HRA guide: Coverage through OneExchange
The Ohio Public Employees Retirement System uses a reimbursement process administered by OneExchange to help participants in the OPERS Medicare Connector pay their expenses.
This week we’re releasing a series of four blogs and videos that will show participants how to conduct Connector transactions. Today’s blog addresses how to pay medical and prescription drug premiums for plans enrolled in through OneExchange. You can view an accompanying video series on our YouTube channel.
Paying your bill
- You pay the insurance premiums directly to your medical carrier and, if applicable, your prescription drug carrier.
- How the carrier receives your payment depends on how you choose to set it up based on the options your carrier provides, such as:
- Automatic bank account deduction
- Monthly mailings to the carrier using a coupon book
- Automatic credit card charge
Getting your money
Reimbursement can be automatic or manual.
- Automatic reimbursement: If your carrier permits automatic reimbursement, you can arrange for it during the OneExchange enrollment call. You also can set it up through your OneExchange online account, or ask OneExchange (844-287-9945) to do so after your enrollment call.
- Manual reimbursement: You can submit a manual claim form to OneExchange monthly or at longer intervals, if you wish.
Verifying your claim:
If you set up automatic reimbursements, you don’t need to provide documentation of your bills on a regular basis. If you’re submitting manual reimbursements, you will need documentation. It can include:
- A premium statement and a bank statement or canceled check showing the amount paid
- A payment coupon
Make sure your submitted documents include:
- The covered participant’s name
- The insurance provider name
- The date of service
- A description of coverage (for example, Medigap)
- Proof of payment
Next topic: Medicare Part B coverage
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.
To my understanding, this has always been the way it was set up.
After staying on top of all blogs, I see there is a problem with OneExchange considering reimbursement based on the amount, not the coverage. I believe a blogger has been trying to get her coverages for months and the hold-up is that OneExchange just looks at the dollar amount. They need to start looking to compare the insurer to the claim. Not Rocket Science!
Also while I have your attention (hopefully), for all retirees:
We will no longer be prepaid the $31.80 Medicare from our OPERS’s retirement 2017 checks. Are you taking into account for an adjustment to our next year’s HRA accounts?
I understand that Medicare is to go up in 2017. I believe on your past information proposed that we are going to have a reduction of our HRA for 2017. I understand that when the program started out, the Connector was to give us an mandatory way to meet our insurance costs. The HRA account barely covers the basic premiums to date and your original “Connector” proposal was to make a reduction in the coming years. WHY?
You (as OPERS) state the “Spousal coverage” was never written in law ( however it was provided for 8-10 yrs. of retirement) and we retirees are forced to accept that, but OPERS is mandated by law to provide equal coverage to Medicare.
Are you going to increase our HRA deposits to cover the extra retirees costs for the coming years or is OPERS going to fulfill the promised health contract?
(PS…I know my comments and questions will never be posted, but I am going to stay on to of this.)
Bill,
We have stated many times that we are transitioning to the age-and-service-based health care allowance over a few years. We have said that when the transition is over that allowance will be about $337. If you are getting more than that this year, it’s likely that amount will be reduced in 2017 because of this gradual transition. It’s not that we are taking away money next year — we just gave more this year because we allowed for a transition instead of going to the base amount right away.
–Ohio PERS
I understood that OPERS would give us extra money over and above our basic allowances in 2016, reduced in 2017, until we would receive our basic allowances in 2018. We were all told the amount of our basic allowances way back in 2015 on the back of a letter in our Connector Readiness packet. I also understood that after 2018, OPERS might be able to make some adjustments to our basic allowances (upward) for inflation if the budget permitted. No guarantees here, but OPERS is aware that our insurance expenses will probably increase and will try to help with those increases if possible.
I forgot to say that I am grateful to OPERS for the HRA they are providing to us. Although I believe my HRA is generous, it does not cover my health care expenses mainly because I take some expensive medications. Health care expenses are increasing, and I appreciate what OPERS does for us.
During the session which I attended in Ohio (Dayton area) questions were asked and at NO time was anything mentioned about the monthly service fee. Isn’t OPERs paying them to administer the program.
After a somewhat rocky start, it seems that transactions with One Exchange have smoothed out. One thing that I find interesting is that through all of this I do not remember anything mentioned during all the meetings, mailings, etc, that an administrative fee would be deducted until I read the e-mail that One Exchange was forgiving the first 3 months due to the rocky start. If the number of PERS customers on this program is 100,000, that is $233,000 per month to One Exchange. I’m just saying!
