Some health care changes upcoming in 2013

The Board of Trustees and staff of the Ohio Public Employees Retirement System invest a great deal of time and effort to preserve the pension plan and provide access to health care coverage for retirees.

These efforts have been developing on separate but collaborative paths, which now are converging.

First, pension legislation is being debated in hearings in the Ohio House this summer, after the Ohio Senate unanimously approved Senate Bill 343 in May. This legislation would alter the pension benefit structure for current members in part by raising retirement ages, changing the terms of the COLA, altering the benefit formula and increasing the final average salary determination. We are working with the legislature in hopes that they pass the law in 2012.

While the pension legislation has been working its way through the General Assembly, the OPERS Board needed to consider significant changes to the health care plan, changes that could affect many current and future retirees. The Board is interested in member feedback this summer (you will find a link to the health care survey here), and will make a final determination in the fall on all aspects of health care coverage.

There is no option on whether to act or not to act. The financial and demographic challenges we currently face simply will not allow us to maintain our current level of coverage. The pension bill has been pending for more than two years, causing the fund to diminish the employer contribution into the health care fund. If we do nothing, the OPERS health care trust fund could be exhausted in as early as eight years. At that point, access to coverage would be available only for the coverage required under Ohio law.

Meanwhile, we are preparing to implement more immediate changes to the OPERS Retiree Health Plan, which we began communicating in July. In 2013, the plan will offer one level of coverage for our non-Medicare participants.

Why is OPERS offering one health care plan instead of three? First, we have about 90,000 retired members on our non-Medicare health care plan. An overwhelming majority of participants – nearly 85 percent – are signed up for the enhanced plan. The new plan offers no increase in monthly premiums for a majority of participants.

These changes are not part of pension legislation or the implementation of the long-term health care preservation plan. They simply represent the maintenance changes our Board makes annually to the plan so we can continue to offer affordable coverage.

Affected members received letters in July explaining the basics. We will soon be mailing the annual open enrollment packet and “Special Health Care Bulletin,” which will explain the changes in greater depth. (Open enrollment for the plan will be held from Oct. 1-31.)

The following are some of the 2013 plan design changes for non-Medicare enrollees:

  • One plan offered
  • An $850 in-network deductible for medical care
  • A $2,500 in-network, out-of-pocket maximum
  • Lower office visit copayments to encourage participants to see their doctor before problems arise
  • One hundred percent coverage for generic medications used to treat common chronic conditions such as high blood pressure and high cholesterol

Multiple plans contribute to a greater chance of adverse selection. That means the healthiest people tend to pick plans with less coverage, and those with chronic illnesses tend to pick the more comprehensive plans. This drives up the cost for everyone by going against general insurance principles in which everyone is in one pool, thereby spreading the costs equally among those with good health and bad health.

Cost is another consideration.  Currently, members who enroll in the less expensive Intermediate or Basic plans, depending upon their allowance amount, receive the difference between their monthly allowance and the monthly cost of their chosen plan deposited into their Retiree Medical Account (RMA). 

RMA dollars can be used to cover IRS-eligible medical expenses including those incurred in future years.  At the current rate of spending, with no changes to the plan, the OPERS health care fund is predicted to run out of money in 8-14 years.

Change is seldom easy. However, the OPERS Board is making them, including the move to a single health care plan, to provide increased efficiencies resulting in plan cost savings that benefit everyone.

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133 Responses to Some health care changes upcoming in 2013

  1. RSH says:

    In 2012:
    In-network deductible is $750.00 and
    in-network, out-of-pocket maximum is $2,000

    So, it’s $600.00 more for these two items

    Am i correct?

    • Michael Pramik says:


      Yes, you are. The deductibles and out-of-pocket costs will remain the same for our Medicare-eligible retirees enrolled in the Humana Medicare Advantage Plan.

      –Ohio PERS

  2. Frustrated veteran says:

    Please reconsider your proposal to exclude purchased military service from health care eligibility. Service credit/Service time should be the same for OPERS Pension and OPERS Healthcare. At the very least, Grandfather those that spent their money to purchase the additional time. Honor the obligation for which OPERS was paid.

    • mjm says:

      I agree. Furthermore, how is this change legal since O.R.C section 145.301 states that purchase of service by a veteran “shall be considered as the equivalent of Ohio Service for each year of service.” Are you planning to go to the legislature and alter this section, or are you asserting that this section has no applicability to health care?

      • Mark says:

        I paid you 16k to purchase my military service credit. I honored my side of the deal. Honor yours. Grandfather the military service I purchased.

    • Peter says:

      Read the ‘specialized health care service bulletin’ that was just mailed out,page 8-the last page.
      It appears that you vets who purchased credit are still covered, at least those retired before the implementation date of any legislation passed.

      • Michael Pramik says:


        Only USERRA military time, or that which interrupts public service, would count toward health care eligibility.

        –Ohio PERS

        • Mark says:

          PERS made it such big deal that we should hurry and purchase our military service time because it was going to get more expensive. Hurry! Hurry! Hurry! Only now we find out that the purchased time is basically valueless because we will have no health care if we retire before the ex post facto changes being made by PERS. PERS used the thousands I paid them and now plans to renege on the deal.

          • Michael Pramik says:


            Purchased military time still counts toward determining your pension benefit. We’re not sure how that can be perceived as “valueless.”

            –Ohio PERS

  3. Mike Goffee says:

    Are you going to continue with the vision and dental coverages ?

    • Michael Pramik says:


      Costs to participate in the OPERS dental coverage plan will increase slightly for 2013, and the plan will continue to be administered by MetLife. The costs to participate in the OPERS vision coverage plan also will increase slightly. Aetna will continue to adminster that plan. See the Open Enrollment packet, arriving in September, for detailed information.

      Also, the OPERS education team will be holding seminars around the state in September and October to explain the 2013 health care plan. They will be listed in a Special Health Care Bulletin, which will be mailed to members next week.

  4. Daisy Carter says:

    What do you mean “this practice is being reviewed” when referring to Retiree Medical Accounts in the intermediary and basic plans? My husband already received a letter from opers stating that you are doing away with the intermediary and basic plans and that no money will be deposited into his account to help cover the cost of my insurance! What in the heck is going on? I think it’s a shame what you are doing to the retirees.

