Find answers to common benefits question. Browse our FAQs to learn more about important benefit topics.
Qualifying Life Event (QLE) FAQ
Qualifying Life Event FAQ
A Qualifying Life Event (QLE) gives you the opportunity to make benefit election changes outside of Open Enrollment. Certain changes in your life – such as gaining other group insurance coverage, marriage, divorce, birth of a child, etc – may allow you to make changes to your benefits. Find answers below to common questions about QLEs.
Submitting a QLE
- Adoption
- Death in Family
- Divorce
- Employee or Dependent Gains Other Group Coverage
- Employee or Dependent Gains Medicaid or Chip Coverage
- Employee or Dependent Loses Medicaid or Chip Coverage
- Employee or Dependent Loses Other Group Coverage
- Legal Guardianship
- Marriage
- Newborn
If your event is not listed or you are unsure if it qualifies, contact the Employee Benefits Division before the deadline to determine whether your situation qualifies.
Benefit election changes during a plan year can only be made with a Qualifying Life Event.
Qualifying Life Event changes must be submitted within 31 days of the effective date of the event, with the exception of life events for Newborn, Adoption, or Medicaid/CHIP eligibility which allow a 60-day limit.
If you don’t have a qualifying life event, Open Enrollment is your annual opportunity to make changes and is typically held in October. Changes made at open enrollment are effective January 1st of the following calendar year.
No. Benefit changes must be consistent with the QLE and supported by the documentation.
Qualifying Life Event changes must be submitted within 31 days of the effective date of the event, with the exception of life events for Newborn, Adoption, or Medicaid/CHIP eligibility which allow a 60-day limit.
Your request is not complete without the supporting documentation. Supporting documentation is due within 60 days of the effective date of the event.
If changes are approved after the effective date, new/revised premium contributions may be applied retro-actively to the date of the event and applied to your upcoming paycheck(s).
If you have missed the deadline for your QLE, Open Enrollment is your annual opportunity to make changes and is typically held in October. Changes made at open enrollment are effective January 1st of the following calendar year.
QLE changes must be submitted through the Employee Benefits Portal from OnlinEnroll, umr.workterra.net, no later than the deadline.
Click the button below for full instructions on submitting QLE changes related to that event.
If your event is not listed or you are unsure if it qualifies, contact the Employee Benefits Division before the deadline to determine whether your situation qualifies.
Below is a list of supporting documentation required for QLEs. See the full instructions, including required documentation information, in the "Where can I find full QLE instructions?" section above. Additional documentation may be required depending on the event.
Adoption or Placement for Adoption
- Adoption papers/court documents
- Court order placing child pending final adoption
Death in Family
- Death certificate
Divorce
If you are adding yourself and/or dependent child(ren) to the County plans:
- Divorce decree
- If Event Date is the date of the loss of other group coverage, proof of past group insurance coverage. This documentation must identify you and/or your dependent(s), show in which plan(s) each were enrolled – medical/dental/vision – and the date coverage ends. (Example: COBRA Notification)
- If you are adding a dependent(s), proof of relationship: birth certificate for a child.
If you are dropping your ex-spouse and/or ineligible step-child(ren):
- Divorce decree
Employee or Dependent Gains Other Group Coverage
- Proof of new group insurance coverage. This documentation must identify you and/or your dependent(s), show in which plan(s) each are enrolled – medical/dental/vision – and the date coverage begins.
Employee or Dependent Gains Medicaid or CHIP Coverage
- Proof of new Medicaid/CHIP coverage. This documentation must identify you and/or your dependent(s) and the date coverage begins.
Employee or Dependent Loses Other Group Coverage
- Proof of past group insurance coverage. This documentation must identify you and/or your dependent(s), show in which plan(s) each were enrolled – medical/dental/vision – and the date coverage ends. (Example: COBRA Notification)
- If you are adding a dependent(s), proof of relationship: marriage certificate/common law affidavit for a spouse; birth certificate for a child.
Employee or Dependent Loses Medicaid or CHIP Coverage
- Proof of past Medicaid/CHIP coverage. This documentation must identify you and/or your dependent(s) and the date coverage ends.
- If you are adding a dependent(s), provide proof of relationship: marriage certificate/common law affidavit for a spouse; birth certificate for a child.
Marriage
- Copy of your marriage certificate
If you are dropping County plans, because you are enrolling on your new spouse’s plan(s):
- Copy of your marriage certificate
- Proof of new group insurance coverage. This documentation must identify you and/or your dependent(s), show in which plan(s) each are enrolled – medical/dental/vision – and the date coverage begins.
Newborn - Birth of a Child
- Birth certificate
Documentation may be attached in the Employee Benefits Portal through the QLE process in the Upload Documents screen or emailed to employeebenefits@elpasoco.com.
If you are adding the documentation in the portal after initially submitting your QLE, you may need to re-enter the QLE and attach your document(s) in the Upload Documents screen, then be sure to make it through to click the “Finish” button.
Supporting documentation is due within 60 days of the effective date of the event. However, your QLE election changes should be submitted through the Employee Benefits Portal no later than 31 days* from the event's effective date.
Your change request will remain pending until the required supporting documentation has been received and reviewed by the Employee Benefits Division.
