Making the most of the Connector call
The Ohio Public Employees Retirement System has released the November health care chat with OPERS Health Care Director Marianne Steger.
This month Steger provides tips for making the most of the OPERS Medicare Connector enrollment call.
You can access the video on our YouTube channel.
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 have cancelled medical mutual sometime ago and signa rx. the word has not gotten to medical mutual and i keep getting paters and card from them. the opers office is closed till next week. i will call them again on monday and try again.. i called mutual and they said they didn’t get the message and to call opers which i will do mon. i stayed with humana ad humana rx thanks
I have a question I’m sure you have been asked 1,000 times. I’m turning 65 in June. I know I have to file for medicare, which I am eligible for both parts A & B. What do I have to do to get set up with this connector. I went to a seminar last year for it, left totally confused. I continue to read about it, and still unable to understand how this program works, or how I go about getting into it. Can you please provide a schedule of events I need to follow to simplify this whole thing and walk me through the process? When do I need to contact Social Security and when do I need to contact OPERS? Who do I need to speak to, to enroll, and how does it work with co pays to doctors and prescription benefits. Very confused and trying to get it straight so when I need to file I’m prepared.
Frank,
When you or your covered spouse becomes eligible for Medicare, you will choose an individual Medicare plan using the OPERS Medicare Connector administered by OneExchange. The individual plan will pay after Medicare, which you can sign up for 90 days before you reach age 65.
We will contact you prior to you turning 65, and we’ll ask about Medicare coverage at that time. OneExchange will also contact you prior to your birthday to begin the plan selection and enrollment process.
As far as co-pays, reimbursements, etc., there is a lot of information about that on our website and the OneExchange/OPERS portal.
–Ohio PERS
I made 5 calls to OneExchange, twice I was cut off by an employee, once by the automated answering system and once their computer system crashed. Seems like they were not very prepared with a system or people to cope with this.
My husband and I signed up for a Medigap program and drug program on Nov 3rd. One exchange gave us confirmation numbers for both plans. One Exchange web site indicates the applications were sent to Humana on Nov 4th. Humana had never received this application. I have spoken to Humana on numerous occasions. I have also spoken to One Excange on numerous occasions. One Exchange just says “give it time”. Why can’t they resubmit the applications at this point? I think they were not properly submitted. Many friends that signed up after us have already received their ID cards. Our drug plan cards with Silver Scripts were received several weeks ago. This is very frustrating and I don’t feel that One Exchange has followed through. We have done everything we can do on our end. It is very important to “us” that we have medical insurance. It doesn’t seem important to One Exchange.
Linda,
We’re sorry there has been a delay, but insurance carriers could take up to six weeks to process applications.
–Ohio PERS
The problem has been on OneExchange’s end. Humana did not receive the applications to process.
One Exchange was a nightmare!! Everything about it was horrible!!!
I’m shocked that OPERS entrusted us to this unprofessional group for such an important transition to Medicare.
PS I have edited out all the politically incorrect comments I made and swear words.
Judith,
We’re sorry that you had a bad experience with OneExchange. If you have specific questions, give us a call at 800-222-7377, or voice them to OneExchange at 844-287-9945. Or state them in the blog and we’ll try to help you.
–Ohio PERS
I also am having problems with my calls. I read all the literature and viewed the videos so I would be well prepared. Also filled out the pre-application on-line. I was on for two hours the first call when the system crashed and I was asked to call back. I did and was on hold for 30 minutes before I hung up. Called back the next morning and on hold 40 minutes before my call was taken. Began 2nd part of application and was 15 minutes into it before I was informed that I was not POA for my husband just because I was the OPERS retiree and that he would have to call in. This was not told to me on the previous call the day before. I am disappointed and believed OPERS when they said this would be a smooth transaction. My appointment was not scheduled until 12/2 so not I have 4 days to get this completed.
Elaine,
We’re sorry you have having issues with signing up for coverage through the Connector. Just as a reminder, you do have until Dec. 31 to enroll if you are currently enrolled in our group plan.
–Ohio PERS
Do we have until 12/31 to sign up for Part D as well? Or must Part D be signed up no later than 12/7?
Suzy,
As long as you’re currently enrolled in our plan, you have until Dec. 31.