    • Michael Pramik says:


      While the information in the letter to which you refer is true, it also is correct that OPERS is reviewing, not eliminating, the Retiree Medical Account practice. There are still incentives available, such as wellness goals, that can result in deposits to the accounts.

      –Ohio PERS

      • Vickie Lockwood says:


        Where can I find info about the incentives? I am fine with wellness incentives, my employer has had them for two years and I think they are great.

        From what I just saw when I ran the Health Care Calculator, my premiums are going to be $108.62/month if I retire in 2013. I will opt to NOT pay for the OPERS health insurance if that is what it is going to cost me.

        Also, I agree with those who are suggesting that the plan be nationwide for those who move out of Ohio.

    • Steve Hlabse says:

      I was forcedto retire because of ‘physical issues” that my supervisors deemed neccesary.(They obviously know more than my surgeons or therapists) Any way,I was told by PERS the hospitalization coverage I opted for was the same as what I had when I was working.So I bought it.WRONG!!!! Prescriptions are 3X the cost,the dental coverage is basic at best and eye care???? Well let’s just say I won’t need a dog to go somewhere.As for the healthy and the sick paying the same??!!! Isn’t that Socialized Medicine? Obama Care? Does the “Government” think regular people are in capable of making our own decisions in life?

      • David says:

        “Healthy and the sick paying the same” has nothing to do with any political system. That’s just how insurance works. The insurance might come from a big-profits firm where the lobbyists buy politicians, the executives make 7 figure salaries, and the stockholders get rich. Or it might come from a non-profit government agency where the employees helping you file your claim work for ordinary salaries like ours. (After all, we ARE all government workers here, no?)

        Either way, the principle is the same. Everyone chucks money into a big kitty, and those who need health care take out what they need. (Of course, the less the insurance operation spends on fat salaries and lobbying, the less you pay and the better your benefits. Which of the above two systems do you think is more likely to lead to this?)

        If you’re unlucky and you get sick, you get the care you need even if you don’t have hundreds of thousands of dollars to pay for it. If you’re lucky and you stay healthy, you haven’t lost anything – you’ve gained peace of mind from knowing that if you HAD gotten seriously ill, you’d have been cared for.

        Take away the pooling of risk, and you might as well just make it every man for himself and every woman for herself. Better start saving up!

      • Brian Enck says:

        Its clear that the overall principle behind a well run insurance system (which is not gouging customers and one which actually pays out needed health care benefits), is in fact a socialized cost structured. And until recently when extreme politicians started recklessly throwing the term about we all agreed that most us need some sort of insurance to help pay for needed expensive health care costs. Members pay into a pool of funds in hopes that if they need benefits, they will be available. Socialized market principles have been misconstrued by unscrupulous politicians. These changes to the current opers health care system for current retirees appears appropriate and necessary.

  5. Tom Coady says:

    Very glad to hear OPERS is holding the line for the most part in health care coverage costs for non-medicare retirees in 2013 – your diligent efforts are appreciated!

    • Peter says:

      I agree with you, Tom. I don’t believe the proposed changes are out of line. I’m thankful to have reasonable coverage. I’ll never see any Social Security payments of any kind,as the majority of my ‘working life’ was in government service. Especially since health coverage is not mandated by law from the retirement systems! I’m fortunate to have been in the PERS system, rather than one of the others.

  6. Charlette Buescher says:

    I understand what you are trying to do here. Moving everyone to the most expensive plan does seem a bit counter-intuitive to trying to save costs. Having been on your highest deductible plan and paying first dollar coverage for physician visits and prescriptions AND having been on a similar plan at my former place of employment, I can tell you that you do NOT have the best discounts available. I would HIGHLY recommend you work with an independent health care insurance consultant (one that does NOT sell the insurance) to rebid the package and look for a better set of discounts. AND, as an aside, a NATIONAL network would be MUCH appreciated by those who have settled outside the state of Ohio.

    • Spouse under 60 says:

      They aren’t going to look into any other coverage. If you read the posts here you’ll see that the whole point is for OPERS to get out of the health care insurance aspect of retirement altogether. It may be another 20-30 years but the trend is going that way.

      • Brian Enck says:

        I expect opers to continue to manage the overall retirement system which has been in place for over 75 years, longer than the federal SS system. As the numbers of retirees increase and the cost of health care increase faster, the balance sheet projected out over the foreseeable future demands adjustments. If health care cost increases can be slowed by improvements to the overall US medical system, then I would expect opers to continue to provide affordable benefits in a sustainable manner for future retirees. These changes appear appropriate and necessary.

  7. Linda says:

    I also am asking that OPERS honor the Federal Government time which I purchased 7 months and several weeks towards health care. further I ask that they continue picking up the Part A coverage for those of us who worked our careers under OPERS. Thank you.

  8. Arnold Frye says:

    OPERS said, “There is no option on whether to act or not to act.” I have reached the same conclusion. Because I have a duty to provide health care coverage for my wife, who was a stay-at-home mom so our children would not be raised by strangers, I have decided to come out of retirement and go back to work to obtain health care coverage for my wife, who is not as qualified or able as I to work. If the goal of OPERS is to get retirees to come out of retirement, its planned radical elimination of my OPERS spousal health care benefits has succeeded in motivating me to return to work.

    • tom says:


      Call your state rep and ask what legislation is out there that will affect your pension. I know their out there.

  9. Spouse under 60 says:

    Take a look at your estimate for your Health Care cost using the Health Care calculator on

    Change the start date to 01/2013. There is one Medical Mutual option and you can see the effect it will have on your monthly pension payment.

    For my husband and I, the net effect is that $400 a month will be deducted from our pension payment. The Basic Plan that we have had for years was around $600/month each and the Enhanced Plan which we are being changed to is around $800/month each, so the additional cost for the two of us is $400 every month for a level of coverage that we do not need or want.

    So for 2013 our income will drop by $400 a month = $4800.

    Then in 2014 I will be dropped from having any coverage at all because spouses are just excess baggage.

