Health-care plans in place for re-employed retirees
The Ohio Public Employees Retirement System has created new, alternative health care plans for retirees who have returned to work with an OPERS-covered employer.
The Humana Interim Medicare Plan is for Medicare-eligible re-employed retirees, and the Medical Mutual Interim Plan is for those not eligible for Medicare. Both plans will be effective on Jan. 1.
The new plans are in response to federal rules that affect coverage, as we told you about them in a PERSpective blog posted in April.
The basics of the new plans are summarized in a video that we’ve recently posted to our YouTube channel. Here are some of the details:
Medicare retirees
Current Medicare-eligible re-employed retirees without employer coverage who will continue in employment have two options:
- Enroll in the Humana Interim Medicare Plan by completing and submitting a Health Care Open Enrollment Change Form no later than Dec. 31, 2015. Participants will not pay for the full cost of this plan as OPERS will provide an allowance toward the monthly premium. This deadline also applies to dental and vision coverage for 2016.
- Choose an individual Medicare plan through the OPERS Medicare Connector. Re-employed retirees will not receive or have access to allowance dollars while re-employed.
In 2016, Medicare-eligible retirees who selected an individual Medicare plan through the Connector and participate in the Health Reimbursement Arrangement when they become an OPERS re-employed retiree will have the following choices:
- Enroll in the employer’s coverage. If a re-employed retiree’s employer offers heath care coverage to other employees performing comparable work or in a comparable position, the employer must offer the coverage to the re-employed retiree. If the retiree waives the employer’s coverage, the retiree is not eligible for any coverage or HRA allowance from OPERS during re-employment.
- Remain enrolled in the individual Medicare plan selected through the Connector, but without receiving their HRA allowance or reimbursement for claims incurred while re-employed. (There are plans available that offer premiums as low as zero dollars per month that could make this option more attractive.)
- Disenroll in the individual Medicare plan they selected through the Connector and enroll in the Humana Interim Medicare Plan. OPERS will provide the appropriate allowance similar to our current health care plan, based on age and service. If the allowance doesn’t cover the full premium, we would deduct the remaining amount from retirees’ pension benefits.
Medicare-eligible and non-Medicare-eligible spouses may be enrolled in OPERS coverage if the retiree elects to participate in the Humana Interim Medicare Plan.
Non-Medicare retirees
Re-employed retirees not yet eligible for Medicare will automatically be enrolled in the Medical Mutual Interim Plan in 2016. Coverage under this plan is the same as coverage for non-Medicare retirees who are not re-employed. Allowances will follow the same guidelines as those for participants in the general plan. However, premiums for re-employed retirees may be higher.
If you’d like to see how re-employment affects your health care costs, please log in to your account at www.opers.org and use the Health Care Calculator available in your online account.
If you do not choose one of these options, you will not have health care coverage through OPERS in 2016.
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.
Yes. The re-employed premium is higher. Just high enough to supplement the discount given other plans.
Mike:
With the additional cost to the rehired retirees I’m guessing some will volunteer to drop coverage until they become Medicare eligible. My question regards the ability to get back in the plan at age 65. I understand you need credible coverage, so my question is this–Is Tricare credible coverage?
Thanks..
Roy,
If you are trying to rejoin during open enrollment and voluntarily terminate your coverage, then yes, TriCare would qualify as creditable coverage in that case. If you want to come back in outside of open enrollment you would need a qualifying event, such as involuntary loss of coverage.
–Ohio PERS
where do I find the 2016 rates for Med. Mutual health care, dental and vision high and low rates for 2016.
I am retiring Nov. 30 at the age of 58. I know what Dec. 2015 is going to cost but I cannot find the 2016 rates on the OPERS website.
Heidi,
When you apply for retirement you will receive the information on health care coverage that you’re seeking. In the meantime, you can log in to your online account and use our health care estimator to approximate what your coverage will cost.
–Ohio PERS
Will they still have express scripts?
Christine,
The interim health care plan will have Express Scripts as the pharmacy provider.
–Ohio PERS
I am a re-employed medicare retiree with no health benefits from my employer. I visited OPERS on Oct. 2, 2015 and signed up for the Humana Interim Medicare Plan which will cost me approximately $187/month next year. I just received a letter from OSU Medical Center that states that they will not cover Humana Medicare plans. My doctors are at OSU. Does this mean that I have to change doctors and hospitals? Is there a comparable Medical Mutual plan that OSU will accept for me?
Bill,
You have until the end of the year to change your plan. We’d recommend talking with your health care providers to see which plans they do accept.
–Ohio PERS
Bill: I’m in the same boat you are, signed up for the Humana Interim Plan and trying to find out what doctors and hospitals are in the Network. No help from OPERS or Humana other than waiting until the health care cards are issued in December sometime. I got the letter from OSU also and after reading it a few times it states that OSU will not except Humana Advantage plans but the last section mentions OPERS retirees who select traditional Medicare coverage are covered in the OSU system. The best I can figure after talking to OPERS is the Humana Interim plan is a traditional Medicare Supplement ( Medigap ) plan not an Advantage plan. I hope the ID card shows up in Mid December so I have time to switch plans if need be.
Tom- After many calls and being put on hold while teams of people discussed our situation, I am convinced that the Humana Interim Plan you and I will be getting WILL ALLOW us to continue using OSU doctors etc. I talked to OPERS and they say that indeed, it is a plan that will require us to show both our Medicare card and our Humana card. That seems to be the big difference, having to show both cards rather than just the Humana card I show today. I talked to OSU billing and they confirmed that they will take the interim plan because it requires us to show both cards. I’ll let you know if I hear anything different, and ask that you do the same for me.
Bill Johannes
Mike,
Just curious….why didn’t OPERS pick up Silver Sneakers for the 2016 Humana Interim Medicare plan?
