Answers to Health Care 2022 questions
This month: Learn details regarding health care and re-employment
By Michael Pramik, Ohio Public Employees Retirement System
Oct. 28, 2021 – As we draw nearer to 2022 and the changes that will affect OPERS 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 how health care will be applied in 2022 for retirees who are re-employed in an OPERS-covered position.
Q: If I become re-employed with an OPERS-covered employer in 2022, I understand that I will not have access to the funds in my HRA. Why?
A: The OPERS HRA is a retiree-only plan. Federal regulations state that re-employed retirees are eligible to receive monthly deposits to their HRA plan, but ineligible from receiving reimbursements for expenses incurred during the re-employment period. For this reason, during your re-employment period, HRA deposits will accumulate in a separate Re-employed Accumulated HRA which is not combined with your existing HRA balance until you terminate re-employment.
Q: If I become re-employed with an OPERS-covered employer in June 2022, will I have access to my HRA deposits prior to the start of my re-employment?
A: Yes, you will have access to your existing HRA balance, but you can be reimbursed only for expenses prior to your re-employment period.
Q: I’m a Pre-Medicare retiree. If I plan to continue my re-employment in 2022, what are my health care options?
A: Like other Pre-Medicare retirees, you will opt in to the HRA and select an individual or family health care plan on the open market or through your employer. If you haven’t done so already, you’ll need to contact Via Benefits and set up an appointment between Nov. 1 and Dec. 15 to opt in to the OPERS HRA and explore individual and family medical plans for 2022.
Regardless of whether you plan to enroll in a new medical plan through Via Benefits, you must opt in to the HRA to begin receiving HRA deposits in 2022.
The difference with being re-employed is that you will not have access to your Re-employed Accumulated HRA for qualified reimbursements during your re-employment period. Remember, if you choose to enroll in a marketplace plan, we encourage you to work with Via Benefits so that you can benefit from the individualized support when thinking through your plan options. Learn more about Via Benefits at marketplace.viabenefits.com/opers.
Q: I’m a Medicare retiree. If I plan to continue my re-employment in 2022, what are my health care options?
A: If you are enrolled in a medical plan through Via Benefits, effective Jan. 1 you will receive monthly HRA deposits in a Re-employed Accumulated HRA. Think of this as a holding place for HRA deposits. You will not be able to receive reimbursements during your re-employment period. However, upon termination of your re-employment, you will have access to the accrued balance to receive reimbursement for expenses that are incurred outside of re-employment. To enroll in an individual Medicare plan through Via Benefits effective Jan. 1, contact Via Benefits between now and Dec. 7.
For more information on this transition, visit the Health Care 2022 page at opers.org. Also, plan to attend a Retiree Health Care Under 65 webinar. This webinar was updated with new information in February. If you have attended one of these sessions, you may consider attending again this year. 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.
Good information.
I am very interested in knowing who I can call to inquire about my time of service and the amount Accumulated .
Lynn,
You can call our Member Services department, at 800-222-7377, for that information.
I’ve asked before and think I understand but to be sure. When you retire and have pre Medicare and you get HRA money monthly. If you are married and your spouse can get insurance through their work place and for example it cost the spouse 700 dollars a month for a family plan through their employer could the HRA monthly money be used to pay for that and if so how would that happen ? Thanks In advance
Thomas,
The HRA allowance can be used to be reimbursed for post tax health care premiums.
Thanks,
MS
Where are the benefits for people on medicaid who worked 18 years in PERS?
Joseph,
Please forward you questions through the online message center or contact our Member Service Center at 800-222-7377, there we can review your account and answer your account specific question.
Thanks, MS
If I qualify for a subsidy for my premium for the Marketplace Health insurance for Pre-Medicare and decide to take it initially, I understand that I cannot receive the HRA money at the same time. My question is, if anything changes, like qualifications change and I no longer qualify for the subsidy payment can I start receiving the HRA deposit at a later date?
Robert,
There is a special enrollment period for a recipient that enrolled into the premium tax credit and their eligibility changes during the year. If you have additional questions about the process please contact OPERS through the online message center or by phone at 800-222-7377.
