Paul Sanchez
OPERS, the health care program, offers a range of medical insurance options to its benefit recipients. The OPERS Connector helps eligible individuals find and enroll in a suitable medical plan and also administers the OPERS Health Reimbursement Arrangement (HRA). While OPERS does not cover the entire cost of health insurance, it does provide flexibility, allowing participants to opt for lesser coverage to potentially cover the full premium with money left over for dependent coverage or future healthcare expenses. OPERS is also compliant with the Affordable Care Act, ensuring that pre-existing conditions are not restricted and that essential health benefits are covered. Medicare-eligible recipients specifically have access to a wide range of Medicare plans, and they must enroll in both Medicare Parts A and B.
| Characteristics | Values |
|---|---|
| Does OPERS offer medical insurance? | OPERS does not offer medical insurance but provides access to a wide range of Medicare plans from over 90 national and regional health insurance companies. |
| Who is eligible for OPERS? | Pre-Medicare and Medicare benefit recipients. |
| What is the OPERS Health Reimbursement Arrangement (HRA)? | OPERS HRA assists benefit recipients in finding and enrolling in a medical plan. |
| What is the OPERS Connector? | The OPERS Connector helps eligible OPERS benefit recipients find and enrol in an individual Medicare plan. |
| What is the OPERS vision and dental plan? | OPERS benefit recipients can enrol in optional OPERS vision and dental plans. |
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What You'll Learn
OPERS Connector
The OPERS Connector is a service that helps benefit recipients find and enrol in a medical plan. It also administers the OPERS Health Reimbursement Arrangement (HRA). The OPERS Connector provides access to a wide range of Medicare plans from over 90 of the largest national and regional health insurance companies.
OPERS benefit recipients must enrol in both Medicare Parts A and B as soon as they become eligible. Medicare is federal health insurance for individuals aged 65 and older, those under 65 with specific disabilities, and people of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or kidney transplant). Once enrolled, individuals will select a Medicare Advantage plan or a Medigap plan (Medicare Supplement) and a Medicare D prescription drug plan using the OPERS Connector.
It is important to note that Medicare costs vary depending on the plan, coverage, and services used. While OPERS provides reimbursement for certain expenses, it does not cover the entire cost of health insurance. Participants have the flexibility to opt for lesser coverage to cover the full premium and potentially have money left over for dependent coverage or future healthcare expenses.
Pre-Medicare benefit recipients are not required to enrol in a medical plan through Via Benefits to receive monthly HRA deposits or reimbursements. However, they will be required to do so once they become Medicare-eligible. Medicare-eligible benefit recipients must enrol in a Medicare medical plan through the OPERS Connector to receive monthly HRA deposits from OPERS.
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Pre-existing conditions
OPERS, the Ohio Public Employees Retirement System, offers health care coverage to retirees aged 60 or older with at least 20 years of qualifying service and to all retirees with 30-32 years of qualifying service. This is dependent on the group. However, it is important to note that Ohio law does not require OPERS to provide health care coverage.
OPERS has partnered with Via Benefits to create the OPERS Connector, which helps benefit recipients find and enrol in a medical plan. Via Benefits offers ongoing support for carrier claim resolution and medical plan questions. The OPERS Connector assists retirees in understanding coverage options through a robust online experience supported by a customer service team.
The OPERS health care program does not aim to cover the entire cost of health insurance. However, it does offer some flexibility. Participants can opt for lesser coverage, which may allow them to cover the full premium and potentially have money left over for dependent coverage or future health care expenses.
OPERS is compliant with the Affordable Care Act (ACA), which means that pre-existing conditions are covered. Health insurance companies cannot refuse to cover individuals or charge them more due to pre-existing conditions. This protection applies to all plans offered by healthcare.gov and the OPERS Connector's private market.
Additionally, OPERS provides an HRA (Health Reimbursement Arrangement) account, which offers tax-free reimbursement for qualified medical expenses, including monthly insurance premiums, deductibles, co-insurance, and co-pays. This is available to eligible retirees, regardless of their location, even outside the United States.
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Medicare
OPERS, or the Ohio Public Employees Retirement System, offers health care benefits to its members. These benefits include helping members find and enrol in a medical plan and administering the OPERS Health Reimbursement Arrangement (HRA).
OPERS provides benefits to both Pre-Medicare and Medicare recipients. Medicare is a federal health insurance program for people aged 65 and older, or under 65 with certain disabilities, and for people of any age with End-Stage Renal Disease (ESRD) or permanent kidney failure requiring dialysis or a kidney transplant.