Effective dates will be based on the event type along with the supporting documentation.
- Divorce: 1st of the month following the date the divorce decree is filed. (Ineligible spouse and/or stepchildren's coverage will end on the last day of the month that the divorce is finalized.)
- Gains other coverage: Date of new coverage
- Loses other coverage: Day following the last date of other coverage
- Marriage: Employee may choose an effective date of (1) the date of the marriage or (2) the 1st of the month following the date of the marriage
- Newborn: Date of birth
For questions on effective dates for your situation, please feel free to contact the Employee Benefits Division.
Your request is not complete without the supporting documentation. Effective date may not be changed based on employee submission date or Employee Benefits Division approval date. If changes are approved after the effective date, new/revised premium contributions may be applied retro-actively to the date of the event and applied to your upcoming paycheck(s).
The Employee Benefits Division will review your QLE request and notify you via email of the decision or any required next steps within 5 business days of your submission.
To help avoid delays, if possible, submit all required supporting documentation with your request. Once reviewed, the Employee Benefits Division will notify you at your County email and, if on file, personal email of your request's approval, denial, or if additional documentation is needed.
If additional documentation is requested, please allow up to 5 business days for your request to be reviewed after you have submitted the additional information. If further documentation is still needed, the 5 business day review period begins again for each additional documentation submission.
Children enrolled on the El Paso County plans are eligible until the last day of the month that they turn age 26.
No action is needed by the employee, the child will automatically be dropped from coverage as of that date.
Dependent children that are age 26 or more years old and primarily supported by you and incapable of self-sustaining employment by reason of mental or physical handicap that are enrolled on the plan before age 26, may continue coverage after age 26. You may be required to provide proof of the child’s dependent status to the health care plan carrier or to the Employee Benefits Division.
Contact the Employee Benefits Division no later than 31 days from the event. We're happy to help determine whether your situation qualifies.
After Your QLE is Approved
If you are newly-enrolled:
Please allow 7-10 business days* for ID cards to arrive in your mail.
While you wait, you may be able to access cards electronically on the carrier sites or apps. Contact information is provided below.
If you have added or removed dependents:
You will automatically receive new medical ID cards within 7-10 business days.*
In the meantime, you/your dependents can use your existing medical plan ID card as the member ID will remain and be the same for all members.
For all other ID cards, only your (employee) name is listed on the cards, therefore, new ID cards are not automatically issued. If you need additional or replacement ID cards, please contact the plan's member services to request new cards.
Additionally, you and your dependents can access cards electronically on the carrier sites or apps. Contact information is provided below.
Contact Information (click here for a full contact list)Medical:
elpasocobenefits.com | (866) 885-1484
Download the App: Apple App Store or Google Play
Dental:
deltadentalco.com | (800) 610-0201
Download the App: Apple App Store or Google Play
Vision:
eyemed.com | (866) 723-0596
Download the App: Apple App Store or Google Play
*7-10 business days is based on enrollment data updates sent to the plan carriers. Updates are sent at midnight on Thursday.
After your QLE benefit changes have been approved, you/your dependent can start using your benefits on or after the effective date. Before obtaining services, check the plan network for provider listings.
The effective date will be provided in the approval notification email from the Employee Benefits Division and can also be found on your Confirmation Statement in the Employee Benefits Portal.
It may take up to a week from the Employee Benefits approval notification email for the plan carriers to receive the updates.
If services are needed on or after the approved effective date, but before the plan carrier has received the updates: You/your dependent should discuss options with your provider/doctor. Some providers may require a payment ahead of the appointment if they cannot confirm eligibility. If services are received without the plan information, make sure to provide your plan ID card to the provider as soon as you have received it so that they can bill the plan for your services.
At times, benefits may be approved with a retro-active effective date. If services were received on or after the approved effective date, contact your provider to ask them to bill your new insurance and provide a your ID card information.
After your QLE benefit changes have been approved, an approval notification email will be sent to you from the Employee Benefits Division. We recommend reviewing your approved changes in the Employee Benefits Portal.
You may view the changes by logging in to the Employee Benefits Portal from OnlinEnroll at umr.workterra.net and viewing your Confirmation Statement.
To view future changes: from the home page, click the arrow (>) next to “Current Benefits” on the top-right menu, then scroll down for your Future Enrollment Summary.
Please notify the Employee Benefits Division immediately via email at employeebenefits@elpasoco.com.
If you are still within the submission deadline for that event, you may still be able to make changes to your elections. Use the QLE instructions to submit another change request through the Employee Benefits Portal.
Medical
The El Paso County Medical Plan is an EPO medical plan. EPO stands for Exclusive Provider Organization. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care.
An EPO has no out-of-network benefits. That means if you utilize a provider or hospital outside of the network, you are responsible for 100% of the claim.
In-network provider listings can be accessed online by going to the Quantum Health portal or calling Quantum Health.
elpasocobenefits.com | (866) 885-1484
Download the App: Apple App Store or Google Play
Dental
Dental Plan network providers can be found on the Delta Dental of Colorado website.
