Health care details for spouses

Coverage will not automatically end in 2018

By Heather Drago, Ohio Public Employees Retirement System

Nov. 7, 2017 — Although OPERS no longer will provide allowances for spousal health insurance in 2018, current coverage for spouses won’t automatically end next year.

If your spouse is enrolled in pre-Medicare health care coverage, you’ll be charged the full premium amount in 2018 unless you contact OPERS to cancel the spousal coverage. Details can be found in your Open Enrollment kit.

Regarding spousal health insurance coverage for those in the OPERS Medicare Connector, we’ve received questions from retirees regarding spousal access to health care coverage in 2018. To be clear, spouses, including surviving spouses, will not lose their existing medical, pharmacy, vision or dental coverage in 2018.

The facts:

  1. While all spouses will continue to have access to OPERS health care, they will no longer receive a monthly Health Reimbursement Arrangement allowance effective Jan. 1.
  2. Retirees can still seek reimbursements from their HRA for any qualified medical expenses incurred by their spouse.
  3. Surviving spouses can continue to access the HRA balance for qualified medical expenses.
  4. All spouses will remain enrolled in their selected plan(s) until the individual cancels the coverage. If a spouse is enrolled in a Medicare plan through the OPERS Medicare Connector administered by OneExchange, that coverage will continue into 2018.

Prior to open enrollment, OneExchange attempted to contact spouses in an effort to reinforce these messages. If you or your spouse missed the call and have enrollment questions, please contact OneExchange at 844-287-9945.

Retirees: Remember, in order for OPERS to provide you with an HRA allowance, your agent of record must be OneExchange. If you enroll in a medical plan through a broker or insurance carrier, you will not receive future HRA allowance deposits from OPERS.

Often during this time of year, you will receive information from many sources outside OPERS. Please remember that OPERS is your source for health care coverage information. Call us at 800-222-7377 with any questions or concerns regarding spousal access to 2018 health care coverage.

    • Ms. Dively,

      That will depend on how you have your HRA set up to submit for reimbursement – automatically or manually. Automatic Premium Reimbursement allows you to be reimbursed for insurance plan premiums without submitting a monthly reimbursement request form. AR is available for most insurance plans offered through OneExchange. Manual reimbursement is how it sounds- you retain your receipts and supporting documentation and are responsible for submitting to OneExchange for claim reimbursement. For account specific information, call OneExchange at 1-844-287-9945 or email them through your secure, online account and a representative will be able to better assist you.

      Julie, OPERS

  • Could my 2018 subsidy allowance allocation be going down by $13.50 because of a spousal portion being eliminated

    • Mr. Hendricks,

      In 2012, the OPERS Board of Trustees adopted a set of changes to the health care plan to increase the sustainability of the heath care fund. As you may know, those changes included a Health Reimbursement Arrangement to provide funds to OPERS Medicare Connector participants. Beginning in 2016, for pre-Medicare retirees the amount OPERS pays toward the total monthly cost of your coverage, known as an allowance, is based on your qualifying years of service at retirement and your age when you first enrolled in the OPERS health care plan.
      For those eligible for Medicare, the allowance is a monthly amount we provide in an HRA account. You can use these funds to receive reimbursement for the cost of Medicare plans and other qualified medical expenses as you wish.
      In order to make the transition to the new health care plan flow more smoothly, OPERS did two things: (1) furnish enrolled retirees with an additional $300 deposit to their HRA accounts once per year between 2016 and 2018, and (2) provide a higher allowance amount for the first three years. Between 2016 and 2018, the monthly allowance amount was decreased annually until the final allowance amount is reached in 2018.

      Julie, OPERS

    • Ms. Denney,

      Please contact your health care insurance provider for specific details on your plan. We do not have that information.

      Julie, OPERS

    • Ms. Brooks,

      Retirees enrolled in the OPERS health care plan may also enroll an eligible family member. In accordance with Ohio Administrative Code 145-4-09 and Section 152 of the Internal Revenue Code, retirees receiving a monthly age and service or disability benefit may only enroll:
      • Their legal spouse – They must have a valid marriage certificate.
      • Their child(ren) – This must be their biological or legally adopted child or minor grandchild if the grandchild is born to an unmarried, unemancipated minor child and they are ordered by the court to provide coverage pursuant to Ohio Revised Code Section 3109.19.
      Visit the Eligible Dependents section at, review the Health Care leaflet online as well, and of course, please don’t hesitate to call us at 1-800-222-7377 or send us a message through your secure, online account.

      • My fiance’ tells me that medical/dental insurance coverage will no longer be covered by PERS. However, then I read that an eligible family member (eg, a spouse) can be enrolled for coverage. Please advise. Thank you!

        • Cindy,

          I’m not sure if you are referring to a Pre-Medicare spouse or Medicare spouse, however there is information about both spouse scenarios in the Open Enrollment bulletin that accompanied the 3rd quarter 2017 retiree newsletter. (

          In the Open Enrollment Bulletin, you’ll see that [Medicare] spouses continue to have access to health care plans through Via Benefits; however, 2018 is the first year spouses, including surviving spouses, do not receive a monthly HRA allowance. From a pre-Medicare perspective, spouses now pay the full cost of coverage, which may be more costly than some can comfortably afford. In that case, they may want to explore options on the open marketplace.

          In regards to our dental and vision coverage plans, spouses/dependents are able to enroll in plan coverage.

          Hope that clears things up,

          Julie, OPERS

  • My spouse is enrolled in non-Medicare health insurance through PERS. I was not aware I could claim out of pocket healthcare costs for her from my HRA. In fact, I was told by One Exchange that I could not. Which is correct?

