HRA guide: OPERS-sponsored insurance
The Ohio Public Employees Retirement System uses a reimbursement process administered by OneExchange to help participants in the OPERS Medicare Connector pay their expenses.
Today’s blog addresses how to pay for OPERS-sponsored medical insurance for a non-Medicare dependent, as well as OPERS’ dental or vision coverage, and how to be reimbursed. You can view an accompanying video series on our YouTube channel.
Paying your bill
The premiums for OPERS medical and dental/vision coverage are deducted monthly from your pension check, so you need to take no action.
Getting your money
If you’re a Connector participant, you can be reimbursed for OPERS medical, dental and vision premiums by submitting claim forms just like you do for insurance selected through the Connector. You also can set up regular reimbursements by using the recurring claim form available in your OneExchange “Getting Reimbursed” packet and on the OneExchange/OPERS website.
Verifying your claim
You’ll need to document your expenses. Make sure your submitted documents include:
- The covered participant’s name
- The insurance provider name
- The date of service
- A description of coverage (for example, Medigap)
- Proof of payment
For proof of payment, use a copy of the OPERS premium receipt. You can find it at the bottom of the Requestable Documents list in your OPERS online account, or ask us for it at 800-222-7377.
Next topic: Out-of-pocket expenses
Michael Pramik
Michael Pramik is communication strategist for the Ohio Public Employees Retirement System and editor of the PERSpective blog. As an experienced business journalist, he clarifies complex pension policies and helps members make smart choices to secure their retirement.
I found the easiest way to use the reimbursement system, is to put all premiums in to the request system. That way you never have to bother submitting bills. My husband’s Medicare of $104.90 plus my dental, vision, medigap and medicare premium, the money is all used up. Now all of them aren’t paid back completely but it rolls over, so who cares ?
What do I do if I do not want the vision and dental coverage through OPERS?
Here in Michigan, I have coverage through the state health insurance, and I want to cancel the OPERS coverage. I really cannot afford to pay the premiums on my very low income
Nancy,
Call us at 800-222-7377, and you can cancel it.
–Ohio PERS
As a beneficiary of opers I realize opers do not have to provide health care money. The problem I have is opers forget that many of the retirees get very little from their social security check due to the Off set requirements. So even though money goes in to the HRA some people have a difficult time coming up with the money to pay for medications and Dr bills before getting paid back by the HRA. Also I chose United health care policy that expects me to pay 20% of my bill. This could run into the thousands if I went to the hospital. I do not understand what the purpose of the insurance if Medicare pays 80% and I must pay 20%. I call United they said I could with draw I called Oneexchange they said I couldn’t change policy till end of the year. I am now locked in a policy that is no better or worse than medicade as many physicians are refusing to take it. I am willing to pay a premium if necessary if I can change. This policy is not meeting my needs.
Rema,
There are two ways to look at it — it’s unfortunate that you have to wait until Open Enrollment to find a new policy, or it’s beneficial that you can change your policy at Open Enrollment. Either way, that is the next available time to change policies.
–Ohio PERS
Rema, isn’t United Health Care a medigap policy ? They pay the 20% not you. Otherwise why would have chosen it ?
You probably have a Medicare Advantage Plan. If you have had it less than a year, you can drop it anytime. You don’t have to wait until the end of the year. And, you have a guaranteed issue right to buy a Medigap Insurance policy.
Regarding recurring expenses: You can use the letter that comes from OPERS, at the beginning of each year. This letter shows what is deducted each month for insurances like dental and vision. It is the same letter that has the information regarding what your pension amount is etc. A copy of this letter was accepted by one exchange to verify I had dental insurance as a recurring expense.
Wow, that sure is a long to do list for something that starts out by saying you need to take no action.
My wife will be 65 on 11-11-16. Will she be elegible for an HRA reimbursment for herself?
Dennis,
Yes, spouses will still receive an allowance through 2017.
–Ohio PERS
We have OPERS dental and vision premiums deducted from my pension check. We were told numerous times that we could not fill out a recurring reimbursement form for monthly reimbursement of these premiums. According to the above video, we are now allowed to use a recurring reimbursement form. Has your policy changed or am I incorrect?
Martin,
Yes, that policy has changed. We were initially given incorrect information by OneExchange. They are able to process those now as recurring reimbursements.
–Ohio PERS
Thank you for addressing my question. I sent in a manual reimbursement form for the first 3 months of 2016. I will now send in a recurring reimbursement form for the remainder of the year.
I signed up for Humana Medigap Plan F through One Exchange and received an email verification. When I received bills from Humana I called and found out I was enrolled in Plan B not Plan F. After several phone calls and hours on the phone I was told by OE that I should pay the $68.57 because they could do nothing and “you do have money in your account”. This $68.57 was a deductible which I wouldn’t have had if in Plan F that I signed up for. I reluctantly submitted a Reimbursement Form to OE. The $68.57 comprised a charge of $50.37 for the doctor and a charge of $18.20 for lab, both of which was detailed in the one bill. I paid the $68.57 by credit card and submitted a copy along with a copy of the bill and the Reimbursement Form. OE reimbursed the $50.37 but not the $18.20 stating “we did not receive any documentation for this expense”.
I wasn’t able to print the healthcare premium receipt from the list of requestable documents from my OPERS online account as instructed. I’m not sure why since the income verification letter printed without any issues. Hopefully, One Exchange will also accept this as proof of coverage. Please check the link since other members may be having the same problem.
Larry,
I’m not sure why that didn’t work. We have not been having issues with that print function. Can you take a screen shot of the receipt and print that?
–Ohio PERS
Hi. I check my account frequently and see that the fees have started. For some reason, I thought I read that the fees would be in the $2-3.00 range. I was surprised to see $5.86. Seems a little excessive to me. Just saying . . .
Margaret,
Does it say what the fee is for? OneExchange is supposed to charge a $2.33 monthly administrative fee. That doesn’t fit into $5.86 evenly.
–Ohio PERS