Thanks, MS
We need help with Via Benefits. We had an appt at 4pm today 11/1, to call in and ask questions about Healthcare for retirees. It is now 7:28pm, and we are still on hold! This is a nightmare!
As is typical during open enrollment, OPERS and Via Benefits are experiencing a high volume of phone calls, and on-hold times have been extensive for some. We recommend calling first thing in the morning, and the best days to call are Wednesday and Thursday. Please be assured that both OPERS and Via Benefits are committed to providing each retiree with the assistance they need.
J Glomski had an appt. scheduled for 4 pm – what is the point of an appointment if 3 1/3 hours later you are still on hold. OPERS has pushed for this for over 2 years and selected a vendor that is not capable of handling the work. The suggestion of calling early in the morning when you don’t have an appt is a strange solution. Can you go with a different vendor to hold your account if they are unable to appropriate service your account!
Jim,
We acknowledge that OPERS and Via Benefits are currently experiencing the same labor shortages affecting businesses all over the country, but we are training and adding staff members as quickly as we can. We apologize for any inconvenience and frustration this may cause. Please be assured that both OPERS and Via Benefits are committed to providing all retirees with the assistance they need.
To answer your question, Via Benefits is the sole administrator of the Medicare and Pre-Medicare Connectors.
Is there anyway my wife and I (both OPERS pre-Medicare/HRA eligible retirees) can get our HRAs merged so that we can buy a family plan with our joint HRA monies to avoid paying for two, more expensive individual plans. It seems we are being punished for being married to another HRA eligible person! Via benefits say they can link our separate Via Benefit accounts but that does not help unless our HRAs can be linked by OPERS. Suggestions?
David,
Households with more than one retiree with an HRA cannot merge the HRA deposits to receive both allowances into one account.
Thanks MS
Can one spouse, in a couple who are both pre-Medicare OPERS retirees & eligible for HRAs take the HRA allotment but not join a medical plan while allowing the spouse to pay for a family plan with their HRA allotment only (assuming the non-medical program spouse accepting the HRA only could not use their HRA funds until such time as they gain a medical plan at a later date). On alternative years you switch roles as to which one buys coverage and which one accure unused HRA funds?
David,
The pre-Medicare recipient is not required to enroll into a medical plan through Via Benefits to be eligible for the HRA. The member must opt into the HRA during open enrollment to receive the HRA allowance in 2022.
Thanks, MS
Bob
I’m 61 years old if I retire with 27 years of service and I wait until February of 2022 am I entitled to the pre Medicare HRA Allowance? Or do I have to retire before December 31 2021 to be eligible for the pre Medicare HRA allowance ?
Thank you
Bob,
Please forward your questions through the online account message center or contact our Member Services Center at 800-222-7377 for further assistance.
Thanks,
Megan
Will we receive a pre Medicare insurance book to choose out of?
Elizabeth,
There is not a book available that provide the pre-Medicare plans. You can contact Via Benefits at 1-833-939-1215 or visit the Via Benefits website to shop the plans available in your area.
https://marketplace.viabenefits.com/opers
Thanks, MS
Bob
Can you shop for plans for pre Medicare from the link above if you did not apply to retire yet? I am looking to retire in February or March next year and would like to see what plans are available to me.
Thank you
Bob,
For further assistance Please reach out to OPERS through the online message center or by contacting us by phone at 800-222-7377.
Thanks, MS
Am I reading the 2022 OPERS Health Care Program Guide correctly where it states on page 1, in bold print?:
Effective Jan. 1, 2022, OPERS no longer provides a group medical or prescription drug plan.
If this is correct, what options do we have as far as getting medical and prescription coverage?
Helen,
OPERS has been communicating this change continually since the Board of Trustees approved it in January 2020. We have a section of our website dedicated to Health Care 2020.
I see from other comments, that you suggest calling 1-800-222-7377 for any information on various questions. I tried numerous times, and the message was, “we are experiencing a higher than normal call volume. Call back later”. 2:20pm on a Thursday, one would expect there not to be a high call volume. I would not be surprised if one were to call anytime, during business hours, that they would receive the same message.
