Open enrollment draws near

Packets will begin mailing in late September for 2021 health care coverage

By Michael Pramik, Ohio Public Employees Retirement System

Sept. 15, 2020 – Open enrollment time is almost upon us for participants in 2021 health care coverage through OPERS.

This year’s open enrollment season will run from Oct. 15-Dec. 7. The changes will take effect on Jan. 1. Packets of information explaining coverage options and other details will begin arriving in late September.

As open enrollment nears, we encourage participants to think about your health care needs and to be prepared to make choices best for you and your family. A few items to be aware of:

Pre-Medicare

Next year will be the final year for the OPERS pre-Medicare group plan. In 2022, OPERS will switch to a Health Reimbursement Arrangement model, in which participants will receive a monthly allowance that can be used for reimbursement of plan premiums and other qualified medical expenses. Beginning early next year, watch for information on the transition process.

Meanwhile, if you’re not yet eligible for Medicare next year, you may be eligible to enroll in the OPERS Retiree Health Plan, administered by Medical Mutual. It’s a network/PPO plan.

If you’re not yet eligible for Medicare and are re-employed, consider the Pre-Medicare Re-Employed Plan, also administered by Medical Mutual.

Premiums will not increase for 2021, so the monthly cost for participants in the pre-Medicare group plan will remain the same as this year. Premiums for OPERS dental and vision care will be slightly reduced in 2021.

There will be some plan changes:

  • The prescription drug out-of-pocket maximum is increasing by $400, from $2,400 to $2,800. The increase aligns us with the Affordable Care Act guideline for overall maximum allowable out-of-pocket expenses, which is $8,550 for 2021.
  • The medical out-of-pocket maximum is staying the same as in 2020.
  • There will be additional preventive drugs covered at 100 percent. They include medications used to prevent breast cancer and HIV in high-risk patients.
  • The three-day hospital stay requirement before being admitted to a skilled nursing facility is being removed.

If you’re making no changes, your coverage will automatically continue in 2021, and you need take no action during the open enrollment period.

If you’re enrolling, making changes or canceling coverage, you must complete and return your open enrollment form or contact OPERS between Oct. 15 and Dec. 7. You can cancel medical coverage or adjust dental and/or vision coverage by calling us at 800-222-7377.

OPERS Medicare Connector

The HRA base monthly allowance will remain at $450 for 2021. Your monthly allowance amount, which is a percentage of the base amount, will remain unchanged.

Review your current medical and prescription drug plan. Look for changes in premiums, plan design and prescription drug formulary. If your health conditions, medication or medical providers have changed in the last year, consider if your current plan will meet your needs next year.

OPERS will continue to offer vision and dental coverage. Refer to the open enrollment packet for more information.

In 2021, premiums for the OPERS vision and dental plans will be automatically reimbursed monthly from your HRA with no additional forms to complete or receipts to provide. This is a convenience that retirees have requested. However, if you do not wish to have these premiums automatically reimbursed monthly from your HRA, you can opt-out by using the form within your open enrollment packet.

Also, If you currently receive automatic reimbursement for your individual Medicare plan through Via Benefits and do not change plans for 2021, automatic reimbursement will continue. If you change medical plan carriers, automatic reimbursement will not carry over to a different plan. Talk with Via Benefits about whether automatic reimbursement is an option for the new plan that you are considering.

Recurring premium claim forms for Medicare Part B premiums must still be resubmitted each year.

If you’re making no changes, your coverage will automatically continue in 2021 and you need take no action during the open enrollment period.

If you are enrolling, making changes or canceling coverage, contact Via Benefits between Oct. 15 and Dec. 7.

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

  • I understand the challenges of trying to maintain a pension plan while still trying to balance some type of healthcare for the participants. What I never understood is how you can reimburse or provide a monthly supplement for those needing the OPERS health plan but for those who have selected to be a participant on their spouses insurance (not OPERS) there is no consideration for some type of payment. Did you not consider that the reason to not select your plan may have been based on how the benefit may compliment their personal needs but their still may be costs associated to get that plan? Why do you not provide some type of financial benefit to the pre-Medicare participants who have selected a plan outside of your offering.

    • Pam,

      OPERS doesn’t currently have the ability to offer financial support the way you suggested. But as part of the recent health care changes that will be effective in 2022, pre-Medicare retirees may be able to seek reimbursement for premiums from other plans in the manner you’re requesting. For more information, see the Health Care 2022 section of the OPERS website.

  • I retired at age 51 with 30 years of service. I am now 72. This should put me in the “65 and over” column of the “Health Care Allowance Percentage” table. Correct?

    • To determine your allowance percentage using the allowance table provided on our website you would use your age when you first enrolled in the OPERS Health Care Program and your qualifying years of service at retirement (Partial years are not rounded up to the next year.) Please forward additional account specific questions through your online account message center or contact us at 800-222-7377.

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