You mentioned a rocky start. oh my goodness! I could write a book. All I could do is make sure my blood pressure meds were taken. I thought that this must be a ponzi scheme. Some people get their reimbursement and others do not. It is now September and I am still watching One Exchange very closely. I am hopeful that things are finally going to smooth out.
The question is, am I going to have to go through all of this again next year? I feel like a have a part time job trying to figure out what Towers Watson One Exchange is doing with my HRA money. I had done everything correctly, with only one error. I have little confidence in TWOE that they will ever get things straight. There is much more to this story.
Yes, as you pointed out, this is a very lucrative plan for TWOE and yet a major headache for me. lp
I use the HRA account for prescription refills. It’s a little slow to send in the paperwork and receipt with every refill but it seems to go ok
What is the RMA account for? Is it the same as the HRA account?
Thanks, Dave Price
Dave,
OPERS members in our Member-Directed Plan (defined contribution plan) are credited a portion of the employer contribution to a Retiree Medical Account. Amounts contributed to the RMA may be used at separation of service to pay for qualified health, dental and vision care expenses.
–Ohio PERS
Dave, I just simplified my account. I sent in for all premiums. My $73,my medicare, my husbands medicare $104, my vision $6 ,my dental $32. my medigap $166 comes out around $ 360 or so. My check was in my account for that 6-12-16. I did have to send in my husband’s medicare. Not sure I have too since is is recurring..
Should have read 6-2-16 for check in account. I guess that was obvious, huh ?
We have to agree with Ron Hammons about the administrative fee. Neither of us can remember hearing anything about that. In fact, at one of the seminars I asked the question if what One Exchange was doing was going to cost us anything. And the answer was NO.
Gary & Judy,
We apologize if that was stated at a seminar. However, we took the fee into consideration when we set the allowance rates for the Connector.
–Ohio PERS
I live here in California. Can and how do I participate in One Exchange? Thank you. Margaret Coon
Margaret,
You participate in the same way as everyone else. We’re not sure when you are eligible. If you have questions about that, call us at 800-222-7377.
–Ohio PERS
I would like to thank OPERS for picking up the ball that OneExchange fumbled from the start. OneExchange needs to be actively managed. Thank you for stepping up! We all assumed that OneExchange was competent to handle this job. It has become obvious that not only were they not prepared staffing-wise for the volume but their ignorance of Medicare and Social Security basics and lack of computer programming to handle relatively simple tasks was absent from the start.
The failure of system knowledge and computer programming is not a function of volume. If the computer programs had been in place in the beginning most of the processing problems would not have occurred. It bears repeating, these kinds of problems are not volume related.
As a retired computer systems Development Manager for a national university system and a medium sized city, I was surprised at the incompetence at OneExchange. OPERS is so far into this contract that starting over would be more of a disaster but the problems that OPERS has shared with us easily leads me to the conclusion that OneExchange is in partial breach of contract based on lack of competency to perform a small set of basic functions. Maybe that explains the three months we did not get billed for the fee? Then again OneExchange may be so screwed up that it took three months to figure out how to charge people for their services.
Again, thank you, OPERS for stepping up!
I think OPERS is doing a wonderful job of being proactive in keeping our pension fund solvent.
Take a look at the mess the teamsters have made of their pension fund.
I agree, Nora. I am grateful every day for my pension and am glad that OPERS took the necessary steps to keep the pension fund solvent.
I believe you should have grandfather the retirees. To change the whole thing that you have done has certainly made a hardship on the elderly. I spent 41 years at Ohio University and now working two parttime jobs and it is still a hardship. By the sound of things it is not going to get any better. Those of you making these decisions really don’t have any ideal what you have done to those of us who have put their life in working for the OPERS.
It is the middle of May , 2016, and I still have not been able to be reimbursed. It took one exchange 6 months to correct their mistake making my husband the employee instead of me. They are now saying that they have us down for two insurance companies, so it will take another 4-6 weeks to correct that, even though I picked my insurance through one exchange. I have spent at least 50 hours on the phone since October of 2015. This is the worst company I have ever dealt with. It will be a miracle if in 6 weeks I get the reimbursement for our medical insurance. I am not calling them any more. Maybe channel 5 news on your side can help me! Ever time I call one exchange there is another problem. I spent over an hour today on the phone with them.
Next year can we arrange for our own healthcare and pharmacy or are we locked into One Exchange. I feel I can get better coverage and service than what One Exchange has done for me thus far. They over deposited reimbursements into my bank account resulting in a zero balance in my HRA account and now they have requested that I send the over reimbursement amounts to them. Had I not noticed this discrepancy they would still double reimburse me for health care.