–Ohio PERS
I am concerned about the support my husband and I are getting from OneExchange and the correctness of the content on the website. On 11/14 we submitted applications for Medigap and drug plans. Within two weeks we had confirmation of the drug plans. On 12/3, I contacted Humana for a status on our application and was simply told it was rejected. I persisted with several Humana staff to find the reason – first, I was told it was because I had drug coverage. This didn’t make sense. I persisted talking to them to find out the error reason code indicated the plan name was wrong. I was disconnected from Humana during yet another transfer to another department. Next, we called OneExchange. I explained the problem to the BA (benefits advisor). He stated the error was caused by OneExchange and “they would correct it”. He added he did not see any rejection message from his view of the system. If OneExchange can display acceptance messages why can’t they display rejection messages? The BA told us this was the error was theirs not ours and he “was sure” they could fix it without our having to redo the application. He gave us reference numbers for the issues, adding they would be passed to a group who dealt with these issues, and asked us to call back in two weeks because “it took two weeks for this group to work with the provider”. We replied we needed closure by 12/18 because we would be out of town and were concerned on 1/1/16 we would not have insurance. He replied not to worry because since OPERS was new on OneExchange we had until March 31 to sign up… I replied that meant from 1/1/16 – 3/31/16 we could be without insurance! Folks, if you are unhappy with your dealings with OneExchange consider filing a complaint on the Medicare website.
I have been trying off and on to get through to One Exchange to ask a question without any luck. I’am also thinking about changing from Humana . Thanks ajHamburger
After completing application for Medigap supplemental insurance through OneExhange on November 3rd, my husband and I still have not gotten our medical ID cards. Also the Carrier (Humana) has not received our applications from One Exchange. OneExchange has changed the date submitted to carrier on my account from 11-4 to 12-1. They have then changed it to 12-2, 12-3, 12-4 and now 12-5. I can’t get any answers from One Exchange as to what is going on. I have called and called for answers. I have spent quite a bit of time on hold also. I am totally frustrated and in fear we will not have insurance Jan. 1st. I need assistance in getting OneExchange to carry out their obligations. We have fulfilled ours. I posted this earlier and did not receive any answers. January is quickly approaching.
I was sent a statement from opers that my wife had 162.00 to use with the connector. They tell me,she is not eligible to use it? After calls,waiting to talk someone,then getting someone who can,t speak English. Opers should be ashamed, to put retirees with this company,so you can have your $162.00! I,m sure the people in charge have to go with the connector.
Both Humana and OneExchange have left me in a state of limbo to monitor the resolution of the fix for rejection by Humana for our (husband and me) applications for medigap plans. One Exchange admitted the error was theirs and a “special team” would contact an equivalent team at Humana for resubmitting applications. The process will take 4-6 weeks, which will probably take us into 2016. On advice from OPERS, I called back OneExchange to ask to talk with a supervisor to seek expediting the process because we will be out of town. One Exchange’s customer agent stated he would talk with his supervisor and he would decide if we needed to talk directly with the supervisor. He replied their special group had resent the applications, cautioning us not to contact Humana because their customer service representatives would not have access to the reapplication’s status. He stated that we simply have to wait to hear from Humana. Therefore, we may be in health care limbo on 1/1/2016, depite our following all OPERS’s and One Exchange procedures correctly.
We had a terrible time with One Exchange. The first lady we got only offered Humana Medicare Advantage. We asked 3 times if they had another plan to offer and her answer was a Humana Medicare plan. We were on with her for 2 1/2 hours and got absolutely no where. She was just as confused as we were by the time she was finished. Her computer mal-function 3 times and she had to start over and could not remember what policy we were talking about. We decided to go out on our own where we could set down and talk to an insurance agent and see policies in writing. The thousand people that Tower Waters hired should have been given a lot more training, as many of our friends that were trying to get signed up had the same thing happen to them. I think OPERS would have been better off to just tell all of us to go out on our own and find an agent that sells Medicare insurance. As far as we are concerned, both Towers Water and OPERS really let us down and caused all of us more stress than we needed.
My experience with One Exchange was not what we were promised. Luckily I did many hours of research before my call, but I am concerned about those retirees who trusted that they would have a helpful, knowledgable insurance professional advising them. That didn’t happen for me.
My wife turned 65,july2015 her insurance from opers was 2tmes the insurance we went with. Come October we get a statement she has 162.00 to use with the connecter. They say she is not eligible to use it. Then why would pers send me that statement?
David,
We’re not sure exactly what you mean. You’ll have to call us at 800-222-7377 to discuss your situation. We recommend calling early in the morning, at 8 a.m. or shortly thereafter.