    OPERS, I understand the reality of living within your means and watching costs. but as another poster said in another health care related topic, it looks like your are just managing by crisis. Drastic changes to retired people have a deep impact.

    How would you deal with a drop in income of $4800 a year in your household?

    I see no options being considered, just the one Medical Mutual plan, take it or leave it.

  10. jim johnson says:

    what is the minimum age that spouse can recieve medical benefits and is that age going to rise

    • Michael Pramik says:


      It’s currently 55, and no final decision has been made regarding the future of spousal health care.

      –Ohio PERS

  11. David says:

    I did not receive a letter from OPERS on proposed changes to our Medical Mutual,Dental & Eye
    coverage for 2013; we have the enhanced medical mutual family (retiree & spouse) low Aetna
    vision & low Aetna dental…so what is the proposed retiree cost for the proposed Medical
    Mutual, Low Aetna vision & low Aetna dental in 2013 please? I completely understand OPERS
    is trying to keep our not required by law Health Insurance however; loosing spouse coverage or
    access to it and these other cost increases is hard on our fixed income and we had no way to plan
    for these drastic increases & cuts; since we have been retired for sometime. Thank you for working
    hard to keep we current retirees from being even more hurt by these changes/eliminations/cost increases.

    • Michael Pramik says:


      Rates will increase slightly in 2013 for dental and vision coverage. We will include complete details in the Open Enrollment packet that will be mailed in September.

      –Ohio PERS

  12. Froggy says:

    I understand that the rules change over time. I understand that I made my choice to work under Opers. But, my choice was made based on the facts at the time. Now that we have retired, we based our decisions on what we were told up to then. My monthly retirement amount will not cover my bills and the increase of lnsurance costs. Dropping the spouse increases the sorrow! I thought I worked all these years so I could retire. It is going to be difficult to find a job at my age that provides health insurance for me and my spouse and God help us If I get ill and can’t work. Who would have thought retiring from a gov’t job would Bring us to a state of poverty. Maybe our only hope is Obama care or that we get a State approved plan like the one Mitt Romney passed for his State.

  13. S says:

    All current retirees should be GRANDFATHERED IN. If PERS wants to make changes, then make them GOING FORWARD for all those employees who are still working and receiving full salaries. Why penalize the retirees who finished the game under the old rules and were looking forward to the benefits as PROMISED?

    • l says:

      I agree! We have struggled with health care costs since the ruling of “no subsidy for spouses under 55.” I am just now available for subsidy and it looks like I will lose it again. We cannot live on our fixed income and pay for all the health insurance. I have worked for 32 years but never used any health insurance because my husband’s insurance was always better than what I could get. Now we are both retired and we cannot afford the proposed changes.
      I hope things can change to the positive because I will have a difficult time getting a job that has medical coverage that won’t eat up whatever salary I could make, let alone being able to get a job at my age and with this economy.

      • Ron Shanbrom says:

        When I retired I did not want to take the OPERS health insurance because I was covered by my wife’s health insurance plan through her employer. However, I was told by OPERS that I had no choice, I had to take it or forever lose access to it. I found that out that a former co-worker of mine was told the same thing. But, at the OPERS healthcare seminar this past July we were told that we could have opted to not participate in the OPERS healthcare plan until our spouses retired and/or went on Medicare. Had I known this before I would have been in a position where OPERS would be giving me substantially more money to apply towards my health insurance when your planned changes are finally put into effect.

        The OPERS staff counselling prospective retirees need to have a better understanding of how the system works so they can give out accurate information!!!

    • BH says:

      I agree. Current retirees should be GRANDFATHERED in as they made decisions based on the rules at that time.
      What can be done about this?

      • Michael Pramik says:


        The OPERS Board of Trustees this morning approved the new health care plan, which will begin in 2104. Please refer to the OPERS website and blog for more information in the coming days.

        –Ohio PERS

        • Kathy says:

          But the book is confusing. Mty husband plans to retire May 1, 2013 with his 30 years. He came to Comumbus, did his exit interview – and spoke to 3 different persons between th e face to face and phone calls. I work fo r county – will staill have health insurance coverage for both of us until I retire in Sept 2019. That is the plan. He wants to stay onmy insurance- and delay enrolling in OPERS insurance. He was told he needs to enroll by Jan 2014 or lose ability to enroll . Does he need to enroll by May 30 , 2013 and at what % or can he wait until I lose my insurance whether it be by disability, death or retirement.? and at what % cost ?

          • Michael Pramik says:


            Is it not true that a member with 30+ years of qualifying service credit needs to enroll in the health care program by January or risk losing the ability to enroll.

            –Ohio PERS

  14. Chris says:

    The health care survey OPERS is asking us to fill out is a joke. Do you want your left hand cut off or do you want your right hand cut off? We really value your input! It is quite clear what the board wants to do with health care and the survey provides no choice except to reinforce what the board wants. I know it is currently popular to bash public employee’s and the board is piling on that wagon.

    The board needs to think outside the box and come up with additional options and solutions. Change the law to allow current employee’s to contribute towards their retirement health care. I think most of us would willingly ante up to help ensure health care.

    Those with over twenty years in should be grandfathered under the current plan.

    Law enforcement retiree’s should be able to access health care when they retire regardless of age and with at least 25 years of service.

    I think , as others have stated, that OPERS will not be providing any health care in the future. This is just the start down the slippery slope.

  15. MG says:

    I was employed by the State before I joined the military, then joined the military and was told there would be no penalties if I did etc. and at the end of my tour I made the decision to work 30 years for the State instead of 25 in the USAF. (I could now be retired) I now have over 28 years with the military time that I bought and if I understand correctly, am now not going to be covered by health care unless I keep working to cover the years that the employer did not contribute when I was serving our country. It was said that only COLA would be affected and everything else grandfathered for those of us who are getting close to retirement. I have always worked hard and played by the rules. There are so many people who have non-critical State jobs who have a kick back job and if their jobs were audited would not be employed by the State any longer. If any of the retirement board have any of these jobs, how would they like if their jobs were cut because they are nonessential? After all we need to “save the taxpayers dollars” and realize things have now changed!
    I do not know the history of the board, but a few years ago there seemed to be a different attitude about making sure everyone and everything was covered. I would like to know also what happens to all that has been contributed if I retire at 30 years with about 4 years of that in service credit that was paid. Do I just loose it altogether? I am already getting a big hit with having a wife who has been staying home to raise our 5 kids!