On the Delta Dental of Colorado homepage, click “Find a Dentist.” Enter your search parameters by selecting “Plans Participating In” (Delta Dental PPO or Delta Dental PPO Plus Premier), entering your location (address or zip code) and/or other criteria you wish to include, then click “Search.” The list will indicate the networks in which each provider participates. The greatest discount and least out-of-pocket to you will be with a Delta Dental PPO network provider.
deltadentalco.com | (800) 610-0201
Download the App: Apple App Store or Google Play
Vision
Vision Plan network providers can be found on the EyeMed website.
On the EyeMed homepage, click “Find an eye doctor.” Choose your network (Access) and click "use my location" or enter your ZIP code and click "search by ZIP."
eyemed.com | (866) 723-0596
Download the App: Apple App Store or Google Play
The prescription plan provides you with convenient access to a nationwide network of pharmacies.
You can obtain a complete listing of pharmacies in your network by logging on to express-scripts.com. Click on the “Prescriptions” menu and select “Find a Pharmacy” enter your zip code and click “Search.”
90-Day Maintenance Medications
Smart90 is a feature of your prescription plan. With it, you have 2 ways to get up to a 90-day supply of your long-term medications (those drugs you take regularly for ongoing conditions): you use a Walgreens retail pharmacy or the Express Scripts Pharmacy Home Delivery.
express-scripts.com | (855) 738-1153
Download the App: Apple App Store or Google Play
Related Items
Name Change
If you have a legal name change, from My Apps, click on the Employee Virtual Assistant (EVA) app. In EVA search for and select "Legal Name Change Request," then follow the on-screen instructions to submit your name change. Supporting documentation, such as your updated Social Security card, will be required.
Personal Data Changes
If you have changes to your personal information – marital status, address, emergency contacts, etc. – visit the Employee Self Service (ESS) to update the information within the proper application(s) in the Update My Information section. ESS can only be accessed on the County’s network or VPN (GlobalProtect).
Retirement Beneficiaries
A Retirement Plan Beneficiary Designation Form must be updated and submitted to the Retirement Office along with a copy of your marriage certificate to epcrpsupport@elpasoco.com or fax (719) 520-7495.
Name Change
If you have a legal name change, from My Apps, click on the Employee Virtual Assistant (EVA) app. In EVA search for and select "Legal Name Change Request," then follow the on-screen instructions to submit your name change. Supporting documentation, such as your updated Social Security card, will be required.
Personal Data Changes
If you have changes to your personal information – marital status, address, emergency contacts, etc. – visit the Employee Self Service (ESS) to update the information within the proper application(s) in the Update My Information section. ESS can only be accessed on the County’s network or VPN (GlobalProtect).
Retirement Beneficiaries
If you are removing your ex-spouse as a beneficiary of your Retirement Plan, the Beneficiary Designation Form must be updated and submitted to the Retirement Office along with a copy of your divorce decree to epcrpsupport@elpasoco.com or fax (719) 520-7495.
Open enrollment is the annual period when you can sign up for, change, or review your health insurance and other benefits.
Open enrollment is held annually in the fall, typically in October. Changes made at open enrollment are effective January 1st of the following year.
Outside of open enrollment, changes during a plan year can only be made with a qualifying life event.
Employees classified as full-time are eligible to participate in El Paso County’s health insurance benefit plans.
Eligible dependents may participate in the plans in which you are enrolled. Eligible dependents are:
- Your lawful spouse (marriage, civil union, or common-law
- Your children who are less than 26 years old (natural-born, adopted, step-children, and legal guardianship)
- Your dependent children that are age 26 or more years old that are primarily supported by you and incapable of self-sustaining employment by reason of mental or physical handicap that are enrolled on the plan before age 26 – You may be required to provide proof of the child’s dependent status to the plan carrier or to the Employee Benefits Division.
You can enroll in RYP (standard) anytime throughout the year. RYP+ enrollment is only offered for QLEs when an employee is newly-enrolling into the medical plan.
For an eligible QLE, follow the RYP+ enrollment steps below no later than 31 days from your medical plan effective date. If enrolled, RYP+ Perks are effective the 1st of the month following your medical plan effective date.
- Register on the RYP Portal from Personify Health, join.personifyhealth.com/reachyourpeakepc.
- New Medical Plan Participants: Complete the Health Check survey to receive current year RYP+ Perks! Health Check survey must be completed no later than 31 days from your EPC medical plan enrollment effective date.
RYP+ enrollment must be completed annually to participate.
RYP and RYP+ Benefits
Challenge your wellbeing for a chance to win prizes! RYP and RYP+ participants can earn points by participating in program activities and making healthy decisions. By achieving quarterly levels, you can earn prize drawing entries!
RYP+ Perks include:
Medical Plan Subscribers Only
- Premium Reduction: Medical plan contribution savings of $20/month.
- Health Reimbursement Account (HRA): For reaching quarterly levels, you can earn up to $600 per year into an HRA which can be used for out-of-pocket Health Care FSA-eligible expenses! Continued RYP+ participation allows you to roll over up to $2,000.
HRA funds will be forfeited on January 1 if you do not re-enroll in the RYP+ program during the annual (open) enrollment period.
Retiree Benefits FAQ
Retiree Benefits FAQ
Planning for retirement comes with a lot of important decisions, and understanding your health benefits is one of them. This FAQ is designed to answer common questions about retiree health plan benefits, so you can be informed and confident as you prepare for retirement.