Bernard,
The reason for the higher call volume is that open enrollment is now effective for both our Medicare and Pre-Medicare retirees, and our Pre-Medicare retirees are going through choosing their own health care insurance for the first time. There is always a high call volume this time of year in the afternoon. We encourage members to call early in the day.
I am 61, pre Medicare and currently on my spouses health plan coverage through his work. I will be taking COBRA from my spouse’s employer plan when he retires starting Jan 2022. Can I use the HRA to pay for the COBRA premiums for myself?
Mary,
A Pre-Medicare retiree who enrolls in COBRA coverage through another employer can submit the COBRA premium as a qualified medical expense to be reimbursed from his/her HRA.
Thanks, MS
Can you clarify I’ll be retired Dec 1st, pre-medicare 60yoa with 40yrs of service can I use the HRA to pay for my COBRA monthly premiums for now thru my ex- employer?
Gary,
A Pre-Medicare retiree who enrolls in COBRA coverage through another employer can submit
the COBRA premium as a qualified medical expense to be reimbursed from his/her HRA.
Thanks, MS
Are you still answering this BLOG? I am confused about the “another employer” language… I am pre- medicare, retiring from a county job and would like to have COBRA coverage continue from the county employment and use my HRA to pay premiums for the COBRA plan. Is the county “another employer”?
Kathleen, the language of “another employer” refers to COBRA coverage offered outside of OPERS. If you have further questions on eligible expenses for reimbursement please contact Via Benefits.
How does one enroll in a re-employed HRA?
Kelly,
This fact sheet contains information about re-employment for Pre-Medicare retirees. The fastest way to opt in is online.
I was told to call VIA Benefits last night for at 645 pm for them to help me pick out a new insurance plan. I was on hold for an 1.50 hours and never was able to speak with anyone. This process has been a nightmare already. I can’t wait to see how long the processing of the actual reimbursements take. It will be a head ache of getting invoices for the premiums from the insurance company every month. Will we have to provide that from the insurance company??? I don’t see them sending out individual invoices….
Donna,
On Via Benefits website they offer a getting reimbursed guide that provides that information that is needed for reimbursement.
https://marketplace.viabenefits.com/
Thanks, MS
I am a pre medicare OPERS I would like to get in my Husbands insurance plan where he is employed. But he plans on retiring in April. So should I take the HRA or the Tax deduction? If I take the HRA can we later take the tax deduction since we will have a change in status?
Dusty,
Please send your questions through the online account message center, there we can review your account and provide account specific answers. If you do not have access to the online account please contact our Member Service Center at (800)222-7377.
Thanks, MS
I’m 57 years old, with over 30 years of employment – is there an age qualifications to receive HRA.?
Kenneth,
You do not indicate whether you are currently active or retired. Eligibility requirements will change next year only for those retiring on or after Jan. 1, 2022. If you’re currently retired and eligible (or retire and are eligible prior to Jan. 1, 2022) to participate in the OPERS health care program, you will continue to be eligible after Jan. 1, 2022.
Here is a description of new eligibility requirements beginning in 2022 for active members.
If you are 62 and pre-medicare and the past several years have got insurance coverage through spouse’s work do you still sign up for the HRA? And does it still deposit money monthly then? If you sign up for the HRA do you have to pick a plan for insurance coverage or can you stay with your spouse’s coverage but get the deposit?
John,
That’s a question in the Q&As on our website. If you’re a Pre-Medicare retiree who’s covered as a dependent on your spouse’s medical plan, you’re still eligible to receive HRA deposits. But you have to contact Via Benefits to opt in to the HRA. We recommend doing so online. Once you’ve opted in, you 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 premiums, deductibles, co-insurance and other out-of-pocket expenses.
I heard that OPERS would continue to offer MetLife Dental and Aetna Vision. Is this true or will I need to go through VIA? I am reemployed part time Medicare.
Was also told that VIA could compare current plan to new plans. After a wait of 2 hours was told that they could not. Had no idea of current OPERS plan. And then, about only 2 minutes into the call, they disappeared and the phone went silent.
Ken,
OPERS will continue to offer the MetLife dental and the Aetna vision coverage. The coverage details are available on OPERS.org in the Open Enrollment Guide for 2022.
Thanks, MS
I had a 9 45 sxheduled appointment with viabenefits today. I was on the phone waiting for over an hour. …until I was disconnected.