My total experience with One Exchange has been less than satisfying and very frustrating.
I wish I could say I was happy with One Exchange, but they have screwed up on my account from day one. First they sent me the Annual, January and February allowances before they even had any reimbursement request. I let it go for a month thinking they would find THEIR mistake only to get the March allowance. I called them and after running down the battery of two cordless phones and switching to a corded phone, they finally decided to consider it an “overpayment” (DUH?) and I’m just now coming out of the hole. I submitted a reimbursement request (and invoice) for a pair of prescription glasses AND a pair of prescription sunglasses along with the EOB from my Aetna Vision Insurance. They didn’t even look at the second page of the invoice, they only looked at the EOB. (Stupid? Lazy?)Again, I ran down two cordless phones and switched to a corded phone till they finally decided to make me resubmit for the prescription sunglasses marked “No Insurance”. Hey, as long as they don’t have to do anything to correct THEIR own mistakes. I asked them to return my call when they figured out these issues and they told me they “had no way of calling out”. What kind of company can’t return calls? I personally feel OPERS could have done a better job finding an administrator. I have relatives in Arizona who would like to boot them out of their lives too. Their staff is very personable, but they’re poorly trained or lack ambition to learn. When you think of all the time OPERS spent on educating US and then THEY drop the ball on the Medicare Part B reimbursement?
I have to agree with this comment. I am currently having no particular problem with one exchange but have never dealt with an organization so ill prepared to answer questions. The initial enrollment was done adequately (although in retrospect there have been issues arise that we would not have thought to ask and now can’t get answers for). The reps I talk to are more than polite, actually irritatingly so – every reply is prefaced by “I will be glad to help you with that” but no answer is given. Its like talking to a robot who can only reply with what has been written in the instruction manual or read what is on the “grid”. There is no assistance in trying to resolve issues or get someone on the line that has answers. Training has obviously been minimal at best. And when I have asked to speak to a supervisor there has NEVER been one available and no one ever returns my call even though I have asked for one. Extremely poor customer service.
A lot of blah blah blah and they don’t tell you anything
I’m still having a difficult time getting through to One Exchange on the phone. This program is still confusing ….just when I’m beginning to understand what is transpiring, I find out something new is happening or going to happen…not a happy camper for sure!
This is th worth thing that has happened to state employees. I was told if I retired when I did I would not have an increase in health care costs. All this taking money away and increased costs is rediculous. The prescription drug plans are the worst and there is no money to help pay drug expenses. The only drugs we are allowed as Medicare retirees on opera are generic cheap drugs from Japan. Who made this decision?
I did NOT find the first video very helpful. It spoke in only broad generalities. If did not SHOW me how I go about getting reimbursements nor did it tell me which different expenses I could be reimbursed for.
Gerald,
You might find the OneExchange/OPERS website more helpful. For instance, there is a list of eligible expenses you can read.
–Ohio PERS
Reimbursement is being received monthly, however, my helth expenses exceed the reimbursement. A partial reimbursement on one of the charges was made. Can I expect the balance of that charge will be made the following month?
Alice,
Yes. Reimbursement will be completed as funds become available in your account.
–Ohio PERS
As the cost of living goes up so does cost of medical care. No breaks at all. Beginning the first of the year I have to pay more for Medicare because I didn’t pay into Social Security. That’s not right. I pay for my Medicare so why am I discriminated against. People that paid into Social Security get to 65 and can make all the money they want plus draw their Social Security checks. I get no break. Something wrong with this system. I retired hoping to enjoy life but then required to pay out more. JUST WRONG
65 year olds can not collect SS and earn all the money the want.
Check your facts. I was 66 and 10 months before I could collect full SS and earn
money without penalty and that in 2008 the age is higher now
Will our HRA fund be eliminated after a few years or is this a program you intend to keep providing as long as funds are available.
Mike
Mike,
This is the system we are planning to have into the future.
–Ohio PERS
Please send me the operas videos. Also, I have requested the HRA recurring firms and have not received them
Eileen,
Our videos are all on YouTube.
