Answers to Health Care 2022 questions
This month: Learn details about the enrollment process
By Michael Pramik, Ohio Public Employees Retirement System
Aug. 31, 2021 – As we draw nearer to 2022, and the changes that will affect OPERS Pre-Medicare retirees next year, we will periodically post questions and answers to key topics we believe will benefit our members.
This month we’re answering several questions regarding enrollment procedures for both Pre-Medicare coverage and the OPERS Medicare Connector.
Q: When will we receive information about open enrollment for 2022?
A: At the end of September, OPERS will mail open enrollment materials for 2022 to all eligible benefit recipients. These materials will feature general information on the OPERS health care program and details about the optional OPERS vision and dental plans for 2022.
Open enrollment periods are as follows:
- Pre-Medicare: Nov. 1-Dec. 15
- Medicare: Oct. 15-Dec. 7
- OPERS dental and vision: Oct. 15-Dec. 15
Q: I’m enrolled in the OPERS Pre-Medicare health care plan. When we find our own insurance plan for next year, how will OPERS or health care providers know that we are currently enrolled in the group plan?
A: In late September, OPERS will mail a Loss of Coverage letter to each individual enrolled in an OPERS group medical plan. As you enroll in a new plan, you may be asked to provide documentation of your prior coverage. This letter will serve as your proof of prior coverage with the OPERS group medical plan.
If you enroll in a medical plan with Via Benefits, you will not need to provide this letter to them since we have already sent them a copy. You may put this letter in your files. If you choose to enroll in a medical plan through an organization other than Via Benefits, you may be asked to provide this letter during the enrollment process.
Your Loss of Coverage Letter (and letters for any enrolled dependents) will also be available to download and print from your OPERS online account.
Q: Based on what I’m going to receive monthly in my HRA, I don’t think OPERS is providing me enough money to cover my premiums.
A: Covering the entire cost of an individual or family medical plan is not the intention of the OPERS Health Care Program. In the current group plan, all retirees pay some percentage of the monthly premium, based on age and years of service credit. (See the allowance table on OPERS’ website.) It will be the same way with the new coverage.
However, there’s more flexibility. To the extent that a participant opts for lesser coverage, he or she may be able to cover the full premium, and even have money left over to go toward dependent coverage or to save for future health care expenses. Also, keep in mind that the current amount you have deducted from your OPERS benefits for your medical premiums will be added back into your monthly benefit.
Q: What if a retiree chooses not to enroll in a plan and just pays for expenses out-of-pocket? Will they still receive HRA deposits?
A: Yes. Enrolling in a medical plan is not a requirement for Pre-Medicare retirees to receive HRA deposits. Pre-Medicare retirees only need to meet eligibility guidelines and opt-in to receive the HRA deposits.
Q: If a Pre-Medicare retiree is covered as a dependent on their spouse’s medical plan or enrolled in an employer’s plan, are they still eligible to receive HRA deposits?
A: Yes. Once they’ve opted in, retirees will receive HRA deposits regardless. This is how an open HRA works. Retirees can use the funds within their HRA to be reimbursed for qualified medical expenses such as post-tax premiums, deductibles, co-insurance and other out-of-pocket expenses.
For more information on this transition, visit the Health Care 2022 page at opers.org. Also, plan to attend a 2022 Open Enrollment webinar. OPERS will offer a webinar for both Pre-Medicare retirees and Medicare retirees this fall. Visit the Member Education Center at opers.org to register. All webinars are also available as Recorded Presentations to watch at your convenience.
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.
What does this mean for two family members who retired from the State? Will they be able to use funds from both HRAs to purchase a family plan if it would be cost effective?
Jim,
For a household with multiple benefit recipients they can both have the HRA and be reimbursed for post-tax health care qualifying expenses.
Thanks, MS
Keep the good info coming. I need all the help I can get. Also, keep sending reports in the mail. I like to go back and re-read all the new info.
Getting ready to retire, will the HRA cover out-of-pocket expenses for tummy tuck, lipo, etc?
Sharlene, the list of eligible expenses that can be submitted for reimbursement through the HRA are included in the IRS Publication 502. To further discuss eligible expenses you must speak with Via Benefits at 1-844-287-9945. Thank you, OPERS
Plain and simple, Since you will be saving Millions of Dollars under the new health care plan, I do not believe you need to stop our Cola for 2 years.
