The Ohio Public Employees Retirement System is publishing a series of six videos to explain the key factors of the upcoming OPERS Health Plan changes, which begin in 2014.
The third video in the series discusses the program’s new transition plan. The video features OPERS Health Care Director Marianne Steger.
You can click here to watch the video, which is on our YouTube channel.
During the video, Steger refers to the Comprehensive Guide to Pension and Health Care Changes. You can link to the guide for current members here. Click on this link for the guide that was written for retirees.
Is it possible to have the information posted for people to read?
JA,
Much of this information is contained in the Comprehensive Guides to Pension and Health Care Changes, which we mailed to members last year and which are on our website. Click on the large “Pension & Health Care Changes” box at the top, and you’ll then find the links to the guides.
–Ohio PERS
Why didn’t you discuss the transition for spousal health care?
Chris,
We are going to post a separate video on the implications of the new health care program on spouses and children of members. We discuss the transition in that video. Look for it next week.
–Ohio PERS
I am extremely unhappy with the information provided by OPERS in its OPERS 2013 Health Care Open Enrollment Guide. Page 10 of the OPERS 2013 Health Care Open Enrollment Guide promised me and my wife that if I enrolled in the MetLife Dental High Option Plan than it would provide 50 percent coverage for dentures. So I enrolled in the MetLife Dental High Option Plan with an effective date of coverage of January 1, 2012 with $59.64 being deducted from my OPERS pension being deducted each month for the supposed coverage. My wife and I have not tried to used the coverage until yesterday, when our dentist informed us that MetLife would not provide any coverage whatsoever for the dentures that my wife ordered from him. The MetLife customer service representative informed me when I called MetLife that the OPERS MetLife High Option Plan has a “missing tooth exclusion/prior loss clause” which means that it would not pay to replace my wife’s dentures. She also said that the only way that it would provide coverage for replacing my wife’s dentures is if she paid for her new dentures out-of-pocket and filed a claim 8 YEARS LATER, even though OPERS is eliminating spousal health care coverage entirely in less than 8 years.
I detrimentally relied on the information that OPERS provided me and my wife in its OPERS health care open enrollment guide, which has already cost me well over eight hundred dollars for supposed coverage that my wife and I haven’t received.
I am shocked that my wife and I are being treated so horribly by MetLife and that OPERS led us to believe that we were receiving quality dental care coverage, when I have since discovered from this denial of coverage incident that MetLife has a bad reputation for denying dental insurance claims.
I assert that OPERS should pay for the coverage it promised my wife and I that we would receive or refund the many hundreds of dollars that I paid for the “high” option dental care coverage that MetLife is refusing to provide.
I also strongly suggest that OPERS find a better dental care plan for its members and do a much better job of providing information to its members about its offered health care plans and protecting them from bean-counting insurance companies, who use boilerplate legalese language to deny claims.
After all, my wife wasn’t filing a claim for a missing tooth or prior loss, but for denture replacement coverage that OPERS led us to believe that it was providing us coverage for.
Arnold,
The MetLife certificate of coverage explains the exclusion you are referring to. Check page 20 of the coverage certificate that you should have received upon signing up. Here is part of the information. For more information, contact MetLife:
Type C Covered Services
5. Replacement of a non-serviceable fixed Denture if such Denture was installed more than 8 years prior to replacement.
6. Replacement of a non-serviceable removable Denture if such Denture was installed more than 8 years prior to replacement.
–Ohio PERS
That information should have been provided before I signed up. I relied upon the information provided by OPERS in its 2013 Health Care Open Enrollment Guide, which did not mention any such exclusion.
OPERS should have provided this information to protect its members, but it didn’t.
So I have paid hundreds of dollars for dental health care benefits that my wife is ineligible to receive, according to MetLife.
This plain stinks!
So what remedies will OPERS provide my wife and I with?
Can I at least cancel this horrible MetLife Dental Insurance immediately?
Arnold,
Members may enroll only in the dental/vision plan when they first retire, or during our open enrollment period. After they enroll, they must remain enrolled until the next open enrollment period unless there is a change in family status, including a divorce, death or a child reaches age 26. Members must notify OPERS immediately of a change in family status.
–Ohio PERS
I have tried many time to use the health care planning tool on my I pad and my wife’s computer and can not get it to do anything. Any tricks that I can use?
Charles,
We have found that it’s best to have the latest version of spreadsheet software. If you are using Excel, you need Excel 2010.
–Ohio PERS
Why wasn’t I provided notice of this boilerplate legalese clause in the OPERS 2013 Health Care Open Enrollment information I was sent by OPERS?
I relied on the information provided by OPERS, which did not warn me there was exclusions to what it promised that the MetLife Dental Insurance would cover.
OPERS should have provide my wife and I and all other OPERS members with complete information about their health care coverage.
It didn’t, and it has cost me many hundreds of dollars for relying on the incomplete information that OPERS gave me, and it will cost many hundreds of dollars more, since OPERS has now informed me that I can’t immediately cancel its lousy MetLife dental insurance coverage.
Has any decision been made yet regarding Dental and Vision plans for retirees using the Connector?
Bill,
Thanks for asking. The answer is no. It’s possible that it will be part of the Connector. But we might find that it’s more affordable to provide dental and vision plans on the open market. This issue has not been decided.
–Ohio PERS
Will there be a video explaining health care for people over 65 who do not qualify for medicare part A? Where can I get information on this?
Susan,
Retirees and spouses not eligible for premium-free Medicare Part A will be enrolled in an OPERS-sponsored Medicare Part A equivalent plan. Spouses without Medicare A will also have access to an OPERS-sponsored Medicare Part A equivalent plan and will transition to a 50 percent allowance by 2017.
There is more information about this coverage in the Comprehensive Guide to Pension and Health Care Changes for retirees:
https://www.opers.org/News/ORSC/Retiree%20Version%2010.26.12.pdf
–Ohio PERS
I also fall into this category. I have never paid into social security so I will not have access to medicare other than through OPERS. Since I understand that healthcare is not a guaranteed benefit is there a chance that I may lose access to the OPERS sponsored medicare part A plan at some point in the future?
Retiree,
The Medicare Part A equivalent coverage that OPERS provides members who do not qualify for Medicare Part A on their own is written in Ohio law and contained in Section 145.584 of the Ohio Revised Code. So the line of thinking that it might go away simply because health care is “not a guaranteed benefit” doesn’t apply.
–Ohio PERS
Did PERS raise everyone’s years of service by 5 years to get health care ? It appears it only affects Law Enforcement. If you are going to raise it for one class of retirees then it should be raised for everyone.
I agree, LE has paid more into the program than other groups. If we’re not recognized then we should be compensated for the extra money we’ve paid into the system.
Tim