Know Before You Go
Employees retiring from El Paso County have the option to elect to continue health plan benefits in retirement. For the retiree to be eligible for continuation of health plan benefits (medical, dental, and vision), the retiring employee must be currently enrolled and elect to continue the coverage at the time of retirement.
Retiree definition: An employee whom the El Paso County Retirement Plan has found to be eligible for retirement benefits and is receiving a monthly pension benefit from the El Paso County Retirement Plan.
Benefits that can be continued into retirement:
- Medical
- Dental
- Vision
Employees separating from the County have the option to continue Life Insurance and Supplemental Benefit plans, but these are offered through the plan carrier, Unum.
Please review the Benefits Termination Letter for more employee coverage termination information.
Yes. For a retiring employee to be eligible for continuation of El Paso County health plan benefits, the retiring employee must be currently enrolled and elect to continue the coverage at the time of retirement.
Current coverage must be on the El Paso County plan(s) as an active employee, dependent of an active employee, or COBRA enrollee.
Please find the Retirement Checklist in the Retiree section of our Employee Benefits Website. The checklist will provide you some guidance to who and when to notify about your retirement.
If you are not yet enrolled in Medicare Part A and Part B, you will need to enroll to participate in the El Paso County Medicare-eligible Medical Plan.
- We recommend beginning the enrollment process with Medicare as soon as possible, but ideally, 8 weeks prior to your retirement date. You will need to enroll in Medicare Part A and Part B.
- For Special Enrollment:* When you are ready to begin the enrollment process, you will need a Medicare Employment Verification Form as proof of employer-sponsored health coverage. Contact the Employee Benefits Division for this form.
- Be sure to request that your Medicare coverage becomes effective on your official retirement date – first of the month following your last day of employment. (If approved for paid leave beyond your last day of work, your last day of employment will be the last day of approved leave.)
Typically, no.
However, it may be possible if you are able to obtain/maintain your El Paso County coverage up to the point of your retirement. This could be through coverage as a dependent of an EPC active employee or continuing EPC benefits through COBRA (duration limits apply).
The retiring person must be currently enrolled and elect to continue the coverage at the time of retirement. Current coverage must be on the El Paso County plan(s) as an active employee, dependent of an active employee, or COBRA enrollee.
Enrollment & Premiums
Eligible retirees may elect continue coverage for their enrolled dependents on the medical, dental, and vision plans. Additionally, eligible dependents may be added to a plan during Open Enrollment or due to a Qualifying Life Event.
Eligible dependents may participate in the plans in which you are enrolled. Eligible dependents are:
- Your lawful spouse (marriage, civil union, or common-law
- Your children who are less than 26 years old (natural-born, adopted, step-children, and legal guardianship)
- Your dependent children that are age 26 or more years old that are primarily supported by you and incapable of self-sustaining employment by reason of mental or physical handicap that are enrolled on the plan before age 26 – You may be required to provide proof of the child’s dependent status to the plan carrier or to the Employee Benefits Division.
Visit the Retiree section of our Employee Benefits Website to find the latest Retiree Benefits Brochure which includes plan costs.
The County provides a subsidy for retiree EPC medical plan premiums based on years of service. The retiree subsidies may be re-evaluated and adjusted each year. There are no subsidies for dependent coverage or the dental or vision plans.
Premiums are deducted from your monthly pension.
If pension pay does not cover the premium total, information will be provided to you for payment submissions.
Your first month of retirement's premiums will need to be paid by you to the Employee Benefits Division no later than 2 weeks after your retirement date. This is because your pension pay will begin in the month following your retirement date. Our payment portal can be found under the “Make an EPC Benefits Premium Payment” section on the Employee Benefits Website. Use your employee ID as the account number. Transaction fees will apply as listed below.- Electronic check: $0.95 per electronic check transaction
- Credit/debit card: 2.39%, minimum $2.00, per card transaction
Years of service details are provided to us by the Retirement Office for use in the application of the Medical Plan Subsidy.
Purchased years will not apply toward the Medical Plan Subsidy year of service for employees hired on or after January 1, 2022.
Visit the Retiree section of our Employee Benefits Website to find the latest Retiree Benefits Brochure which include plan costs.
The County provides a subsidy for retiree EPC medical plan premiums based on years of service. The retiree subsidies may be re-evaluated and adjusted each year. There are no subsidies for dependent coverage or the dental or vision plans.
Plan premiums may change as the County's cost for the plans change, whether an increase or decrease.
Benefits are reviewed regularly, through careful analysis, thorough research, and collaborative effort. The Employee Benefits Division provides updated retiree subsidy schedules and premium information annually in the Retiree Benefits Brochure available on the Employee Benefits Website in the Retiree section.
Medical premiums can change for retirees with less than a 100% medical plan subsidy. Dental and Vision premiums can change as these premiums are fully paid by the retiree.
Yes.
At the time of retirement, you may remove dependents from your benefits. You will not be able to add dependent or change plan levels (e.g. Dental Plan option change) at this time without a Qualifying Life Event.
Outside of your initial retiree elections, you may add or remove eligible dependents from your enrolled plans at Open Enrollment or with a Qualifying Life Event.