Why make an appointment?
I’ve been on the shopping/compare site..none of my doctors are on the plans. They are all hmo’s.
Exactly how I thought it would be..so disappointed.
I am very disappointed with my VIA Benefits experiences to date. I won’t share specifics because they are already addressed by numerous other commenters. The counseling, support, and assistance that was greatly lauded by OPERS that this company would provide is non existent. I understand your responses of they are doing their best and high call volumes, etc. but this is really unacceptable. VIA Benefits had plenty of time to prepare. The relationship with OPERS going back to 2016. I navigated the health care options myself and choose a policy. The premium seems very high and I really just made my best guess. No real idea of my options since attempts to connect with a VIA Benefits representative did not come to fruition. The appointment process simply doesn’t work. Please encourage this company to meet their obligations and responsibilities to your members. Thank you in advance for any assistance you can provide.
Is OPERS aware of the problems members are having reaching someone at VIA Benefits to help us with selecting our plans? I had an appointment on 11/11/21. Waited on line for 1 hour and no one assisted me. Tried to reschedule today and the earliest they have appointments is December 6, 2021. No one answers the phone when you call, you just get put on hold and they NEVER ANSWER. Tried doing it on line but no plan seems to accept my hospital with my medications. Would appreciate some assistance from OPERS in getting this resolved.
Can’t find information on medical mutual. Have had this plan since went on Medicare but when I check the Via Benefits site it’s not even listed. What’s the problem. Phone appointments as are none available, Can’t stay on hold for hours. Got the up dated email about lack of employee issues etc. Tried to get on the the Wednesday webinars but can’t find the banner advertising it to click on. What a poor system, Can’t believe OPERS wasn’t’ better prepared to enrollment.
Patricia,
We are researching your comment about Medical Mutual. Meanwhile, we have reinserted a link to the Wednesday webinars at the top of our homepage.
Is a certain number I can call to get my email address changed so that I can give my new email to reset password. Thanks
Mary,
If you are not able to access your online account due to your email needing updated please send your request through the general benefitquestions@opers.org email to see if you can get further assistance.
Thanks, MS
What’s the reason for OPERS denying vison and dental access to a dependent who is incapacitated above the age of 26 when OPERS is not paying any part of the premiums for anyone choosing to have OPERS vison and dental insurance? Seems mean spirited when the person is unable to do for themselves anyway, and the premiums are not costing OPERS anything? This information should be included in OPERS health coverage webinars.
Bill,
The members that were impacted by this change in eligibility have been sent a letter notifying them of the change.
Thanks, MS
If you take the government subsidies are you still eligible for the one time deposit if 1200?
Charbeth,
A member who chooses the premium tax credit must opt out of the HRA making them ineligible for the transition deposit.
Thanks,
MS
I understand from conversation with OPERS dental benefits person that all retirees that have an adult with a disability over the age of 26 living with them will not be allowed to enroll them in vision and dental coverage. My daughter is in the Medicare connector plan but cannot have dental or vision coverage? I have seen no notice of this change in policy anywhere and are interested when and how this decision was reached without the members knowing. Happened to stumble on this today!
Mark,
Our goal with Health Care 2022 is to stabilize the Health Care Fund so that we can continue to provide access to meaningful health care to current and future retirees. Over the last few years, we’ve had to make some tough health care-related decisions that impact spouses and children. This means that any child over the age of 26, regardless of status, will no longer be eligible to enroll in OPERS dental and vision coverage. We recognize that not everyone will be happy with these decisions, but we hope that our retiree population can appreciate why we are making these changes. Please understand that you may work with Via Benefits, our administrator of the Pre-Medicare and Medicare Connector, to explore individual dental and vision plans that may be right for your child.
I’m a pre-Medicare retiree…I thought HMOs and PPOs were going to be offered through VIA Benefits. I only see options for HMOs when looking for a plan on their website. I have emailed them and called them twice and have not been able to talk with anyone to get an answer. Are PPOs not being offered?
