OPERS answers member questions

Topics include health care for Medicare-enrolled retirees

By Michael Pramik, Ohio Public Employees Retirement System

April 19, 2018 – We receive many questions through our social media sites, but we can’t always post responses to them.

So periodically we’ll use our PERSpective blog to answer questions we believe will have widespread interest.

Q: I’m fast approaching age 65, when I plan to retire. What are my options for OPERS health care in retirement when I’m on Medicare?

A: If you’re 65 or over, Medicare will serve as your primary medical/prescription drug coverage. If you’re enrolled in both Medicare Parts A and B, and meet other eligibility requirements, you also can enroll in secondary medical coverage through the OPERS Medicare Connector.

You enroll in an individual plan with an insurance carrier by telephone through our third-party Connector administrator, Via Benefits. A licensed benefit advisor will help you select a medical/prescription drug plan that’s right for your health and budgetary needs.

Via Benefits has a variety of insurance plan options. They can be your source for Medicare information and can serve as an advocate when you need help in talking with your insurance carrier.

The Connector is a reimbursement model. You pay for the premiums and other eligible expenses, and you’re reimbursed for them through an account set up for you called a Health Reimbursement Arrangement. Upon enrolling in a medical plan with Via Benefits, you will receive monthly allowances from OPERS into your HRA. Your funds can accumulate month-to-month and year-to-year.

After you submit premiums and other qualifying expenses for reimbursement, you can use any remaining funds toward your spouse’s premiums.

For more information, including assistance with how the reimbursement process works, go to the OPERS Medicare Connector section of our website, visit Via Benefits’ OPERS-specific website, call Via Benefits at 844-287-9945, or give us a call at 800-222-7377. We also suggest you become familiar with the main Medicare website, which contains lots of helpful information.

Q: I’m a relatively new OPERS member, and I’d like help accessing my OPERS information online. How do I do that?

A: Pretty easily, actually. You can set up an online account via the OPERS website. Just to go opers.org, and click on Member Login in the top-right corner. To set up the account, click on “Need an Account” and follow the instructions. You’ll just need to enter your Social Security number, date of birth and home ZIP code to get started.

We’ve recently posted an entry to PERSpective, our weekly blog, about the online account and what you can use it for. You can view this video and many others on our YouTube channel.

Q: I’ve recently retired from a job with the state of Ohio. Other than calling your 800 number, how can I find out information about the retirement plan that I chose, or other information, like verifying my income?

A: We’ve recently upgraded that feature.If you retired in 2018, you now can look up that information in your Personal Benefit Statement, which you can locate through the Document History feature in your OPERS online account.

The statement shows you a breakdown of the first benefit payment as well as the next one, including any deductions. It also reminds you of the payment you chose, your beneficiaries and the lump sum death benefit amount.

We’ll continue to mail the statement to new retirees, but it takes a couple of weeks. In the meantime, you can find this information in your online account.

Meanwhile, all retirees can find this information by selecting “My Account” and then “Benefit” through their online accounts. The Payment Summary shows a breakdown of the next monthly benefit, including any deductions.

At the bottom of this page, you’ll find the Benefit Calculation section, which offers more details about what you selected at retirement, your original benefit amount, what payment plan you chose and the lump-sum death benefit.

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

  • Please explain the government offset when one is also getting Social Security as a widow. How is it determined by what format to calculate, and is this an ongoing process?

  • As a retiree, I was told that our reimbursement for our Health Insurance paid thru One Exchange, now VIA would end after three years. This would make it in about March of2019. Is this information still correct?

    • Carol,

      You may be thinking of the additional $300 that was deposited to your HRA each January to ease the transition to the Connector. That transition period is complete and 2018 was the last year for the additional amount into your HRA.

      As to your HRA amount, the Board finalizes plan selection and pricing every year, including the HRA amount. Those details will be communicated in your fall newsletter.

      Julie, OPERS

  • I wasn’t aware that SERS retirees could enroll for medical/prescription plans through VIA benefits. (Connector)
    I’ve never read anything about this.

    • Maralyn,

      OPERS retirees select a health care plan through the OPERS Connector administered by Via Benefits. They receive a monthly HRA allowance that can be used to reimburse the cost of qualified medical expenses. SERS retirees participate in the plan sponsored by SERS.

      Please let me know if that answers your question.

      Julie, OPERS

  • I read that the Ohio state legislature has killed OPERS’ legislative attempt to cut future COLA benefits. Is this true or fake news? If it is true, is OPERS working on a new proposal to cut benefits? If so, what benefits are OPERS considering to cut?

  • I don’t agree with your advice about letting VIA help to choose a health plan and explaining the various options. When I signed up for insurance thru One Exchange, I made several calls and spoke to several advisors. Some were very knowledgable, some not so much. Plus, they are busy during open enrollment and may not have time to explain the various options, which are complicated. Everyone should educate themselves before calling VIA to enroll. They should understand the difference between medicare advantage and medigap plans and decide which plan they want before calling VIA. They can call OSHIIP for information about the various plans.

  • if it takes 45 days before first opers check, does it mean i wont get my plop till 90 days from that or from first day retired. since when did it take 45 days till receiving first check

    • PLOP payments are made 90 days after the first benefit has been paid, not 90 days after your effective date.

      Once all documentation and paperwork is in order, the first benefit will be paid in 30-45 days. While we would love for everyone to be paid sooner, that isn’t always possible. A lot depends on when we receive all documentation, including confirmation from your employer.

      If you have additional questions, please call us at 1-800-222-7377.

      Julie, OPERS

  • For those asking above, the Columbus Dispatch reported on March 23, 2018 that Ohio lawmakers killed HB 413 because there were not enough votes to pass it.

  • Why do I have to pay for every pill they give me the hospital or ER? I have Medicare and Blue Cross

    I never receiv an answer from Pers

    • Thank you for your question. We encourage you to call Via Benefits at 1-844-287-9945 or your insurance carrier for specifics about your prescription coverage.

      Julie, OPERS

    • ERISA is a federal law that sets minimum standards for retirement plans in private industry. OPERS is exempt from ERISA because we are a public-sector, governmental plan governed by state law, specifically Ohio Revised Code Chapter 145, and the Internal Revenue Code. We employ a series of checks and balances to ensure fund stability.

      Julie, OPERS

    • Kathleen,

      You can subscribe to PERSpective by clicking the Subscribe button on the blog’s home page. It’s on the right as you scroll down.

  • So the health care program is going broke in 10 years and according to the newsletter, OPERS intends to take no action until it us exhausted. However, later in the newsletter, it says changes must be made to health care to keep it viable. Which is it?

    • For several months we’ve reported that OPERS cannot continue to provide health care coverage in the same way we have in the past. Therefore, the OPERS Board of Trustees is taking a thorough review of the entire health care program, trends, funding, and costs. While we are carefully exploring options, we don’t yet have definitive information to share. We expect the board to make a final decision by the end of the year for implementation on Jan. 1, 2022. Throughout the process, the Board is committed to continued access to health care for current and future retirees.

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