    • David says:

      “There are so many people who have non-critical State jobs who have a kick back job and if their jobs were audited would not be employed by the State any longer.” I have read that, or something similar, many times in this blog. Perhaps you do know such people. Probably some exist, as they do also in the private sector, though I can’t think of anyone in that category where I work.

      In any case, I think we should be careful about making such statements. They play into the hands of politicians who would like to turn us against each other – employee against employee, working members against the retired.

      These are difficult times for all of us. We have to stand together to resist politicians who would replace us with private sector contractors who may be contributors to their campaigns. We have to stand against the pundits who think we don’t deserve the retirement we’ve worked toward, often for lower salaries than we could have made in the private sector.

      Please, if you’re going to criticize, be critical of those who deserve it, not your fellow public workers. We’re all in this together.

      • MG says:

        I was referring to the attitude that I have read concerning cutting out spouses completely and making it very hard for some of us to retire with some service credit paid only by the employee (military etc.) and having it not counting towards making retiring at 30 years, with regards to receiving full health care benefits.The only thing I was trying to do was to make a point that it is easy to say cut cut cut. What about if their jobs were being decided with the same attitude. I don’t want anyone to loose a job even if it is a gravy job. I also would like to see the same consideration given about drastic immediate planning. Putting in changes over time is the best way. You would get more of a win win this way. The legislation would pass and future options and plans could be on the table for planning on how to fund the short fall.

    • tom says:


      A lot of members have asked a lot of legitimate questions about all of our futures and i would like to know with September nearing, what Board Authority provisions remain and what additions are possible before this becomes law. There does not need to be anymore surprises.

      • Michael Pramik says:


        The provisions that remain in Senate Bill 343 relate to service purchases and the Public Safety/Law Enforcement divisions.

        One request would give the OPERS Board of Trustees the flexibility to charge the full actuarial cost of certain types of service credit not currently included in the legislation. The other would allow the board to merge the Public Safety and Law Enforcement divisions.

        –Ohio PERS

  16. Linda Lucas says:

    I think it is a shame that OPERS has created a plan that will eventually force the retiree back to work.
    There is no way we can afford this. I pray we can find a job at our age to supplement the high cost of deductible and co pays…………

    • kay says:

      I wish we were being left with something to have a deductible and co-pay on. Without insurance or Medicare, we will have to pay in full for any medical service we receive. I guess we will have to negotiate with our doctors to see if they will take a reduced fee for seeing us, MRI’s, Labwork, Scans, etc. It’s a difficult situation for those who are unable to work due to health problems but who need to work to pay cash for medical care.

  17. retired says:

    Are we going to be receiving the information in the mail soon?

    • Michael Pramik says:


      The bulletin will be mailed beginning today. The open enrollment kit will be mailed from Aug. 27-Sept. 7.

      –Ohio PERS

  18. Future Retiree says:

    IF spousal coverage is maintained, single/widowed retirees should get full coverage while married retirees and spouses should only get 50% max coverage, or half what a single retiree recieves, since they would be getting double the benefit with 2 beneficiaries versus what one single is getting.

    • Kay says:

      So using that logic, a retiree who was earning $70,000 when he retired, and paying in 9% of his/her salary, should get 2x more health care coverage than someone earning $35,000? Or possibly the $70,000 employee should get 100% for both themselves and their spouse whereas the $35,000 per year employee would only get 100% for a single or 50% for both since he/she only paid in half as much to the system.

      Once we get away from the pooled insurance approach of everyone paying in according to their ability to pay and everyone getting whatever they need within the parameters of the insurance policy based on health care needs, then we risk the slippery slope of saying that those who pay more should get more coverage and those who pay less get less coverage. In other words, we just as well all keep our own OPERS premiums and save for our own retirements and health care and disband the system altogether. You would only get what you are able to earn and what you are able to pay for or choose to pay for out of your own earnings for yourself and your family.

  19. C ANDERSON says:

    Give us retirees back our seniority, place us on active employment status and let those that choose go back to our positions prior to retirement. This way we all will be able to pay for what you are wanting to take away from us. USA made a contract with people for social security. The state made a contract with me 30 years ago. I never slacked off of the job I agreed to do. I and many others were not part of the “dead weight group”. Instead of the state confronting the real problem of this dead weight, they just want to slash everyone, past and present. I will wait for my call to get my job back. How soon do you think they will call? Then you can explain the new system to me……So disgusted!!!!!!!

    • S says:

      I was thinking the same darn thing! They should reinstate any retiree who wants to go back to their former jobs. A lot of these jobs are still vacant and will not be filled from what I understand.

  20. Darick says:

    Opers need new broad members that care more about the retired. The currents members need to be voted out if this is the best they can come up with

  21. Ragreser says:

    How will it work for the medically retired who may not be able to work for the healthcare for their spouse and children ? Will that remain the same or will it all go under a pool were we all pay the same regardless of the ability to provide extra income or not ? I have not seen any real specific guidelines or information addressing the medically retired that are NOT at Medicare age.

  22. Linda says:

    My feelings are I was hired 31 years ago under the usumption of a great retirement system instead of social security. OPERS has changed many things since I have been paying into this pension. Spousal coverage she be allowed for current retirees. If military time was allowed, it should allways be allowed. They are the ones who should recieve service years and to buy service years. This is crazy that a political person can buy in for more service years on time not served through OPERS and miltary time does not count. Also, changing to only enhanced insurance and no other option is wrong. When I retired I carefully made my decisions on OPERS pension. 2 weeks later after retiring OPERS IS DOING DRASTIC CHANGES TO HEALTHCARE.This is not good for many retirees. It will put many retirees into deeper poverty.

    • froggy says:

      I agree. We should not be changed in mid stream. We were told one thing, lived up to our part of the bargain and assumed we would okay. We are too old to try to find other jobs with health care. This was suppose to be a wonderful steady job with retirement benefits. Put yourself in the place of the retireees. This is a sucker punch!