I believe the last question’s response needs to be clarified… My understanding was that if I remained covered on my employer plan the HRA deposits would be placed in my account but that I could NOT use them to cover allowable expenses UNTIL I WAS NO LONGER COVERED ON MY EMPLOYER PLAN. The current response infers I can be.
Vicki,
You’re referring to rules for retirees who are re-employed in an OPERS-covered position. In that case, they can receive HRA deposits, but they can’t use them for expenses incurred while they are re-employed.
Vicki,
In 2022 an OPERS re-employed retiree can receive the HRA deposits into an accumulated HRA while re-employed and once the employment terminates the member would gain access to the funds to be reimbursed for qualifying expenses. The member would not be eligible to be reimbursed for expenses the occurred during the re-employment period.
Thanks MS
I know that my allowance will not be enough to cover my insurance premium. Im enrolled in auto withdraw from my bank, my question is will via benefits still continue to withdraw the full premium payment monthly and withdraw the difference from the bank account automatically or do i need to make new arrangements to pay the difference? thank you
Edward,
The premiums you will pay in 2022 will need to be paid out of pocket and if the premiums are an eligible expense they can be reimbursed from the HRA.
Thanks MS
OK so..I am now eligible to receive the monthly HRA as a Pre-Medicare, Re-employed retiree with an OPERS -covered employer AND keep my selected medical plan with my employer? I need only to Opt-In? Understanding that HRA accumulated funds are available only after my re-employment ends?
M. Reese,
An OPERS re-employed retiree will receive the HRA deposits into an accumulated HRA while re-employed and once employment ends they would gain access to the deposits to be reimbursed for qualified expenses. The member will not be eligible for reimbursement of expenses that occurred during the re-employment period. The HRA opt in period for Pre-Medicare recipients will be 11/1/2021-12/15/2021.
Thanks MS
For the last question in the answer is an HRA can be used for “qualified medical expenses such as post-tax premiums, deductibles, co-insurance and other out-of-pocket expenses.” My question is why “post” tax? why not pre tax? is that a Federal, State, or OPERS rule?
IRS Publication 502 spells out qualified expenses and specifically excludes employer-sponsored health insurance plan
premiums unless the premiums are included as income. Most employer-sponsored plans are paid using pre-tax
deductions, meaning the premium itself is not reported as taxable income for the employee. Because the employee has
already received a tax-free benefit on the premium when it was deducted on a pre-tax basis, they may not receive a
second tax-free benefit by receiving a reimbursement from their HRA for that same premium. Thanks MS
I appreciate what OPERS has done for their retirees, however I don’t think it it is fair to reduced my HRA, with 30+ years of service, I was 58 years old when I retired, and in 2022, my HRA will be reduced from 75% to 71%. It is the same reaction, I get from receiving a reduced Social Security amount because of the Windfall having worked in both the public and private sector. Sometimes having a good work ethic can turn into a loose/loose situation. I know 2022, the COA will remain in effect, but it just a matter of time before the other shoe drops.
Is it a federal tax rule that a person can’t use both the premium tax credit and receive the HRA money from OPERS ?
Tim,
Yes. Go to this page published by the Internal Revenue Service: “Questions and Answers on the Premium Tax Credit.”
See questions No. 17 and 18. The IRS clearly states that “If you are provided a retiree-only HRA, you cannot claim a premium tax credit for the months you are provided the HRA.”
I am a retired OPERS employee collecting a monthly pension since 2014. I am not presently in the OPERS medical , dental, vision plans. Also, I am a 63-yo pre-medicare part-time employee still working in an OPERS job.
My wife will be 62-yo later this year and is retiring at the end of 2021. Her company will allow us to keep her medical plan until we reach 65-yo.
Question #1: Can we sign up for the OPERS Dental and/or Vision plan without signing up for the Medical plan?
Question #2: Will I still receive the monthly allowance if I don’t opt-in to the OPERS medical plan?
Thank you for any guidance you can help us with.
Ken,
Pre-Medicare retirees that are eligible for the HRA in 2022 will be required to opt in to the HRA during open enrollment 11/1/2021-12/15/2021 to start receiving the deposits 1/1/2022. The pre-Medicare HRA does not require the member to choose a medical plan it only requires the recipient to opt in to the HRA. There will not be a medical plan offered through OPERS starting 1/1/2022 there will only be a health reimbursement allowance provided to health care eligible recipients. The dental and vision through OPERS will continue to be be available and does require participation in the HRA.