–Ohio PERS
I am an OPERS retiree enrolled in a 2016 Medicare supplement plan through One Exchange. My husband is not yet Medicare-eligible and is on the OPERS group plan. I was under the impression that eligible medical expenses incurred by my husband could be reimbursed by One Exchange from my HRA account. This was stated in all of your written material and at OPERS seminars I attended. But now One Exchange tells me I will not be able to do this because my husband is under 65 and still on the OPERS group health plan. So I cannot request reimbursement for his health insurance premiums that come out of my retirement check, nor for any of his co-pays or other medical expenses. One Exchange representatives tell me that any spousal reimbursements can only occur if the spouse also has an account at One Exchange and is Medicare eligible. They approved reimbursement for the 2016 Vision and Dental premiums I will be paying for myself through OPERS—but not those for my husband. Please clarify spousal eligibility for HRA reimbursement.
Mary,
The information you received from OneExchange is incorrect. As long as spouses are eligible, meaning they meet the qualifications for OPERS coverage regardless of age or where they receive coverage, they can receive reimbursement for their qualified medical expenses through the HRA.
–Ohio PERS
On 12/28/15 a representative from One Exchange advised us that errors One Exchange made in the first two application processes caused Humana to reject our applications for Medigap insurance. She stated we needed to repeat the application process a third time now that “they had corrected the errors”. When I replied that an email from Humana that I received that day stated that my application was in process and provided an encounter number. The email did not mention my husband’s application, nor was there a separate email about his. The One Exchange representative stated that One Exchange had received rejection notices from Humana and that we had to reapply. We were then transferred to a benefit advisor who told us we couldn’t apply for the Humana Medigap age-related insurance we originally signed up for because it was no longer offered, so we signed up for an AARP plan. As of 12/31 everything appeared to be OK. The One Exchenge web site showed that the insurer had the application. A check on the status screen on 1/1/16 shows no information about the application being active — completely blank.
I do not feel confident in the success of this third registration process or in any future encounters with One Exchange. They are simply incompetent. It took them two unsuccessful tries to send our applications to notify us their errors caused the rejections. One Exchange stated specifically that we were not at fault. The errors were theirs. Our initial appllication was on Nov. 13, the date One Exchange scheduled us back in September. I had to contact Humana to find out the reject reason and badger One Exchange to fix the problem. When, on the advice of OPERS, we asked to talk to a One Exchange supervisor to expedite the process One Exchange staff refused to do this. We asked ahead of time not to phone us between Dec. 19-27 as we would be out of the country. Nonetheless, on 12/21 and 12/23 One Exchange called. In the call on 12/28 the One Exchange agent cited no record of our away time. We have notes of the dates and times of providing OneExchange that information. In that call we were also told not the contact OPERS at all if we have problems with our insurance and to remember if we didn’t get our insurance with One Exchange OPERS would not provide the supplement for our insurance. I feel betrayed by OPERS and stuck with an insurance broker who cares only for its own bottom line. A pathetic email from OPERS without identifying the source received several weeks ago tried to justify how One Exchange, part of Towers Watson, an $18 billion valued corporation, is a premier company. Yes! Premier at ineptly seving people who follow all the guidelines provided by them and OPERS. Whether or not we get our desired health coverage, One Exchange gets its OPERS’s contract fee. While OPERS probably doesn’t care, we can provide detailed transcripts of all communication with One Exchange.
I sympathize with you Sharon. I had a multitude of problems with One Exchange. I spent hours on the phone with them. Our initial sign up was Nov. 3rd. I also documented dates, the person I spoke with, etc. Our account information was changed many times by One Exchange. My wait time to speak with them on the phone was very lengthy. We eventually got our insurance ID cards the end of December. One Exchange kept indicating to me that the application was sent to Humana. Humana indicated they did not receive the application. My experience with One Exgange was very stressful. I certainly would not recommend them to anyone. I can only hope we made the correct choice about our health insurance.
Sharon’s experience makes me realize that my problematic interaction with One Exchange could have been much worse. It seems that in truly horrendous cases like Sharon’s (and I hope there are not too many) someone from OPERS should be intervening.
Holly,
We are intervening in many cases related to the Connector, including the one you cited. Thanks for your comment, and we hope your experience will turn out to be positive.
–Ohio PERS
opers should be ashamed that they subjected their members to the likes of towers watson.there is a tremendous amt. of money at stake.it is obvious that towers watson is not in compliance with their contractual requirerments,what’s to be done?i can never get in touch with one exchange so how can i do business,disgraceful!oh,and what about that 300$ deposit to hra,where will that show up i haven’t seen it anywhere.
Jim,
That deposit is scheduled to be made by Jan. 8.
–Ohio PERS