependents in coverage effective the first of the month following the separation date.
- Change the category on the work tab to 12 Month RIF enrollee = YES
- Open a case via OnePlace 365 to have Benefitfocus complete the process.
- Click here to view step-by-step instructions.
Important Note: 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 eBenefits system under the Manage employee->Manage Medicare section.
The state monthly contribution amount for the RIF members is included in the active group bill.
The member will be billed directly by iTEDIUM, the Plan's direct bill administrator for any employee or dependent premium.
Premium payments are due by the first day of the effective month. The premium payment grace period ends thirty (30) days after the due date. For detailed information on the policy for cancellation for non-payment, view the Policy and Procedure on Arrears.
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.
Prior to the cancellation, the member will be sent the Forever RIF offer letter and will need to call the Eligibility and Enrollment Support Line at 855-859-0966 to enroll.
The member may remain covered under Forever RIF as long as the 100% required monthly premium is paid. Dependent children are eligible to continue coverage until they cease to be an eligible dependent.
Unlike COBRA, there is no limit to the coverage period. In addition, there is not a 2% administrative fee like with COBRA coverage. iTEDIUM will then bill the member directly for the full amount of the premium.
Medicare eligible RIF members must enroll in Medicare Parts A & B in order to receive full benefit coverage when Medicare is primary. If members are covered under the State Health Plan as a member or a dependent of a member, and they are eligible for Medicare Parts A & B, their benefits under the State Health Plan will be paid as if they are enrolled for coverage under Medicare Parts A & B, regardless of whether they have actually enrolled for such coverage. In other words, even if they have not enrolled in Medicare Parts A and/or B coverage, their health benefit plan will reduce their claim by the benefit that would have been available to them under Medicare Part A and/or B, and then pay the remaining claim amount under the terms of their health benefit plan. As a result, they are responsible for the amount that would have been paid by Medicare Parts A and/or B if they do not enroll in Medicare Parts A and/or B.
Employees need to confirm their eligibility for RIF health coverage with their Health Benefits Representative (HBR). The HBR will enroll the employee, along with eligible dependents, into the RIF health coverage.
The decision to continue or not continue benefits is binding and must be made directly after the termination of employment. Members electing not to continue coverage under RIF privileges directly after their employment terminates forfeit their right to coverage under the RIF benefit.
Forfeiting RIF privileges automatically forfeits COBRA privileges.
You will not be eligible if you become re-employed with the State (of North Carolina) or with another subsequent employer and are eligible for health coverage on a noncontributory basis.
Because you are no longer employed, Medicare will become your primary health coverage and the State Health Plan will be secondary once your RIF health coverage begins. Therefore, it is important for you to enroll in Medicare Part B in order to receive your same level of coverage.