Thanks, MS
Do I have to enroll in automatic reimbursement from the provider I select to Via Benefits, or can I manage my reimbursement requests from Via Benefits myself? Ex: if I choose to not do monthly reimbursement but hold it and request a few months at a time, can I do that and manage it myself?
Trudie,
Via Benefits will go over the reimbursement options that are offered, if the automatic reimbursement is an option it would not be a requirement. If you have additional questions about the HRA reimbursement options please follow up with Via Benefits.
Thanks MS
The HRA reduction for Medicare retirees means that there will be sufficient reimbursement for only one recipient in the family. Currently, myself and my spouse are enrolled in a Medicare supplement/advantage plan through via benefits. I am the retiree, will my spouse still be able to enroll in a Medicare supplement plan through via benefits even though there will be insufficient reimbursement for her plan?
Jim,
The health reimbursement allowance that is offered by OPERS is provided to offset the cost of the medical expenses. Spouses will continue to have access to use the plans offered through Via Benefits.
Thanks, MS
If I have my husband add me to his medical insurance, will I be eligible for the HRA to reimburse him for that additional cost of his plan?
Kim,
In 2022 the pre-Medicare HRA can be used to be reimbursed for qualifying post-tax health care expenses.
Thanks MS
Is the pre-Medicare HRA that I will receive monthly only used to reimburse my eligible healthcare expenses or can it also be used to reimburse my family expenses, e.g. my spouse and college aged dependent?
TJ,
Retirees will be able to use HRA dollars to be reimbursed for qualified medical expenses incurred by eligible dependents.
Thanks, MS
How can I be sure I am not signed up for Vision and Dental with BOTH OPERS and Via? I don’t understand how that would happen.
Judy,
You can verify the plans you are enrolled into with OPERS through your Member online account. You would need to contact Via Benefits to confirm the coverage you have enrolled into through them.
Thanks, MS
I see that dental and vision premiums for coverage offered by OPERS and paid via benefit deductions will automatically be reimbursed from my HRA. What if my health care premiums exceed my allotment? What will happen to the dental or vision reimbursement …will it just be denied?
David,
If you are signed up for the automatic reimbursement of the dental and vision premiums that are deducted from your OPERS benefits those premiums would be reimbursed and then the remaining funds in the HRA will be used for other reimbursements.
Thanks, MS
There has been very little mention in the webinars or in written material if both husband and wife are both OPERS pre-Medicare and health care eligible retirees. Via benefits nor OPERS counselors seem very confident in answering if two Via Benefit accounts can be linked, how a family plan will or can be paid for by combining the 2 allotments, which spouse will choose the family plan, etc. I am obviously not alone in this situation.
David,
The HRA for two separate members cannot be combined together. Please contact Via Benefits to get additional information on reimbursement options in your situation.
Thanks, MS
I just called Via benefits (VB); they CAN link to two (VB) accounts of husband and wife, both of whom are OPERS Pre-Medicare retirees and who are both eligible for the OPERS Healthcare Program (HRA); but VB does not think OPERS can link HRA allotments, from separate VB accounts to reimburse premiums for a family plan by combining assets from the two HRAs, although VB would think in doing so would likely result in reduced total premiums for a couple (a family policy being likely cheaper than two individual policies). Thus linking VB accounts is probably not a good idea.
David,
If you have additional questions about the subject please send your questions through the online account message center or contact our Member Services Center at 800-222-7377.
Thanks, MS
I just received the 2022 OPERS Healthcare Glide. In looking at eligibility for the HRA, I have never seen groups A & B broken down by age (60-64 and 59 or younger). Did eligibility requirements change? If you worked 31 years, of which 30+ years had qualified health care service credit and were at least 52 years of age at retirement, are you in group A or group B under the Age 59 or younger category? It seems like you are in both.
David,
For Pre-Medicare members, eligibility will change only for those who retire on or after Jan. 1, 2022. See the OPERS website for details. Regarding your retirement group, that information is contained in your annual statement, which you can find online via your OPERS online account.
Is there any healthcare benefit or HRA for a surviving spouse under the traditional plan?
Slr,
A spouse will have access to use Via Benefits to help with choosing a plan, but they will not receive an HRA allowance.
Thanks, MS
Where can I get a Loss of Coverage Letter?
Kathy,
The loss of coverage letter can be printed from the OPERS member online account document history.
Thanks, MS