Open enrollment deadline approaches

OPERS offers reminders, tips for retirees choosing health care coverage

By Heather Drago, Ohio Public Employees Retirement System

Nov. 6, 2018 – As open enrollment for the OPERS health care plans approaches on Dec. 7, here are a few reminders if you haven’t made your choices yet.

  • Eligible dependents, including spouses, have access to health care coverage. OPERS has discontinued the allowance for under-65 spousal health care, but spouses may secure coverage by paying the full premium.
  • You can cancel medical coverage over the phone. However, you cannot use the phone as a method to enroll in or change coverage. Use the Health Care Open Enrollment Change Form to enroll in, change or cancel coverage. You can cancel medical coverage at any point in the year, and the cancellation will have an effective date of the following month. Open enrollment is the only time that you can cancel vision and dental coverage.
  • If you received a disability benefit on or after Jan. 1, 2014, OPERS health care coverage is only available during the first five years of receiving a disability benefit. To continue health care coverage through OPERS beyond this time period, you must enroll in Medicare due to a disability, or meet the minimum age-and-service requirements.
  • Check with Medicare regarding your coverage eligibility. Medicare enrollment can take up to two years. You may qualify for health care coverage through Medicare even if you do not qualify for Social Security disability insurance.
  • OPERS requires documentation within 30 days of receiving your Medicare eligibility confirmation from Social Security. Your health care coverage will be terminated if we don’t receive notification within this time frame, and you will be responsible for repaying OPERS the cost of claims incurred, dating back to your Medicare effective date. Request a letter from Social Security containing both:
    1. The date Social Security provided notification of eligibility
    2. Your Medicare Parts A and B effective dates

Consider these tips as you think about 2019 health care plan options:

For Medicare-eligible plan participants

  • Review your current medical and prescription drug plan. If your health condition, medication or medical providers have changed in the last year, consider if your current plan will meet your needs next year.
  • Look for adjustments in plan design, premium cost and the prescription drug list. If you want to explore other plans or switch from a Medicare Advantage plan to a Medigap plan, ask how medical underwriting may apply.
  • Watch out for scams. You may receive calls and mail from other insurance agents and/or brokers offering medical and prescription drug plans. To remain eligible for your health reimbursement arrangement allowance, you must enroll in a medical plan through Via Benefits.
  • Has any thought been given to replacing Medical Mutual with another company with hopes of getting similar coverage for lower premiums. If so could you provide a cost comparison for members to review? My wife has Blue Cross/Blue Shield and under her plan eligible children are over $200.00 cheaper per month with almost the same benefits. Thanks

    • The plan you reference enrolls children which typically means a younger population. The plan the OPERS offers is one for retirees, with the premium driven by utilization, plan design and population demographics among other factors. You can’t really compare these two plans since they focus on different factors, it’s apples and oranges.
      On the procurement question, OPERS selects a health care provider after the completion of an exhaustive Request for Proposal, search and interview process. Several factors are considered before a provider is selected, including the amount of coverage offered, availability across the state and cost – both for OPERS and for retirees. The contract with Medical Mutual is in place through Dec 31, 2022. Historically an RFP will be distributed the year before, in 2021.

    • I hate the fact that I take the time to search for a cheaper plan and later during the year the insurances companies have the right to raise the premium on the plan I had purchased before the year is over! That is frustrating for me. I had always assumed they had to wait till a new year. Found that not to be true.

  • Has anyone who has a medigap policy through Medical Mutual purchased from Via Benefits, received notification of their policy cost effective 1/1/19, for the retired member and spouse?

  • I’m thinking about changing to blue cross blue shield with my VA benefits” Is this a good idea? OPER will no longer offer this after this year. is this right?

    • Both websites are working. In addition, you can call Via Benefits at 1-844-287-9945 if you’d like some help accessing your online account.

      Julie, OPERS

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