No. If at any point you waive a benefit, you will not have the option of electing to have that benefit in the future.
If your eligible dependent loses or gains other coverage - employer/group, Medicare, or Medicaid - you are able to make changes to your enrolled* benefits due to a Qualifying Life Event.
Visit the Retiree section of our Employee Benefits Website and for documents and forms.
You can make changes to your benefits by submitting a Retiree Benefit Election Form to the El Paso County Employee Benefits Division within 31 days of the life event effective date. Documentation is required for the event. If there is no qualifying life event, changes can only be made at annual Open Enrollment
Required documentation:
- Completed El Paso County Retiree Benefit Election Form
- Proof of other coverage including who is/was covered, the type of coverage (medical/dental/vision), and when coverage starts/ends.
- If adding a dependent, proof of relationship - spouse: marriage certificate; child: birth certificate
*If you have waived a benefit for yourself, you cannot elect to add this benefit at any point.
If you have a Qualifying Life Event as defined by the IRS (i.e., marriage, divorce, loss of group coverage, etc.) you can make changes to your enrolled* benefits by submitting a Retiree Benefit Election Form to the El Paso County Employee Benefits Division within 31 days of the life event effective date. Documentation is required for the life event and, if adding a dependent, proof of relationship. If there is no qualifying life event, changes can only be made at annual Open Enrollment.
Visit the Retiree section of our Employee Benefits Website and for documents and forms.
Required documentation: Contact the Employee Benefits Division for guidance.
*If you have waived a benefit for yourself, you cannot elect to add this benefit at any point.
Open enrollment is the annual period when you can change* your health plan benefits.
Open enrollment is held annually in the fall, typically in October. Changes made at open enrollment are effective January 1st of the following year.
Outside of open enrollment, changes during a plan year can only be made with a qualifying life event.
*If you have waived a benefit for yourself, you cannot elect to add this benefit at any point.
Pre-Medicare retirees (under age 65) that elect to continue the EPC Medical Plan are eligible to continue participating in Reach Your Peak (RYP) and RYP+.
RYP+ perks include prize entries and Health Reimbursement Account (HRA); the premium reduction does not apply for retiree participation.
RYP+ enrollment must be completed annually to participate.
Employees separating from the County have the option to continue Life Insurance and Supplemental Benefit plans through the plan carrier, Unum. Contact Unum within 90 days of your coverage end date at 1-866-220-8460 for an assistance with continuing these benefits.
Using Your Benefits
Yes. The plans can be used nationwide.
Contact the plan's member services for questions regarding coverage and limitations outside of the U.S.
Upon Retirement, you will not receive new Dental or Vision Plan ID cards. You will only receive new Medical Plan ID cards if:
- You removed a dependent - Until your new card arrives, you can use your existing medical plan ID card as the member ID will remain and be the same for all members.
- You are Medicare-eligible - Your Medical Plan will change to the Medicare-eligible plan.
Pre-Medicare Medical
The El Paso County Pre-Medicare Medical Plan is an EPO medical plan. EPO stands for Exclusive Provider Organization. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care.
An EPO has no out-of-network benefits. That means if you utilize a provider or hospital outside of the network, you are responsible for 100% of the claim.
In-network provider listings can be accessed online by going to the Quantum Health portal or calling Quantum Health.
elpasocobenefits.com | (866) 885-1484
Download the App: Apple App Store or Google Play
Medicare-Eligible Medical
The El Paso County Retiree Medicare Eligible Medical and Prescription Plan is accepted anywhere Medicare is accepted.
Retiree First is the administrator of the El Paso County Retiree Medicare Eligible Medical and Prescription Plan. Retiree First is a full-service retiree benefit manager. Their team of dedicated member advocates are available to help you with Medicare or prescription needs, from ordering cards to assisting with medical claims and prescription billing issues and offering advocacy and support.
(719) 249-7788, TTY 711 or Toll Free (855) 531-8844, TTY 711
Dental
Dental Plan network providers can be found on the Delta Dental of Colorado website.
On the Delta Dental of Colorado homepage, click “Find a Dentist.” Enter your search parameters by selecting “Plans Participating In” (Delta Dental PPO or Delta Dental PPO Plus Premier), entering your location (address or zip code) and/or other criteria you wish to include, then click “Search.” The list will indicate the networks in which each provider participates. The greatest discount and least out-of-pocket to you will be with a Delta Dental PPO network provider.
deltadentalco.com | (800) 610-0201
Download the App: Apple App Store or Google Play
Vision
Vision Plan network providers can be found on the EyeMed website.
On the EyeMed homepage, click “Find an eye doctor.” Choose your network (Access) and click “use my location” or enter your ZIP code and click “search by ZIP.”
eyemed.com | (866) 723-0596
Download the App: Apple App Store or Google Play
Pre-Medicare Medical & Prescription
Quantum Health is here to simplify your healthcare experience by explaining your benefits, giving you access to or replacing your ID cards, finding in-network providers, and so much more.
elpasocobenefits.com | (866) 885-1484
Download the App: Apple App Store or Google Play
Medicare-Eligible Medical & Prescription
Retiree First is the administrator of the El Paso County Retiree Medicare Eligible Medical and Prescription Plan. Retiree First is a full-service retiree benefit manager. Their team of dedicated member advocates are available to help you with Medicare or prescription needs, from ordering cards to assisting with medical claims and prescription billing issues and offering advocacy and support.