  23. J.A. says:

    I agree wholeheartedly with “Future Retiree.” I respect the fact that those OPER retirees who have spouses want them covered and I understand why. However, I don’t want to sacrifice my healthcare for people I don’t even know……..cover me at 100% and cover them at 50% each.

    And give me back the security in retirement that I thought I had back in 2007 when I retired. I can’t undo retirement. It’s done. I played by the rules.

    I don’t want to be “farmed out” to a benefits counselor and told to go buy my own insurance. I want to be part of the OPERS group. That is what we agreed on.

    Yes, I am a second-wave baby boomer. You knew we were coming. I am 65 years old. You knew we were on the way since the first wave of us were born in 1946. Sixty-six years ago.

  24. dave says:

    If the proposed healthcare changes go into effect in January of 2014, I will be 7 months short of retiring. I am 58 years old and plan on retiring at age 60 (In july of 2014). I currently have 12 years of service. Will I be grandfathered under the 3 year transition for healthcare coverage or just not be eligible for coverage when I retire?

    • Michael Pramik says:


      It depends on when the new health care plan is implemented. If its implementation date occurs after you plan to retire in July 2014 (for instance, Jan. 1, 2015), then you would qualify for health care coverage because you have 10 years of service. If you retire after the implementation date, then you may not qualify, because the proposed changes include requiring age 60 and 20 years of service to qualify.

      One note: There is no “grandfathering” provision that would extend the time members can choose to retire under current rules. Under the current proposal, there is only “before implementation” and “after implementation.”

      –Ohio PERS

  25. john schade says:

    There is a high amount of fraud where I work. (Playing sick). What efforts are being done to curb the large amount of criminal behavior exhibited by state employees. I have never seen such a place where misconduct is rewarded. Lower the amount of Fraud and change the sick welfare mentality and much of the problem will be solved.

    • Froggy says:

      I agree about fraud. We have had 4 people go out on “disability” in the last year in our small office. They make up to 65% of their FAS ( final annual salary) and none of them have worked more than 10 years. Most of them have less medical problems than those of us who are still working. My co-worker who just retired after 25 years gets less than 45% of his FAS. Now he finds out his spouse won’t get coverage and he pays more for his insurance than the “disabled” folks. One of the ‘disabled’ is making more than she was while working (with unreported income. ). The ‘disabled’ people should not get more than the retirees and the years of sucking up the disabilty SHOULD NOT count towards the years of retirement.

  26. Sue says:

    Regarding the proposed changes in 2014,15 – I don’t understand what you mean by no longer proving an OPERS plan for Medicare eligible participants, but introduce a Personalized Model (????). This is too general to understand what they are proposing. Does that mean OPERS won’t have anything to do with a supplemental policy (a second insurance to pay for what Medicare won’t pay for) any more? What is te Personalized Model thing? Is that a secondary insurance plan of multiple choices to take the place of Humana so that we still will have two insurances – Medicare and something? Or are you must cutting us loose and giving us money to shop for a supplementary plan on our own? This is very confusing.

  27. hoping to retire soon says:

    If someone retires after the new legislation is passed and signed but before the new healthcare rules are implemented, would they fall under the old healthcare rules or the new healthcare rules?

  28. Leigh Weston says:

    I retired after 11 years with a disability retirement. I am only 50 years old. How is the health care change going to affect me and how much of my “barely getting by” pension will be taken from me?

  29. Vicky says:

    The following language appears in the special bulletin linked to the August newsletter, saying the health care plan could:

    “Feature a new allowance table based on age at retirement and years of service with a minimum
    allowance of 51% and a maximum of 90%. No retiree will have a 100% allowance. Many current retirees would see a reduction in their allowance, resulting in an increase in their monthly premium.
    To minimize hardship on those already retired, any retiree with a current allowance at or above 75% will not have an allowance below 75% under the new plan, regardless of what the new allowance table shows.”

    I started looking through the retirement system website and its various links, and I can find no details on how this allowance reduction would be figured. Since it’s under consideration, shouldn’t its details be published? If my health care allowance is about to be reduced significantly, I’d like to know about it ahead of time.

    • Michael Pramik says:


      Please refer to the chart on page 2 of this publication, which is on our website:

      –Ohio PERS

      • Pete says:

        I looked over the proposed changes you referenced here. Verify a couple of estimates for me,please?
        Retired in 2005 with 32 YOS, will be 62 on1/1/13,65 on 1/1/16, so?:
        Proposed monthly health care premium: to be $154, currently $0?
        Proposed monthly allowance upon turning 65: $321,if PM is established?
        Note: no children,no spouse, will need A & B, & pharmacy,I suppose. Whole career in local government service and not enough quarters in for SS benefits nor Medicare.
        Yea, not yet 65, but just looking ahead to then!

        • Michael Pramik says:


          For a customized reply to your individual status, please contact OPERS Member Services at 800-222-7377.

          –Ohio PERS

  30. David says:

    I just read the Ohio PERS I received today (8/21/12) and saw something that I had not seen before (page 8) where it states PERS would “provide helath care for those with 30 years of service (may increase to 32 years after pension legislation is enacted).” I am in group B as far as far as my pension and now expect to work to 31 instead of 30 years (I have 24+ in currently) if proposed legislation is passed. Is this page on “PERSERVING HEALTH CARE for the future” now indicating that I may have to work 32 years to get heath care if pension legislation is passed? There seems to be some alignment issues if I can retire at 31 with full pension benefits under pending pension legislation requirements but would have to work until 32 to get health care per this article if the same pending pending pension is passed? Please explain.

    • Michael Pramik says:


      If the 30-year period for health care eligibility would be extended to 32 years, it is likely that the OPERS Board would take that requirement into consideration for Group B members.

      –Ohio PERS

      • David says:

        I (and your customer service reps) do continue however to see a incongruity between a Group B employee having to work 31 years for a full pension BUT MAY have to work. 32 years for health care. Can not the two proposed reforms at least be consistent with each other for planning purposes?

        • Michael Pramik says:


          As we said, if the period for health care were to be extended, it likely would be aligned with the pension plan.