As an OPERS benefit recipient, you must enrol in both Medicare Parts A and B as soon as you become eligible. Medicare costs vary depending on the plan, coverage, and services used. Once enrolled, you will select a Medicare Advantage plan or a Medigap plan (Medicare Supplement) and a Medicare D prescription drug plan using the OPERS Connector. It is important to note that most Medicare Advantage plans include prescription coverage, so you may not need to enrol in a separate Part D plan.
During your enrolment, a Licensed Benefit Advisor from Via Benefits will guide you through the plan selection process. Via Benefits is a resource that provides access to a wide range of Medicare plans from numerous national and regional health insurance companies.
If you did not pay Medicare tax during your public employment career, you will not have access to Medicare Part A without paying a monthly premium. However, Ohio law allows OPERS to provide premium reimbursement to those who are not eligible for premium-free Medicare Part A. As a Medicare-eligible OPERS benefit recipient, you are required to enrol in and pay the monthly premium for Medicare Part A coverage through the Centers for Medicare and Medicaid Services. OPERS provides a monthly reimbursement for your Medicare Part A premium cost and a 50% reimbursement for eligible spouses.
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Vision and dental plans
OPERS (Ohio Public Employees Retirement System) offers optional vision and dental plans to anyone receiving a monthly OPERS benefit payment, even if they don't qualify for the Health Reimbursement Arrangement (HRA). However, the net monthly benefit payment must be enough to cover the full premium amount.
Eligible dependents can also be enrolled in the same plan, at the same level option (low or high), when the primary benefit recipient first enrols or during open enrolment. Eligible dependents include the spouse of the primary benefit recipient, a biological or legally adopted child of the primary benefit recipient under the age of 26 (regardless of marital status), or the minor grandchild of the primary benefit recipient if the grandchild is born to an unmarried, unemancipated minor child, and the primary benefit recipient is ordered by the court to provide coverage.
Once enrolled, the recipient and any enrolled dependents must remain enrolled until the next open enrolment period unless there is a change in family status, including divorce, death, or a child reaching age 26. If there is a change in family status, OPERS must be notified immediately to avoid any overpayments.
If a recipient is enrolled in OPERS and another insurance carrier's vision and/or dental plan, they should review their coverage needs to determine if both plans are necessary.
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Reimbursements
OPERS, the Ohio Public Employees Retirement System, offers health care benefits to its members. These benefits include reimbursements for health care expenses, which are administered through the OPERS Health Reimbursement Arrangement (HRA).
The OPERS HRA is a flexible spending account that allows members to set aside pre-tax dollars to pay for eligible health care expenses. These expenses can include items such as deductibles, co-pays, prescription drugs, and other qualified medical expenses. The HRA can be used to reimburse members for expenses incurred by themselves or their qualified dependents, even if they are not enrolled in an OPERS medical plan.
To be eligible for the HRA, members must be enrolled in a Medicare plan through the OPERS Connector. The OPERS Connector provides access to a wide range of Medicare plans from national and regional health insurance companies, and members can choose the plan that best suits their needs. Once enrolled, members can submit claims for reimbursement from their HRA to cover their health care expenses.
It is important to note that not all expenses are eligible for reimbursement through the HRA. For example, employer-sponsored health insurance plan premiums are only eligible for reimbursement if they are paid post-tax. Additionally, members living outside the United States and District of Columbia may still be eligible for HRA deposits and can seek health care coverage through their country of residence or enrol in a plan with international coverage.
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Frequently asked questions
OPERS provides access to a wide range of Medicare plans from over 90 national and regional health insurance companies. OPERS also offers reimbursement for Medicare Part A premium costs.
You can enrol in a medical plan through the OPERS Connector, which assists benefit recipients in finding and enrolling in a plan. You can also enrol in a plan with Via Benefits, which provides ongoing support for carrier claim resolution and medical plan questions.
The HRA is a health reimbursement arrangement that OPERS benefit recipients can use to receive reimbursements for medical expenses. Pre-Medicare benefit recipients are not required to enrol in a medical plan through Via Benefits to receive monthly HRA deposits or reimbursements. However, Medicare-eligible recipients must enrol in a medical plan through the OPERS Connector to receive monthly HRA deposits.
Yes, benefit recipients living outside the United States can opt in to the HRA and receive monthly deposits from OPERS. They can seek health care coverage through the foreign country in which they live or enrol in a plan with an insurance carrier that offers international coverage.