(719) 249-7788, TTY 711 or Toll Free (855) 531-8844, TTY 711
Dental
Contact Delta Dental of Colorado.
deltadentalco.com | (800) 610-0201
Download the App: Apple App Store or Google Play
Vision
Contact EyeMed
eyemed.com | (866) 723-0596
Download the App: Apple App Store or Google Play
Lantern Surgical Care is available to Pre-Medicare Medical Plan enrollees.
Visit the Medical section of our Employee Benefits Website for information about Lantern Surgical Care.
The Galleri Multi-Cancer Early Detection Test is available to Pre-Medicare Medical Plan enrollees.
Visit the Medical section of our Employee Benefits Website for information about Galleri Multi-Cancer Early Detection Test.
SleepCharge is available to Pre-Medicare Medical Plan enrollees.
Visit the Medical section of our Employee Benefits Website for information about SleepCharge.
Medicare-eligible retirees should seek transition of care to a Medicare provider. Contact RetireeFirst at (719) 249-7788, TTY 711 or Toll Free (855) 531-8844, TTY 711 for assistance.Medicare
If you or your spouse are or are becoming Medicare-eligible by your retirement date, you will need to enroll in Medicare Part A and Part B to participate in the El Paso County Medicare-eligible Medical Plan.
- We recommend beginning the enrollment process with Medicare as soon as possible, but ideally, 8 weeks prior to your retirement date. You will need to enroll in Medicare Part A and Part B.
- For Special Enrollment:* When you are ready to begin the enrollment process, you will need a Medicare Employment Verification Form as proof of employer-sponsored health coverage. Contact the Employee Benefits Division for this form.
- Be sure to request that your Medicare coverage becomes effective on your official retirement date – first of the month following your last day of employment. (If approved for paid leave beyond your last day of work, your last day of employment will be the last day of approved leave.)
Failure to enroll by/with the required effective date for Medicare Part A and Part B, any lapse in Medicare Part A and Part B, or enrollment in another Medicare plan will forfeit your eligibility for the El Paso County Medicare-eligible Medical Plan.
Medicare may apply premium penalties for each month that you are not covered. Please visit Medicare.gov for enrollment information and requirements.
If you are enrolled in the County's Pre-Medicare Medical Plan and Prescription Plans, coverage will terminate effective the date the retiree or spouse is Medicare eligible. Medicare-eligible retirees/spouses are offered a Medicare-Eligible Medical Plan.
Visit the Retiree section of our Employee Benefits Website for information on the current plan.
For this QLE, you would submit the following items to the El Paso County Employee Benefits Division within 31 days of the life event effective date.
Note: Medicare eligibility does not allow for changes to dental or vision coverage – these benefit changes can be made during open enrollment.
If you wish to waive medical plan coverage due to Medicare eligibility: You must complete a Retiree Benefit Election Form and provide proof of Medicare coverage and submit to the Employee Benefits Division by the end of the month prior to you turning 65.
If you wish to continue your medical plan coverage with El Paso County:* You will have the opportunity to enroll in the County’s Medicare-eligible plan; you must enroll in Medicare Part A and Part B in order to be eligible.
- RETIREE ELECTION FORM: Complete the El Paso County Retiree Benefit Election Form. Only the Medical Plan option for the Medicare-eligible individual can be changed with this event. This form must be signed by the El Paso County retiree.
- MEDICARE ELIGIBLE ENROLLMENT FORM: Complete the Medicare Eligible Enrollment Form. This form must be signed by the Medicare-eligible individual.
- A copy of the Medicare card verifying enrollment in Medicare Parts A and B.
The forms must be submitted to the Employee Benefits Division no later than the end of the month prior to you turning 65. Failure to enroll timely may result in disqualification for eligibility to enroll in the County’s Medicare-eligible plan.
*Enrollment is dependent on the receipt of your Retiree Benefit Election Form, Medicare Eligible Enrollment Form, and Medicare Part A and Part B enrollment. Enrollees of the Medicare-Eligible Plan must be enrolled in and maintain enrollment in Medicare Part A and Part B. Medicare Part A and Part B premiums are the enrollee’s responsibility and are typically deducted from Social Security benefits. Any lapse in Medicare Part A and Part B coverage will forfeit/terminate your Medical Insurance. Enrollees of the Medicare Eligible Plan cannot be enrolled in another Individual Medicare Advantage (MA), Medicare Advantage Prescription Drug Plan (MAPD) or Individual Part D Prescription Drug Plan (PDP) at the same time as this group plan through El Paso County. Other coverage will forfeit/terminate your Medical Insurance.Yes. The Pre-Medicare Eligible Medical and Prescription Plans will terminate effective the date the retiree or spouse is Medicare eligible. Medicare-eligible retirees/spouses are offered a Medicare-Eligible Medical Plan.
Visit the Retiree section of our Employee Benefits Website for information on the current plan.