          –Ohio PERS

  31. David says:

    I retired with 30 years of service – nearly pushed out the door due to pending layoffs. I am 53 years old. How much will my allowance be reduced to and is it guaranteed to stay at that level? My wife has 6 more years in OPERS until she can retire with 31 years. She is paying higher rstes to insure our 21 year old son/ college student. Would we benefit by me carrying my son on my OPERS policy and her paying less for an individual policy at work thus ofsetting any allowance reduction?



    • Michael Pramik says:


      For specific questions regarding your personal situation, call OPERS Member Services at 800-222-7377.

      –Ohio PERS

  32. RAH says:

    Well, I checked your chart which you referred Vicky to but that chart only applies to the upcoming proposed new OPERS rules. It is of absolutely no use to those of us who are currently retired. We would like to see a proposed chart with years of service (perhaps starting with 10 years of service) and age of retirement or age when it becomes effective for CURRENT retirees. Does OPERS have such a chart?

    • Michael Pramik says:


      The information on the chart states that it applies to non-Medicare plan participants who are currently retired or will retire after health care changes are in place.

      –Ohio PERS

  33. JS says:

    This program seems to base its payment on some made up dollar amount and then reduced by a percentage. A voucher program. How is or will in the future this dollar amount be determined?

  34. jm says:

    And the premium can change based on whatever coverage pers whats to use as a premium cost. Which Pers has changed in the past and will in the furture. Reduce the coverage and premium goes down and then take a percentage of that.

  35. hoping to retire soon says:

    I hope this won’t sound like a silly question, but I am wondering about the borderline case where someone might retire the very same day on which the new legislation gets implemented. Suppose someone wishes to retire at the end of, let’s say, December 2012. It would seem like their official retirement date, in terms of OPERS, would end up being January 1st, 2013. What if the new legislation with the new COLA gets passed this Fall and takes effect on January 1st ? Would a member retiring that very same day be eligible for the old 3% COLA or just the new, diminished COLA ?

    • Michael Pramik says:


      Unless the legislation states otherwise, the law would become effective 90 days after signed by the governor. To retire under the current rules, your retirement effective date would have to be prior to the legislative effective date. Your last day of work would have to be no later than the last day of the month preceding your effective date of retirement.

      –Ohio PERS

      • Mike says:

        In your reply to Hoping posted on Aug.24th at 12:18 you stated:

        “Unless the legislation states otherwise, the law would become effective 90 days after signed by the governor. To retire under the current rules, your retirement effective date would have to be prior to the legislative effective date. Your last day of work would have to be no later than the last day of the month preceding your effective date of retirement.”

        I am in the process of purchasing 13 months of military service credit which will allow me to retire with 25 years on Dec. 1st, 2012. I realize that for purposes of my pension I will be in the class of already retired PRIOR to the effective date of any new legislation. I also realize; and I would be already retired prior to any changes in the health care offered by OPERS (having 23 years 11 months contributing service).

        My question comes from your statement: “Your last day of work would have to be no later than the last day of the month preceding your effective date of retirement.”

        What does that mean? Where can I find the rules governing this?

  36. Russell T. Sova says:

    How is it that the people who invest money for OPERS cannot invest our fund into a fixed account of some kind during economic downturns so that the entire fund does not drop 5% or 8% or 20% during a stock market downturn. I know many people smart enough to have gotten out of the last stock market crash before it was too late, how it is that the people who invest our OPERS funds don’t know this?

  37. Bridget says:

    I am 53 years old with 31 years of service time. I plan to retire after the health care implementation date at age 55. Will I have health care coverage?

  38. Darrel says:

    I recently attended a local inservice given by OPERS and literature I received stated “Future retirees must be age 60 and have 20 years of service to qualify for health care, or have 30 years of service at any age. Does that statement still hold true with these changes? I also happen to have purchased 4 years of military service credit in which time of service did not disrupt my employment connected to OPERS. This is the first I’ve have heard that this credit will not qualify towards health care. Whats the latest information related to this situation? Find a way to give us an option to help fund our health plans, those that help receive a better, more sustainable plan than those that choose not to.

    • Michael Pramik says:


      You were presented with the latest information on pending pension legislation changes and health care program adjustments at the town hall meeting.

      –Ohio PERS

  39. Judy McClelland says:

    I retired in 1997 at the age of 51 years with full benefits. Now in 2014, if/when the new ‘Personalized Model for health care costs is implemented and is determined by years of service and AGE AT RETIREMENT, I will be penalized greatly because I was eligible to retire early. I think those of us who have already retired should be grandfathered-in and our ‘Personalized Model’ should be based on years of service only and not on the age we were eligible to retire way back then!

  40. Forced Disabled says:

    This is borderline offensive. 22 years in civil service to be forced into disability and now being forced to take coverage at an increase of more than 180 dollars a month. Give to your community so that when the company who should be helping the helpers can make sure that the 80% wont feel over charged? Makes me sad to think that so much trust was put into this program which caters to the ones most willing to spend the top dollar. To let my medical insurance run out or to feed my family? Life’s biggest questions.

  41. DEA says:

    opers should be ashamed at what they are doing to retired pensioners. It is not right to take away spousal coverage nor use age requirements. SHAME SHAME ON OPERS. We worked for less pay all these years and you want us to be ok with what your doing, DON’T THINK SO. If you want change , do it to new hires. sers isnt doing it to their retirees. Read about their pension…

  42. Brenda Otis says:

    I worked 30 plus years in a hospital./Then could not stand retirement and went back to work at same job for six more years. I always told others to NEVER take their money out of Pers as they would have health care to count on later in life.?? Well I will be 72 soon ,my husband will be 75 and things are not going too good right now.I never made BIG money so my check is not too big.It would devastate us if his health care is removed.Will someone of that age bracket be grandfathered in???I have NO idea how we could even begin to pay a huge sum.He get SS and that is not too large and i have had him covered under my INS and I get Medicare from him as of course i never worked under it.How can I find out whether he will be cut off.