Kim,
The majority of individual and family medical plans offered through the OPERS Pre-Medicare Connector are Health Maintenance Organizations (HMOs) – all plans secured through healthcare.gov for Ohioans are HMOs. HMO plans offer lower premiums and deductibles and typically require a referral from a primary care physician to see a specialist. They also require services through a specific network of providers and hospitals. Remember that because the Pre-Medicare Connector is an open HRA, you are not required to sign up for a plan through Via Benefits or healthcare.gov.
Via Benefits seems overwhelmed. Their Benefits Coordinator basically only asked, “what plan do you want to sign up for?” No counseling or advice. I have been trying to get my mobile app to work for the last week. Finally got through to VB’s IT team …apparently there is a “know issue with the app if you are using Android” as it will not let you even sign in. Why is OPERS or VB not telling us that, letting us become more frustrated every day. It seems to me VB is only a link to Obamacare. There apparently other plans like BC/BS of Michigan that are nationwide PPO plans accepted in Ohio, that include most area Drs./hospitals, and that have low deductibles/maximum out of pockets. VB does not offer choices or mention anything other than Obamacare and OPERS is not telling you where else to look. Disappointed in VB and OPERS.
David,
Yes, there is a known issue with the Via Benefits phone app, and that company is working on a solution. Also, remember that Pre-Medicare retirees have an “open HRA,” meaning you are not required to use Via Benefits to elect a medical plan. You are free to enroll in the plan of your choice.
I made my appointment in October for today with Via Benefits, still on hold for over 2.5 hours past my appointment time.
How do you make you first premium payment – through ViaBenefits of the carrier, in my case CareSource? Where will I be able to see my history of payments made throughout the year?
David,
The payments for the 2022 medical plan should be paid through the health care plan administrator not Via Benefits.
Thanks, MS
I do not understand; Via Benefits told me to pay through their online portal do so I did and my credit card has been charged by my carrier. One VB representative said I could pay every monthly premium through the Via Benefits portal but upon calling back another representative said you could only make the first payment through Via Benefits??? Every question has to be referred to their ‘Help Desk’. Why would Via Benefits have a place to pay by credit card, bank draft or by mail under ‘My Policy’s’ on my Dashboard? Again, both representatives I spoke with did not know about this payment option where VB transfers the money to my carrier. I made my payment on 12/1 and today is 12/7 …still ‘in process.’ I thought this was going to be a quick turnaround? Oh, although I can now access the mobile app, you can’t do anything on it. The Reimbursement screen on the app has said for a week now, “apologizes ….come back later…”
David,
Some plans offer the payment option through the Via Benefits online account not all plans have that option. Overall Via Benefits will need to review the account to determine if the payment was accepted. The Via Benefits app can only be used for the reimbursement process not the opt in or plan selection process.
Thanks, MS
My premium was paid to CareSource through the VB online portal. It has been processed, approved and is now pending reimbursement into my bank account per my VB dashboard. BUT, I was told only the $1200.00, one time deposit by OPERS would be the only HRA funds available to pay your first premium prior to 1/1/22?? VB paid my entire premium that is in excess of the $1200.00 by tapping into my normal HRA amount (apparently for January 2022?) which was deposited into my account on 11/4/21, the same day as my $1200.00 one time deposit??? What day of the month are our HRA deposits by OPERS being put into our accounts???
Strangely enough VB’s mobile app show 2 sets of uploaded documents on the same day(my premium & my receipt whereas my online account only shows one set???
David,
We suggest contacting Via Benefits at 1-844-287-9945 with questions about your individual HRA account.
If my spouse (who is retired and signed up for his HRA account)has family coverage through his work and I am on Medicare parts A&B can my husband use his HRA money to pay my monthly Medicare premiums?
Jim,
The member can be reimbursed for post tax health care qualifying expenses for them and their spouse as long as the member is not working in an OPERS position as a re-employed retiree and the HRA is going to the accumulated HRA. If the members HRA allowance is going into the accumulated HRA they cannot be reimbursed for expenses that accrued in the re-employment period.
Thanks, MS
I am wondering if I am eligible for your insurance. I have Medicare and am thinking of changing my plan. My husband is deceased and he was a member.
Joyce,
Please send your account specific questions through the online message center or contact our Member Service Center at 800-222-7377.