–Ohio PERS
when I signed up for drug plan for my husband I give them his medical list I was put with a plan to cover all his meds now I am finding out they will not cover one of his med an it is very expensive .I give them his list twice to opers
I put $1,600.00 in account only for insurance deposits and withdrawals to get started with this program. I was under the impression that once everything was in place we would be reimbursed what we had put up front to get started,also there was suppose to be a $300.00 bonus from OPERS deposited in our account???I had planned to withdraw my $1,600.00 once it was replaced. OPERS is suppose to give me $614.99 for our insurance monthly. Mine and my spouse total including the part D drug plan only totals $505.99 a month leaving a x-tra $109.00 a month–where is that going?????It shows we have available balance at end of April of $1,239.66 in the account–( which account is this because it is not the checking account I started for only this plan ?????)
Robert,
We can’t answer these questions through the blog. We recommend calling OneExchange at 844-287-9945 to check on your HRA account. Or, you can do so online if you set up such an account with OneExchange.
–Ohio PERS
I was wondering if we were getting quarterly statements showing our balance in our HRA? I haven’t rec’d one and thought I was to get one.
Sue,
There never has been a plan to issue quarterly statement updates. Once you have submitted a claim you should receive an explanation of payment, but not a quarterly update. If you want to see what’s in your account, establish an online account with OneExchange or call OneExchange at 844-287-9945.
–Ohio PERS
You need to hire real “experts”……I was asked by someone from One Exchange if the person that handled my account was a foreigner! She thought that was why there was a mix up with mine. I am warning others to be their own “expert”.
Michael Pramik. I believe you should have thought long and hard before you responded to the Paula Mollica. Ms. Mollica stated what she was ASKED by One Exchange. She did not ask for your interpretation of “foreign” and “expert”.
Judi,
Read the answer again. I was referring to the OneExchange consultant who might have asked the question, not to the retiree.
–Ohio PERS
One Ex has really improved its services in getting my reimbursements to me. The last two requests I submitted took two days to process as opposed to two weeks in the beginning.
Of the last two requests one was paid right away, the other had to be resubmitted because there was a problem with the copy that One Ex received as part of my fax. The name of the eye care company was chopped off. I resubmitted and within two more days, I looked online and the reimbursement had been made!
I get that One Exchange makes its own policies. Is there any way that OPERS can possibly persuade them to implement the automated call-back policy that OPERS adopted a number of years ago? I don’t know exactly what it is called, but it offers the caller the option of waiting for a call back without losing his or her place in line. This is only good, though, if a time frame for getting the call back is given.
For example, OPERS tells the caller the call back will be received in 25-30 minutes.
Another company I do business with does not give a time frame. You could be waiting five minutes or two hours. The auto call back without a time frame would be as annoying as the system they now have in place.
But I am appreciative that they have started making reimbursements in as little as two days.
Thank you to One Ex and OPERS. I know the two organizations meet weekly to iron out the kinks and you did great on this one. Thanks again!
JA,
We have noted that an auto-call back feature would greatly enhance anyone’s customer service process. We are not sure why OneExchange doesn’t have it. Thanks for your comment.
–Ohio PERS
Sir/ms.
Hearing many remarks about if a new president is elected, is there an outside possibility
that president obama health plans would be reversed, and your plans with one exchange,
could go back to the old ways?
thanks,
mr. keenan
William,
The Connector is a private exchange, so the state of Obamacare wouldn’t affect it.
–Ohio PERS
I am confused about dental and vision coverage. Should I get clarification from One Exchange?
Linda,
What is your question?
–Ohio PERS
I am not sure about my choices for dental and vision coverage. Should I contact One Exchange to finish the process?
Linda,
Yes, call OneExchange at 844-287-9945 if you are questioning what coverage you have. If you’d like to inquire about OPERS coverage, call us at 800-222-7377.
–Ohio PERS
Thank you.
I am being charged a late fee for my Silver Scripts every month. I receive a bill for $$19.60 month plus a $16.40 .late fee. I do not understand how I can e charged a late fee for a bill I have never received. I have received a bill like this every since I have started received my bills from OPERS. This is not the understanding I had while I was working. I really feel like I have been totally given the wrong information and taken advantage of. Please advise.
Shirley,
We’ve forwarded your comment to OneExchange and asked them to call you. They should get back to you no later than Monday.
–Ohio PE$RS
I pay a monthly fee for dental and vision insurance through OPERS. Can these fees be reimbursed through one exchange and if so do I use the letter I receive from OPERS as proof or do I need more and if so what. Can I ask for reimbursement only as paid monthly or can this be fixed reimbursement?
Virginia,
You can have these funds reimbursed, and reimbursed on a recurring basis. Read our blog and watch our video on OPERS-sponsored insurance for detailed information.