  43. james eichenlaub says:

    thank you for this website , i have over 37 years in at S.O.C.F. ,i have been here twice i think you should leave anyone w/20 plus year’s grandfathered in old plan ,that was what we were told of when we hired in, and what i have been working for. i understand their has to be a change and why, but don’t penilise retires or those that nare getting ready

  44. david says:

    I will retire with being 55 yrs old and having worked for 25 years . Does this mean I will have to be with out health insurance for 5 years untill I reach age 60

    • Michael Pramik says:


      The current proposal for OPERS health care program eligibility would be 30 years of service at any age or 20 years of service at a minimum age of 60.

      –Ohio PERS

      • David says:

        I know all that, what I’m asking is, after I retire at age 55 with 25 years of service will I be able to get the health coverage after sitting on my butt 5 years later when I turn 60

        • Michael Pramik says:


          Not sure we’d put it that way, but yes, you could do that and then receive health care coverage at age 60.

          –Ohio PERS

  45. Ed says:

    Will 35% credit purchase count toward health coverage?

    • Michael Pramik says:


      According to the OPERS Board’s latest proposal, eligiblity for health care coverage would be limited only to contributing service, service time in other Ohio retirement systems, and restored service credit.

      –Ohio PERS

  46. Jim says:

    Does this mean if you retire and move out of Ohio that you can’t receive health coverage frpm OPERS?

  47. GBC says:

    I have unreported service and exempt service will either of these count towards health care coverage. Planned retirement 4/30/13

    • Michael Pramik says:


      The current proposal is to limit the types of service credit counting toward health care eligibility only to contributing service, service transfers from other Ohio retirement systems, service purchased under USERRA and restored service credit.

      –Ohio PERS

  48. Tony says:

    Are you saying that someone with 29 years of service aren’t eligible for health care but someone with 20 years are,due to age? You can’t be serious.

  49. GBC says:

    So as worded now, if I retire before the effective date of any changes to health care these Services will count towards receiving health care? I have already paid for the service times

    • Michael Pramik says:


      If you are referring to proposed changes to the types of service credit purchases that in the future will count toward health care eligibility, those would not be applied retroactively to members who are already retired when the changes go into effect.

      –Ohio PERS

  50. Anita Caldwell says:

    My husband retired with 33 years, age 56,in 2006.We moved out of the country have always chosen the Basic healthcare so that “BIG” issues would be covered but we put all the excess into the RMA. For basic health needs our physician charges approximate $25 US for an office visit. Xrays, Mammo s,etc… are never more than about $60US, A full ICU bed costs about $150US a day. We have madeno extraneous claims on our insurance or RMA for over 10 years. We save up the RMA difference for our old age helath needs when things will get dicey. I just made the 55 spouse cut off by 6 months.

    Since we do not get our mail with any regularity we don’t change our healthcare. So as I understand it we will get the super expensive policy and not get any RMA deposits of the difference. OK, seems like we will have to get our medical once a year on our trips back to the Ohio.

    But I am unclear about my spouse coverage. It is going to end? When? How will I pay for it? My husband worked all those years as a states attorney for the security of a pension and healthcare. He had many many opportunities to leave and go private, each time we discussed it the benefits of OPERS and the set 40-45 hours a week for family life were more important to us. Silly and stupid us.

    So when does my spouse coverage end? At 57 having been an at home Mom I have only minimal eventual SS and even that is a decade away. What shame.

    • Michael Pramik says:


      The phase-out of the spousal coverage will proceed like this for spouses of members who are retired prior to Jan. 1, 2014:

      2013-14: Current allowance percentage
      2015: 67 percent allowance
      2016: 33 percent allowance
      2017-19: Zero allowance, access to coverage at full premium cost
      2020: OPERS Board plans to revisit the allowance issue

      For spouses of those members who retire after Jan. 1, 2014, or those who add their spouses after that date, the allowance will be equal to the percentage in effect at that time.

      –Ohio PERS

      • Anita Caldwell says:

        Ok. So by 2015 my husbands pension amount will increase 33% of the amount lost by having chose lifetime health for spouse (D) and then in 2016 it will increase another 33% of the amount for a total of 66% of that lot amount and finally in 2017 the entire amount lot from the pension because having chosen lifetime benefits for me.

        In 2017 I will be 60 and I am in the age group which had the SS full eligibility year pushed to 67 and I fully expect the federal government to change the option of early SS at age 62 to be pushed to 65. So I will be 5 years from Medicare and have to cover myself.

        We are going to need that difference. specially since we chose that reduced pension amount specifically due to my being so much younger and needing the healthcare option for my lifetime to be covered. Since we live out of the country the Medicare is not available to us and the OPERS helathcare although 2nd payor to Medicare would actually be our first payor.

      • Larry says:

        Using 820 as the premium
        Spouse 2013 Current allowance percentage
        2014 Current allowance percentage
        2015 820 – 67% = 270.6 Cost
        2016 820- 33% = 549.4 Cost
        2017 820 Cost
        2018 820 Cost
        2019 820 Cost
        When does the tables for retirees and children go into effect?Is it in 2015?
        So a retiree gets 75% then, and a child will be 37.5%
        Lets assume that the rate is still $820-
        2015- Retiree-820-75%= 205 Cost
        Child- 820-37.5%= 512.5Cost
        Spouse- 820- 67%= 270.6 Cost
        Total- $988.1 Total Cost per month in 2015
        $988.1 a month for insurance sure put a crimp into any retirees household budget.
        How can the Board look at these numbers and say this is a viable solution. Banking on ObamaCare vouchers is not written in so you are really hurting the retirees. I am concerned that the Plan was made awhile ago and the members survey did not have very much input if any.Reading the comments it seems that 99% of the respondents did not favor the elimination of spouses.
        Please comment and make corrections on these projections

        • Michael Pramik says:


          Your calculations appear accurate. Changes to the health care program were made in order to preserve meaningful health care for the members who contribute to the system.

          –Ohio PERS

  51. Ron says:

    STRS made changes like the new PERS health care coverage years ago. It was not easy. My wife was a teacher. I have read most of the posts here and people need to make a decision based on their personal circumstance I retired with only 21 years of service (got penalized for not going to 25 years ) and have been getting enhanced Medical Mutual. But that was MY DECISION, MY SITUATION!
    What everyone seems to forget that when they hired in, no one promised we were ” entitled ” to future health care. We, including myself, were informed of the current system’s parameters. Ask questions, become informed and make a choice that is best for you.