Medicare enrollment starts three (3) months before you turn 65. You should review materials from the Social Security Administration and enroll in the appropriate plan coverage. Around this time, you will also receive a Retiree Benefit Election Form with a letter from El Paso County providing instructions for continuing or waiving medical plan coverage on the Medicare Eligible Medical and Prescription Plans. If you do not receive the letter/packet 45 days prior to your 65th birthday, you must contact the Employee Benefits Division prior to turning 65.
Medicare eligibility does not allow for changes to dental or vision coverage – these benefit changes can be made during open enrollment.
If you wish to waive medical plan coverage due to Medicare eligibility: You must complete a Retiree Benefit Election Form and provide proof of Medicare coverage and submit to the Employee Benefits Division by the end of the month prior to you turning 65.
If you wish to continue your medical plan coverage with El Paso County:* You will have the opportunity to enroll in the County’s Medicare-eligible plan; you must enroll in Medicare Part A and Part B in order to be eligible.
- RETIREE ELECTION FORM: Complete the El Paso County Retiree Benefit Election Form. Only the Medical Plan option for the Medicare-eligible individual can be changed with this event. This form must be signed by the El Paso County retiree.
- MEDICARE ELIGIBLE ENROLLMENT FORM: Complete the Medicare Eligible Enrollment Form. This form must be signed by the Medicare-eligible individual.
- A copy of the Medicare card verifying enrollment in Medicare Parts A and B.
The forms must be submitted to the Employee Benefits Division no later than the end of the month prior to you turning 65. Failure to enroll timely may result in disqualification for eligibility to enroll in the County’s Medicare-eligible plan.
*Enrollment is dependent on the receipt of your Retiree Benefit Election Form, Medicare Eligible Enrollment Form, and Medicare Part A and Part B enrollment. Enrollees of the Medicare-Eligible Plan must be enrolled in and maintain enrollment in Medicare Part A and Part B. Medicare Part A and Part B premiums are the enrollee’s responsibility and are typically deducted from Social Security benefits. Any lapse in Medicare Part A and Part B coverage will forfeit/terminate your Medical Insurance. Enrollees of the Medicare Eligible Plan cannot be enrolled in another Individual Medicare Advantage (MA), Medicare Advantage Prescription Drug Plan (MAPD) or Individual Part D Prescription Drug Plan (PDP) at the same time as this group plan through El Paso County. Other coverage will forfeit/terminate your Medical Insurance.The El Paso County Medicare-Eligible Medical Plan is a Medicare Advantage Prescription Drug (MAPD) plan.
Medicare Advantage (Part C) plans cover the same services as original Medicare. Additionally, our group plan is accepted anywhere Medicare is accepted.
When this coverage is effective, you will only need your MAPD ID Card for Medical and Prescription (Part D) coverage. The MAPD will act as your primary insurance for medical and you will not need to use your Medicare ID card. Keep your Medicare ID card somewhere safe.
Medicare Part A and Part B premiums are the enrollee’s responsibility and are typically deducted from Social Security benefits.
No. Medicare-eligible retirees and their spouses are not eligible for RYP enrollment.
RYP enrollment and RYP+ Health Reimbursement Account (HRA) will terminate and HRA funds will be forfeited effective the date the retiree is Medicare eligible. Retirees with HRA balances remaining at the time they become Medicare eligible have a 3-month runout period after the HRA termination date to submit claims to Employee Benefits Corporation (EBC) for services received prior to the termination date.
For more information about RYP, visit the RYP FAQ page.
Possibly. Medical premiums will change for retirees with less than a 100% medical plan subsidy or if you have spouse/family coverage.
Premiums and subsidy schedules can be found in Retiree Benefits Brochure available on the Employee Benefits Website in the Retiree section.
Yes. The County's Medicare-Eligible Medical Plan deductible, coinsurance, and copays differ from the Pre-Medicare Plan.
Annual Deductible for Part A Services: $250
Annual Out-of-Pocket Maximum for Part B Services: $2,250
For more coverage information, view the Retiree Benefits Brochure on the Employee Benefits Website in the Retiree section.
Maybe. The County's Medicare-Eligible Prescription Plan has the same copay schedule as the Pre-Medicare plan, however, the formularies will differ.
Generic medication cost will not differ. Brand names could change tiers based on the plan's formulary.
| Prescription Plan Tiers |
Retail |
Retail or Mail Order Up to 90 Day Supply |
Specialty Mail Order |
| First Tier (Generic) |
$6.00 |
$15.00 |
|
| Second Tier (Preferred Brand) |
$30.00 |
$75.00 |
|
| Third Tier (Non-Preferred Brand) |
$50.00 |
$125.00 |
|
| Specialty Drugs |
$100.00 |
$100.00 |
Only if they are not in the plan's network.
The El Paso County Medicare-Eligible Medical Plan is accepted anywhere Medicare is accepted.
There should be little to no pharmacy disruption. The Medicare-Eligible Prescription Drug Plan has over 65,000 pharmacies in network.
Tuition Reimbursement FAQ
Tuition Reimbursement FAQ
El Paso County's Tuition Reimbursement Program helps eligible employees invest in their education while growing their careers. The questions below cover program eligibility, requirements, qualifying expenses, and other important information to help you make the most of this benefit.