Fran,
Our previous Humana plan, which offered the Silver Sneakers program, was a Medicare Advantage plan. Humana does not offer this feature in the OPERS interim plan.
–Ohio PERS
Very disappointed that Silver Sneakers was not included in this plan. We have been using it for the last three years and would like to see it continue as a benefit with our health care coverage.
I have mailed in my enrollment for the OPERS Interim Medicare plan (weeks ago). I’d like to know 1. If my paperwork was received at OPERS; 2. If this is all I need to do to be sure of Interim insurance in 2016; 3. If I must do anything else or submit anything to Medicare, Humana, or OPERS to insure that I’m covered in 2016.
Joyce,
Filling out the paperwork will suffice, but if you are concerned, call us at 800-222-737. We can’t look up this info through the blog.
–Ohio PERS
Have gotten several different answers to the following: Is the Interim Health Plan being offered by OPERS a PPO, HMO, PFFS, etc. This is critically needed information as my current Doctors accept
only a PPO. The same holds true for Spouse’s Doctors, only a PPO. Need this clarified in order to make a correct selection of Health Insurance.
Edward,
It’s a passive PPO. The coverage is the same regarding networks as it is today.
–Ohio PERS
I want to make sure I fully understand; therefore, I have these questions:
With regards to the passive PPO you mention. Does this refer to the Humana Interim Medicare Plan?
With regards to the plan features, is the Humana Interim Medicare Plan exactly the same as the 2015 Humana Medicare+(Employee PPO) plan? (The plan not-re-employed retirees currently have in 2015.)
Ric,
Yes, I was referring to the interim plan. The interim plan’s coverage is the same as last year’s plan for non-rehired retirees, but premiums are higher in the interim plan.
–Ohio PERS
I signed up for the humana interim plan and have not recieved anything yet , we need to know if our prescrition coverage is included in this plan
Robert,
Retirees who enroll in the Humana interim plan are enrolled in the Express Scripts group plan for pharmacy coverage.
–Ohio PERS
I would like to enroll in the Humana Interim Medicare Plan but I don’t have the Health Care Open Enrollment Change Form. I am supposed to have this form in place no later than Dec. 31 2015.
Shirley,
You can find it in the Document section of your online account.
–Ohio PERS
I’m a re-employed OPERS employee and currently on Medicare, I plan to sign up for a supplemental plan thru the Connector, several questions:
1. Can I get Dental Coverage thru OPERS for my spouse and myself?
2. On the OPERS Health Care Coverage Application- in step 2 it says to skip the section if medicare eligible; Is this correct or do I mark NO and sign?
Roger,
You can secure dental coverage through OPERS for you and your spouse.
Step 2 of the application is only for non-Medicare members to waive medical coverage. Because Medicare participants do not “waive” OneExchange coverage, they do not need to complete this section of the form.
–Ohio PERS
I received all my paperwork and signed up for Humana Interim Plan. I received the Prescription cards from Express Scripts but do not have my Humana Interim Cards. Can you help?
Shirley,
Call OneExchange at 844-287-9945. They are your lifetime advocate, and you can use them as your resource to resolve this issue.
–Ohio PERS
If I were to retire at age 54 with 31 years of service under group b, what are my insurance options going to be?
Gary,
You could enroll in the OPERS group plan. There’s a coverage guide and a plan description on our Health Care information page.
–Ohio PERS
I recently got rehired part time, approximately 20 hours with an OPERS employer. I am put on the Medical Mutual Interim Plan. They are taking out for medical deductions but I also see another deduction for “other health care deductions”. What exactly is this for?
Millie,
We can’t say. We recommend asking your employer.
–Ohio PERS
I am a re-hired retiree. I deferred my OPERS health care as I have health care provided by my employer. I am not Medicare eligible. If I continue to work for 3 more years before re-retiring, will I be able to get into OPERS health care at that time? I still won’t be Medicare eligible.
Richard,
You can retire, go back to work and defer enrollment in health care coverage. But keep in mind that you will not accrue service time, either toward your pension or for health care, as a rehired-retiree. So you would have to have met the health care coverage qualifications for service time (at least 20 years) when you retired the first time. You also would have to be at least 60 to enroll in coverage (unless you had at least 30 years of qualifying service time for health care when you initially retired).
To be certain, we recommend discussing your personal situation with Member Services at 800-222-7377.
–Ohio PERS
I am an OPERS recipient and contacted the connector
In October. I am also retired military and have tri care for life
Insurance. In October I called in my appointment date and explains e
Everything to the gentleman and at end of conversation was told I was
Enrolled in my HRA. Today I called connector and was told I am not
Connected and still needed to enroll in another insurance program. Previous literature
I received stated that tri care filled that requirement.
What’s the right fact here?
Herbert,
In order for you to receive contributions to your HRA, you must be enrolled in a medical plan through OneExchange. There are plans that coordinate with TriCare, and that’s why we wanted those with TriCare to speak with OneExchange to try to find a plan for them.
So the OneExchange representative was correct in that you need to enroll in an insurance plan through the Connector in order to participate in the HRA.
–Ohio PERS
I would like to have confirmation in writing that OSU hospitals and doctors will accept the Humana Interim Medicare Plan before we select this plan upon retirement 12/31/16. Where can I get this confirmation?
Thank you for your question. The Humana Interim Plan is an OPERS group plan. OSU is not in the network however we have the same passive PPO arrangement as we did for the Humana Medicare Advantage plan meaning that Medicare pays first and the Humana Interim Plan plan pays second. As long as Medicare pays first, OSU has to accept payment from Humana as secondary and cannot balance bill you. If you have any questions, please don’t hesitate to call OPERS, 1-800-222-7377.
Thank you,
-Ohio PERS