ESR Review and Updates May/June Edition

ESR Review and Updates May/June Edition. Image of a minnesota lake in the summer during the daytime.

Photo by: Flickr user Mr. Moment

Waiver of medical coverage

Recently, SEGIP issued a new policy allowing some employees to waive medical coverage. This new policy allows employees eligible for the full employer contribution under law but NOT under the applicable labor agreement or compensation plan to waive coverage.

Remember that:

  • Agencies are responsible for informing employees when they are eligible to waive and to provide them the waiver form
  • Employees eligible only under law have the option to elect medical coverage or waive medical coverage—meaning it’s their decision

Employees eligible for the full employer contribution under the applicable labor agreement or compensation plan may NOT waive coverage.

Waiver forms, procedures, and information on SEMA4 coding are available on the SEGIP insurance eligibility webpage.

Waive coverage when moving from full-time to part-time

An employee who was expected to average at least 30 hours of service per week may revoke (drop/waive) medical coverage if the employee’s status changes so that the employee is expected to average less than 30 hours of service. This is true:

  • Even if the reduction in hours does not result in loss of eligibility for medical coverage; and
  • For all types of Reg/Temp code appointments, including Unlimited.

This reduction in hours is a new qualifying life event. Whenever an employee experiences a qualifying life event the employee may change coverage to the extent it corresponds to the life event. With this reduction in hours the employee may waive medical coverage but no other changes to their benefit elections may be made.

The new qualifying life event language is on the SEGIP understand your benefits webpage. Click on Summary of Benefits (the life event language is on page 20)

Waiver and Special Eligibility Codes

We have added the Special Eligibility Code DWF. It indicates that a Seasonal basis employee may waive coverage.

It is important to use the “D” series Special Eligibility Codes to identify a Seasonal Basis employee. If the “D” series codes are not used then the employee will be listed as a NOT Seasonal Basis employee on our reports. When this occurs an agency may receive a penalty because a Seasonal Basis employee is eligible for coverage under different circumstances than a Not Seasonal Basis employee.

  • We recommend that agencies with Seasonal Basis employees review all employees with the Special Eligibility Code “AW12 or AW9.” If any of those employees are Seasonal Basis employees be sure to change their code to “DWF.”

We are in the process of updating the Special Eligibility Code Chart in our resources and reference documents. Once revised, we will repost these documents and let you know they are completed. In the interim, check the website for updated information.

PRO agreements and insurance eligibility

It may be necessary to review all PRO (Post Retirement Option) agreements that were in place prior to January 1, 2015, to ensure the insurance provision is correct. An employee may NOT receive both an employer contribution towards insurance coverage and an employer contribution to the Heath Care Saving Plan (HCSP) administered by MSRS. We are in the process of updating the PRO policy to reflect the ESR and the new waiver policy. We will let you know when the new version is completed.


For questions about SEMA4 coding, please contact your SEMA4 HR Specialist. For questions about an employee’s eligibility, please contact your Agency Services Account Representative. You can find their contact information on the SEGIP insurance eligibility webpage.