–Ohio PERS
I can’t seem to get on the right website to follow my account. Could you tell me the exact website to set up my account? Thanks.
Marjorie,
Go to this website, click on “My Account” at the top, and then on “Create an account.”
–Ohio PERS
OPERS is a well run organization. Once this preliminary enrollment is over, why doesn’t OPERS train its own people to take over the duties of OneExchange. They’re just a clearinghouse. Given the total paid for fees, you should be able to hire several very competent people who only have OUR interests as their top priority.
I’m sure you can hang up on people just as well. 🙂
RJ,
That is not in our plans, but thanks for the compliment.
–Ohio PERS
I had a little bit of a rough time with this in yhe first month. Opers.,One Exchange I want to thank you for all the help and I am blessed. As soon as my receipts are faxed..I get received mrssage. I also get all my money refunded up to allowance amount.
Many thanks in advance.
Sincerely,
Pamela
Since I have done a lot of complaining about OneExchange and PayFlex, thought I would report that, finally after five months of phone calls and e-mails, all of my automatic and recurring reimbursements seem to have been straightened out. Hope things go more smoothly next January.
After reading about 75% of the blogs, that have, for the most part, stressed a negative image of One Exchange, I decided to vent one of my frustration about them regarding a timely reimbursement of the prescription drug plan. Each month the health care premium is deducted from my bank account on or about the 5th of each month. The reimbursement for that premium is deposited back into my account with in days and some time the same day. The prescription drug premium payment reimbursement, however, is a disaster. I make the monthly premium payment for he upcoming month a few days before the 1st of that month, usually the 28th or 29th so it is in their hands by the 1st. I have yet to receive a reimbursement shortly there after. Usually the 18th or later. At the time of this writing, 6/20/2016 my bank account hasn’t received a reimbursement. So, in the next eight days I’ll be making another monthly premium payment. This is where the frustration sets in with One Exchange. Although my issues are not as problematic as most of the blogs I read, I thought I would vent too. Hopefully OPERS will reconsider working with or using this organization in the future. Like most I too am concerned.
One Exchange does not use a name when I get my Explanation of Payment from them so I don’t know if the amount of reimbursement is for my husband or me. I called One Exchange to ask why and they said they didn’t receive this information from the insurance carrier. Why not? I am still having problems with my prescription company and it is June. I have been on the phone with our prescription carrier each month and even had to write a letter explaining my problems. I think my problems are corrected until I receive my next EOP or my bank statement and there still are problems. Our checking account is very hard to balance and I have to be sure to keep extra money in it so I don’t have a bounce check. Could PERS help me on this. Some of my problems are: they charged me for someone else besides myself for several months- I only caught this because the amount was different; my spouse was not signed up for several months but that is now corrected; the prescription company said I was sending my money to them by check which was wrong so someone else was on my account; they owe me $68.60 which I can’t seem to get from them-this is for someone else they were billing me for. I have spent hours on the phone with the prescription company and some time with One Exchange trying to solve my issues.
Concordia,
We have forwarded your questions to our dedicated account team at OneExchange to research. They will call you within 48 hours.
–Ohio PERS
One Exchange still has not called me within the 48 hours. If One Exchange does call I hope my caller ID shows One Exchange and not a long distance phone number. I don’t answer most long distance number unless I know the number calling. If the caller ID does not show One Exchange couldn’t the caller leave a message on my answering machine so I know to call One Exchange back.
Thank you for letting us know. We’ve reached out to our contact there and have requested that they call you. 1-844-287-9945 is what should appear on your caller ID.
-Ohio PERS
I am consistently having problems with Anthem reimbursements. In January, I was reimbursed early in the month. After that it was later and later each month. My premium is deducted from my account on the 6th of the month. In May, I received reimbursement at the end of May; and in June, I have received nothing from Anthem. It is now July 7th and still no June reimbursement. The funds were deducted on June 6th. OneExchange states that Anthem sends a “bundle” of reimbursements to them once a month. I am regretting choosing Anthem as my Medigap provider. In addition, they increased my premium July 1 by $16 per month. That doesn’t seem right.
Martha Lambert
Martha,
We followed up with OneExchange and understand that they were able to speak to you regarding your concerns including premium and automatic reimbursement. Insurance carriers may increase the premiums throughout the year, however, they are required to send notice 30 days prior to the increase. If you have further questions regarding your HRA, please contact OneExchange at 844-287-9945, they will be happy to assist you.
-Ohio PERS
Pingback: OneExchange improving Med B process – PERSpective