    • Mr. Copeland,
      You, your spouse and eligible dependents can request reimbursement for the following expenses: medical and prescription plan premiums, Medicare Parts A and B premiums, medical deductibles, qualified out-of-pocket expenses as defined by the IRS (publication 502) and vision and detail premiums.

      Julie, OPERS

  • With the new COLA changes, how does one determine if one qualifies whether I qualify for the below market purchase power? This is the third time I have asked without a reply. Please explain.

    • One of the changes the OPERS Board of Trustees has approved for the cost-of-living adjustment is a one-time benefit increase for retirees whose purchasing power is less than 85 percent of what it was when they retired. This increase will affect only a small percentage of our retirees who have been retired for more than three decades. Because of several factors, most notably the historically high levels of inflation through the 1970s, their current pensions have a value of less than 85 percent of the original benefit.
      OPERS is still working out final details of what groups the increase will apply to, the increase amounts and how we will administer them. But again, it is likely to affect only longtime retirees – a small percentage of our overall retiree population.

      Julie, OPERS

  • To Heather Drago . Since the Medicare people Medicare with medical problems are recipient of many negative issues. What United Way sponsored organizations can help them. OPERS current management caused per cent age of the problems.

    • Thank you for your question. While not familiar with community resources, your best source for accurate information would be to work through OneExchange to find the best plan that fits your health and budgetary needs. Medicare-eligible retirees will also receive a monthly HRA allowance as well as the HRA lump sum $300 deposit in January. If you need further
      assistance, you may want to look into government assistance programs.

  • My spouse is eligible for Medicare in Dec. 2017. She had a one month HRA of $129 and of course $0 in 2018. Contacted One Exchange, advisor recommended my spouse buy supplemental insurance through local broker since for the same insurance carrier for the same coverage was cheaper and just made financial sense. I am the retiree and will be eligible for Medicare November 2018. My question is this. Will my HRA account completely loose the $129 allowance, or will it stay there until I go through One Exchange and get my own allowance? Further, next November will I be allowed to use my unused HRA balance for my wife’s premiums, dental, and vision premiums?

    • The Health Reimbursement Arrangement allowance amount that your spouse accumulates will roll over month-to-month and year-to-year. When you begin to receive an allowance, the combined allowance can be used towards eligible expenses such as your spouse’s premiums, vision and dental premiums. If you have any further questions, please don’t hesitate to give OneExchange or OPERS a call.

  • Is OPERS aware of any blogs, retiree e-communities, or the like where members share information? Specifically, I’m interested in finding retirees sharing information regarding alternative health care coverage for pre-Medicare spouses.

    • Great to hear from you. If you have not already looked at, there is a page dedicated to pre-Medicare spouse coverage resources. While I’m not familiar with e-community resources, but I’d say your best source for accurate information would be to work through the Health Care Marketplace and other resources noted on our webpage such as

  • Will the 85 % only be one time or will it occur whenever a retiree goes below the percent. Based on CPI being similar to the last 27 years, all retirees will be below 85% in 22 years using the new rules. This does not seem to be addressed in the changes.

  • The majority of us are already painfully aware of this cut.

    But of course the important thing is that you mentioned it in the Blog…

  • What future plans are there for continuing healthcare coverage for pre-Medciare spouses? I understand that the full premium must be paid by the participant but is there any plan in the near future (in the next 7 years) to end coverage altogether for spouses?

    • OPERS continues to believe that health care coverage is an important part of a secure retirement. Even as health care costs continue to rise, we strive to provide
      comprehensive, competitive health care options for you and future generations. You are correct, spouses who remain enrolled in the pre-Medicare plan will be responsible for the full cost of OPERS health care coverage in 2018 and beyond.

      Julie, OPERS

      • Please clarify what “and beyond” means. Does this mean that the spouse can remain on this insurance for 2019 if we pay the 100%? I thought we were kicked off at the end of 2018? Thank you!

        • Linda,

          Retirees enrolled in the OPERS health care plan may also enroll an eligible family member. Spouses are responsible for paying the full cost of their plan.

          Spouses under age 65 are eligible to enroll in the OPERS Retiree Health Plan administered by Medical Mutual. Eligible spouses over age 65 and enrolled in Medicare Parts A and B can enroll in an individual Medicare plan with the help of Via Benefits.

          Please call us at 1-800-222-7377 if you have questions about your specific situation and a member of our staff would be happy to help.

          Julie, OPERS

    • Mr. McCoy,

      Any outstanding, qualified medical expenses in the your name can be submitted to your Health Reimbursement Arrangement for reimbursement up to 24 months following your death. If there are funds remaining after those expenses are paid, eligible spouses and dependents can submit their qualified medical expenses to your HRA for reimbursement until the funds are exhausted. To gain access and utilize the remaining HRA balance for a deceased or incapacitated beneficiary, authorized caregivers should contact OneExchange for next steps and guidance.

      Julie, OPERS

  • Once again as a retiree with thirty years credit I feel shorted. Why not base what insurance premiums retirees are charged on the number of years they contributed and the amount they contributed. A sliding scale based on these factors would be much more equitable since payments to the system were based upon percentages of your income rather than fixed amounts per person.

  • As a spouse I am no longer covered or have an HRI account. I have not used OneExchange for my 2018 supplement insurance. So why did I just receive (almost 7 months later) an overpayment notice ( is not a check) from VIA in the amount of $16.31 which indicates to pay. NO explanation anywhere. I am no longer under OneExchange so what is this…? Why? Who can explain/correct? I should not be charged , that is totally UNFAIR!

    • Please call Via Benefits at 1-844-287-9945 for an answer to your question. They are available Mon-Fri 8:00 a.m. – 9:00 p.m. (Eastern). You can also email your question. More information can be found on their website,

  • >