Thanks, MS
Are healthcare premiums deducted in advanced? I believed so but the premium appears to be deducted from December pension even though won’t have coverage through PERS on 1/22
Paula,
The medical, dental, and vision premiums deducted from the December 2021 benefit are for the December 2021 coverage.
Thanks, MS
What happens to health care deductions from my pension when I go on medicare and use VIA Benefits to enroll in medicare. I think my pre medicare health care deduction from my pension is about $235/month.
Richard,
Those funds will no longer be deducted from your pension benefit, so your monthly benefit will increase.
Can I register for VISION coverage on line?
Julia,
You can complete the Vision/Dental Open Enrollment Change Form that was mailed in the beginning of open enrollment. If you do not have the form you can print it from the document history in the online account.
Thanks, MS
It was my understanding that the $1,200 transitional deposit was to be used for payment of the initial premium once you chose a plan, since those need to be paid in advance for your benefits to be in effect as of Jan 1st. ViaBenefits is telling me my funds are not available until January 1st.
Thus, members will need to pay out of pocket for their first premium and wait a month to be reimbursed. That’s a big expense for us retirees, especially in December. Not good.
I have chosen the HRA as I will be going on my wife’s medical Insurance on Jan 1, 2022, as I am pre medicare. I have called Via Benefits and OPERS with no luck getting through. I am now covered by OPERS for my dental and vision, will this continue? Do I have to re enroll into those plans?. Or will I automatically be re enrolled by Jan 1? Thank You
Mike,
If you’re currently enrolled in OPERS dental and vision, and you want to continue the coverage next year, you do not have to re-enroll.
Why is the transitional deposit of $1,200 not available to use right now to pay for the initial premium?? I thought that whas the whole purpose?? Expecting retirees to pay out of pocket is a big, unexpected expense.
Brian,
The transition deposit is available to reimburse participants for their January premiums. It has to be reimbursed, after payment is made. That’s how a Health Reimbursement Arrangement works.
Thank you, but since the premiums must be paid in December, shouldn’t the reimbursement funds be available in December?
Brian,
Once you have opted in to the HRA, Via Benefits will create your account and send you a “Getting Reimbursed Guide.” Once you receive this guide you can submit your January premium for reimbursement. Keep in mind if you received the $1,200 transition deposit, the only expense that can be reimbursed prior to January is your January premium amount. If you did not receive the transition deposit, you’ll need to wait to receive your January HRA deposit before seeking reimbursement for your January premium. Depending upon your submission method, it could take up to three weeks to receive your reimbursement if you submit it via mail or fax, whereas submitting it through your Via Benefits online account or mobile app would take only approximately a week.
Thanks,
MS
I have not chosen an option for my health care and need to understand what each of them mean to me.
Lora,
You can call Via Benefits at 1-833-939-1215. We recommend that you first take time to explore the Via Benefits website marketplace. Researching plans and building your online profile prior to speaking with a representative will result in your call going more smoothly.
Will costs for Dental and Vision automatically be sent to VIA Benefits from the OPERS file? If so what does a member need to do to get those reimbursements sent to the member?
Phil,
The dental and vision premiums are automatically reimbursed through the HRA for recipients and their dependents as long as the member did not opt out of the dental and vision automatic reimbursement.
I have been denied a premium reimbursement for my daughter who attends Ohio State University because VIA Benefits says Student Health care premiums are not reimbursable. Before I purchased the health care plan I was assured that it was a reimbursable expense. This is a post tax premium.There is nothing on the VIA Benefits site or in the 2022 Getting Reimbursed guide that says Student health care premiums are not reimbursable. Constantly OPERS told us we could use the funds to cover our dependents now I am being told I can’t get reimbursed for the premium. Is OPERS aware that Student Health plan premiums are not reimbursable? Is that true? Why has that not been publicized if it is true?
Phil, There are several factors that could be applicable to the claim being denied. Please forward your inquiry through our online message center in your online account, there we will be able to review your account specific information and respond to your question. If you do not already have an online account, you may register from the upper right-hand corner of the OPERS website. Once you have logged in, click on the my account tab, select message center from the drop-down menu, then click add new at the bottom of the page to submit your question or you may call 1-800-222-7377 to speak to a Member Services Representative.