How to qualify for pension, health care

New guide clarifies eligibility for OPERS members

Jan. 30, 2017 — Ohio Public Employees Retirement System members in the Traditional Pension Plan and the Combined Plan can qualify for both a pension benefit and access to health care coverage when they retire.

What are the terms of becoming eligible for both? We created a guide that will help current members understand when they will be eligible to receive their pension benefit and sign up for access to health care coverage.

The OPERS Pension & Health Care Eligibility Guide is a reference that will tell you the minimum age and years of service credit you must reach, depending on your retirement group, to qualify for both. The guide applies to all OPERS-covered positions except law enforcement and public safety.

To find out your earliest eligibility date, refer to the chart in the guide. Find your retirement group, consider your age and service time, and whether you’re trying to qualify for an unreduced pension or a reduced pension. Look to the right under the “Am I eligible for health care?” column, and see the answer.

We hope this guide can help answer the question of when our members are first eligible to receive their pension benefit and also have access to health care.

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.

Michael Pramik

Communication Strategist

  • Why does it take 7-10 days for ONE EXCHANGE TO PROCESS A CLAIM AFTER THEY RECEIVE A CLAIM , CAN’T GET A ANSWER FROM THEM. IT IS GETTING OUT OF CONTROL , THEY NEED TO HIRE MORE HELP OR OPERS SHOULD FIND ANOTHER COMPANY !!!!!!!!

    • The claim reimbursement process relies upon the retiree, OneExchange and the retiree’s financial institution. Broken down, after a claim is received, OneExchange processes and approves claims within 3-5 business days. After OneExchange transfers payment, the retiree’s financial institution releases the funds to the account, which may take up to 72 hours depending on the financial institution.

      -OPERS

        • Please call OneExchange to help you figure out what needs done to help you move forward with reimbursements (1-844-287-9945).

          Thanks,
          OPERS

          -OPERS

      • Even after they process the claims it takes another two weeks to get the paperwork in the mail showing what action was taken then you have to wait up to another six weeks for it to arrive in your bank statement making it really tough to keep your accounts straight.

        • If you got both your EOBs and bank statements on line, it would be easier. You would get the EOB by email as soon as the claim was processed and the bank statement wouldn’t take longer than 72 hours.

          • You’re lucky you get an EOP. I have to fight for “everyone” I get. Seems you get better service if you use the US mail instead of e-mail. I wish OPERS would dump these clowns. They (OPERS) have no idea the problems because they’re still working and they aren’t “FORCED” to use them.

          • Pers employees should have the same health care that the retirees are getting then it might get fixed I told my retired boss to go to the Ohio attorney general and file a complaint they don’t want anyone to get reimbursed and make it so hard everyone gives up .I am in my 29th year and afraid to retire out of all the retired people in person iknow they are lost and can’t get help to get reimbursed

      • I talk to a lot retired people over 65 and none of them can get reimbursed they feel per is making it so hard so they will give up we do have great ins but the over 65 group can’t get reimbursed and not getting clear help

        • There are many resources available to those over 65 to help with the reimbursement process. Outside of calling OneExchange to walk through the process, there are resources available at opers.org , on the OneExchange website. There is also the Getting Reimbursed Guide book that was mailed to households (and also available on the OneExchange website).

          Most importantly, if someone is having trouble receiving reimbursement, they should call OneExchange (1-844-287-9945) to get to the root-cause.

          • Fortunately, I have no problem getting reimbursed for Medicare, OPERS dental & vision premiums, as well as, other eligible expenses.

          • I have had just a couple of snags but for the most part I am happy with One Exchange reimbursement process.
            When I was denied reimbursement, I had not sent in the proper paperwork.

    • 7 – 10 Days seems reasonable to me. When I’m due a refund from a company, it takes that long once they get the request.

  • In reply to Kenneth A. Prottengeier.

    Ken, just a suggestion in my case with my Med B premium and my husbands it is over the amount allowed. I send in a reoccurring form and never bother the rest of year with anyone. My Med B & my Husband’s. That plus the cost for Medigap is over my allowance, done!

  • IMO, One Exchange is a joke. OPERS took the “low ball” third party to handle retiree medical. I made a suggestion to them about taking a pic of my bill statement and then send in as a text on my smart phone…No way ! We can’t do that ! I just throw up my hands and use more paper. BTW, I opened another checking account and one Exchange deposits goes to that account. I also use a credit card for all medical billing as I don’t have to get copies of canceled checks , etc. My advice to OPERS….Dump One Exchange!

    • Thank you for your feedback, we will send your suggestion to OneExchange. In the meantime, are you aware of the option to submit reimbursements online via PDF format? Check into your OneExchange Getting Reimbursed Guide or visit medicare.oneexchange.com/opers for more information.

      Thank you,
      OPERS

  • Most retirees do not have technical computer skills to ?pdf scan to submit for reimbursement. We were not educated like our grandchildren to work computers. I do facebook and e-mail, but no copy print send stuff. Are you going to provide classes?

    • Thank you for your suggestion. Scanning is just one option; you can always mail a copy of your information for reimbursement.

      We are not planning classes at this time but you may want to check with your local library for assistance. Many of the office supply stores such as Staples or FedEx should be able to help you as well.

      Thank you,
      OPERS

      • I was a small business owner….we sent faxes for people….the charge is low and is based on a per piece basis…not need to make a copy first….your paperwork is scanned/faxed and given back for you to keep for your records. Check with a local business to see if they can fax your paper work.

        One thing to remember…. you have to watch because if the fax fails with one of the sheets, ALL paperwork has to be re-faxed….this happened to me when a reimbursement was denied, that was the reason I was given for denial.

  • My experience with One Exchange has been positive. Early on, I had several telephone contacts with them. There was always a long wait time, but the people were pleasant and helpful. Some were more knowledgeable than others but that is true in any organizations. Once things were in place and running smoothly, I don’t have to call them very often.

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