  52. Looking to retire says:

    I have 37 years and would like to retire by the end of the year. I have twin girls age 10. Will the new health care changes effect them and what will i have to pay?

    • Michael Pramik says:


      Yes, the new health care changes will affect you because in the future your children’s allowance for the health care premium will be half of your allowance percentage. Your allowance will be based on your age and service, according to the chart on page two of this document:

      If, for example, your new allowance covers 80 percent of the monthly premium cost, then your children will receive an allowance equal to 40 percent of the premium, and you will be responsible for the other 60 percent.

      The change to a 50 percent allowance for children will be phased in over three years beginning Jan. 1, 2014. In 2014, the current allowance will be provided. In 2015, the difference between the current allowance for your children and 50 percent of your allowance will be reduced by one third. It will be reduced by an additional third in 2016.

      Beginning in 2017, children will receive an allowance percentage equal to 50 percent of the retiree’s allowance percentage.

      –Ohio PERS

      • Looking to retire says:

        what kind of plan do i pay for my kids single plan for each kid or a family plan and how much is it?

        • Michael Pramik says:


          Insuring two or more children is one cost, so in that respect there is a “family” plan. As for how much it will cost, there is no way to tell you without more information. Please contact OPERS Member Services at 800-222-7377.

          –Ohio PERS

  53. William Schindewolf says:

    I purchased my Air Force service time, and with the purchased time I had enough to retire ( over 30 years ). But now that it will not count towards healthcare, I cannot retire with healthcare until April 2014, AFTER the new rules apply. Those of us that purchased our military service time under the understanding that it would count towards pension AND healthcare should be grandfathered in or REFUNDED our money!

  54. Dennis says:

    It appears you are using an actuarially unsound model when justifying the complete elimination of spousal health insurance for retirees. I am 57 with 25 years of service. My wife is 55 and has no health coverage other than from me. With the proposed change I will not be able to retire at age 61 (with 30 years of service) since I expect to have no viable health insurance coverage options for my wife. This means I now expect to work until my wife qualifies for medicre at age 65, which means I will be 67 with 35 years of service. How many other employees are in my situation and will also delay retirement for the same reason, and for how long? Your current model appears to be actuarially unsound as it does not consider the vast number of emplyees going forward that will have to delay retirement based on their spouse’s age. Can you explain how you have taken this into account?

    • Michael Pramik says:


      The plan is sound. We’re not sure what might lead you to believe that a possible delay in the payment of benefits or health care coverage would make a plan “unsound.”

      –Ohio PERS

  55. Froggy says:

    I am a little confused. It seems there are so many angles to the new rules. If my husband worked 28 years under PERS, bought back his 5 years of out of state time, is he covered for the maximum for health care?
    Also, we did lose over $500 per month because we were told that for me to get health care, as his spouse, we would have to take the plan A. Had we known OPERS was getting rid of spousal coverage, we would have chosen plan B, single life, and we would have had $500 in our pocket to pay toward my insurance.

    • Retiree says:

      I agree, I chose Plan D, a lower pension in order for my husband to have healthcare the rest of his life. This is what was wrriten in the plan rules when I retired 10 years ago. If we call member services, will they be able to tell us that we can change our pension plan from plan D to Plan B so we can have a higher pension to help pay for spouse healthcare in the furure? I sure hope so, because it would not be fair tor all current retirees who were told this when we decided to retire..I’m afraid they may not know the answer to this question since PERS is now changing the rules.

      • Michael Pramik says:


        The answer, as defined in state law, is contained in the OPERS Member Handbook: A monthly retirement benefit payable for your lifetime by Ohio PERS may be modified based (only) on the following life-changing events: marriage or remarriage, divorce, dissolution or annulment of marriage and/or death of a beneficiary (ies).

        Here is a link to the handbook. The information you seek is on Page 43:

        –Ohio PERS

  56. Helen Webb says:

    I know that 3% is the maximum, but is there a minimum on the COLA CPI under the new rules?

    • Michael Pramik says:


      No, there isn’t a minimum. If the CPI is zero or negative, there would not be an adjustment the following year.

      –Ohio PERS

  57. RetiredinMexico says:

    “Children who cannot receive health insurance through employers can stay on their parents’ plans until age 26. This age limit varies by state. In Ohio, for example, the age limit is 28.”

    This is a quote from Medical Mutual website. Does this mean that our daughter will be covered beyond age 26? If so this will help toward my no longer being covered and the increased costs coming out of my husbands pension income.

    • Michael Pramik says:


      You cited the rules for health insurance provided by employers, not retirement systems. In Ohio, retirement systems such as OPERS follow federal law, which sets that age at 26.

      –Ohio PERS

  58. Kathleen Pursley says:

    Question re: Medicare eligibility. I am an OPERS retiree receiving OPERS benefits. I’m age 59. I have 32 social security credits on my own. My husband already had enough social security credits to be eligible for social security. However, he passed away at age 58 and had not received any social security benefits. Will I be eligible for Medicare under my late husband’s work record? I’m having trouble getting this answer through Medicare. Thank you.

    • Michael Pramik says:


      It’s possible that you will be eligible, if certain circumstances exist. Contact your local Social Security Administration office to find out.

      –Ohio PERS

  59. Beverly Baker says:

    Back on January 1st, 2007, we were told that if we were 60 yrs of age and had 10 years in, that we would be eligible for healthcare. (I still have the opers sheet were it states that) How can they take that away from you? Some of my friends still think they are ‘grandfathered’ in. The situation is: We were told in a seminar that we MUST retire by Nov. 30th next year. After that, we need 20 years for health insurance. By that time next year, myself and two friends only will have 18 1/2 yrs in so we must retire?

    • Michael Pramik says:


      The eligibility requirements for health care are changing. Those who retire with an effective date of Jan. 1, 2015, or later, must have either 30 years of qualifying service credit or 20 years of qualifying service credit and be at least 60 years old to qualify. You do not have to qualify by the end of 2014. You can keep working until you meet the new guidelines.

      –Ohio PERS

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