Getting Started
Full-time, regular employees are eligible for the Tuition Reimbursement Program if they have not been on a Corrective Action Plan (CAP) or received disciplinary action, as outlined in Chapter 7 of the El Paso County Personnel Policies Manual, within 12 months before completing their course(s).
Participation is subject to available funding.
The Personnel Policies Manual can be found on the Human Resources Website.
CLICK HERE to view the full Tuition Reimbursement Guidelines and Procedures document.
Visit the Employee Benefits Tuition Reimbursement Webpage to access Tuition Reimbursement documents and links.
To submit your Tuition Reimbursement application, you will complete the following steps.Step 1. Review the Tuition Reimbursement Guidelines in their entirety.
Step 2. Complete the Tuition Reimbursement Form Phase 1 no later than two (2) weeks after starting a course.
Documentation needed to complete this form:
-
- Syllabus for each course
- Financial aid information – if receiving grants, scholarships, stipends, or other reimbursements
Documentation needed to complete this form:
-
- Unofficial transcript identifying satisfactory completion of the course(s).
- Itemized bill from the educational institution documenting all incurred expenses. Must include payments from grants, scholarships, stipends, and other reimbursements, if applicable.
To be considered for Tuition Reimbursement, submit the required application and supporting documentation no later than 2 weeks after your course begins.
There are no requirements before enrolling in a course.
The Tuition Reimbursement Program application is a 2-part process.
Phase 1. To participate, complete and submit the required form and supporting documentation no later than 2 weeks from the start of your course.
The El Paso County Employee Benefits Division will review the submission and make a decision on pre-qualification.Phase 2. If pre-qualified, complete and submit the required form and supporting documentation no later than 30 days after the completion of the course for review and approval of Tuition Reimbursement.
Phase 1. Documentation needed to complete this form:
- Syllabus for each course
- Financial aid information – if receiving grants, scholarships, stipends, or other reimbursements
Phase 2: Documentation needed to complete this form:
- Unofficial transcript identifying satisfactory completion of the course(s).
- Itemized bill from the educational institution documenting all incurred expenses. Must include payments from grants, scholarships, stipends, and other reimbursements, if applicable.
Eligible Schools & Expenses
Only an accredited educational institution or program is eligible. To determine whether an educational institution is accredited, visit the U.S. Department of Education website.
Tuition Reimbursement is only for the cost of tuition (cost per credit hour).
Scholarships, grants, or any other reimbursements will be subtracted from the cost of tuition.
Tuition Reimbursement is only for the cost of tuition (cost per credit hour).
General exclusions include the following:
- Taxes
- Fees
- Textbooks
- School supplies (e.g., computer, tablet, notebooks, pencils)
- Transportation
- Room and board
- Debts or loans from previous terms
- Tuition for which the employee receives a scholarship, grant, or other reimbursement that covers the cost of tuition (tuition amounts remaining after scholarship, grants, etc. have applied would be eligible)
No. Employees may request tuition reimbursement for eligible courses even if they are not pursuing a degree.
Yes. You don’t have to be pursuing education directly related to your current job. As long as the coursework is in a field where the County typically recruits employees, it may qualify for Tuition Reimbursement. Eligible programs include professional certificates, associate, bachelor’s, master’s, and doctoral degrees.
Some may qualify.
Courses through an accredited educational institution qualify for Tuition Reimbursement.
Testing fees to obtain a professional certificate or license do not qualify for Tuition Reimbursement. These costs should be reviewed for approval by the head of department/office or designee and paid for from their budget.
If your scholarships, grants, and/or other reimbursements amount to less than the full cost of tuition, that remaining amount qualifies for tuition reimbursement up to the applicable term maximum.
Reimbursement Process
Employees may be eligible to receive up to $5,250 per calendar year. Course term length maximums are provided below.
- Up to 11 weeks: $1,312.50 maximum
- 12-14 weeks: $1,750 maximum
- 15+ weeks: $2,625 maximum
Tuition Reimbursement is dependent on the amount appropriated in the calendar year’s budget. There is no guaranteed distribution of funds; it is expressly subject to availability.
There is no limit in number of courses, however there are reimbursement limits based on course term length.
Course term length maximums are provided below.
- Up to 11 weeks: $1,312.50 maximum
- 12-14 weeks: $1,750 maximum
- 15+ weeks: $2,625 maximum
Tuition Reimbursement is dependent on the amount appropriated in the calendar year’s budget. There is no guaranteed distribution of funds; it is expressly subject to availability.
Allow 4 weeks from your completed submission of the Phase 2 form for a decision notice (approval/payment or denial). A decision notice will be sent to you via Microsoft Teams and your County email inbox. If approved, the notice will provide the date you can expect payment.
Employment Requirements
Corrective Action Plan (CAP) and disciplinary information can be found in Chapter 7 of the El Paso County Personnel Policies Manual which is located on the Human Resources Website.
If you leave the County for any reason, other than a layoff, you’ll be required to repay 100% of any Tuition Reimbursement you received during the 12 months before your employment ends.
Any repayment will be deducted from your final paycheck. If your final paycheck doesn’t cover the full amount, you must repay the remaining balance or sign a payment arrangement within three (3) days of your separation.