OPERS posts answers to HRA questions
One feature of the OPERS Medicare Connector that we’ve found can confuse participants is how to be reimbursed for expenses.
In short, Connector participants first pay for a qualifying medical item or service then are reimbursed through a Health Reimbursement Arrangement. This is an account that is linked to participants’ bank accounts.
The Ohio Public Employees Retirement System has gotten many questions about the HRA and how it works. In response, we recently have posted a series of questions and answers concerning the HRA to the OPERS website.
For additional information, we suggest contacting Connector administrator OneExchange at 844-287-9945, or referring to the OneExchange/OPERS website.
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.
The FAQ on what happens to the HRA at death of the retiree does not say what happens to the money in the HRA once claims are paid and no dependents are involved. Does the balance return to PERS (which I think it should)? Does it become part of the estate? Does One Exchange keep it? Thanks.
John,
The only way money in the HRA can be distributed is if the participant makes a claim for the funds. If there is money left in the HRA upon the death of the participant, and there are no dependents, the money thus stays with OPERS if no additional claims can be made.
OneExchange never has access to HRA funds for itself.
–Ohio PERS
So wondering what happens to the spouse of an Opers retiree whose insurance premiums are paid through One Exchange if the retiree should die. I know they will eventually be eliminated (shame on Opers) but what would happen if the retiree should die before that happens.
Allen,
The spouse would have access to the balance. The previous question specified no dependents.
–Ohio PERS
Ive requested the Reimbursement Forms from OneExchange several times, they state they are behind and trying to catch up. When will they get these forms out ?
Marc,
We can’t answer for OneExchange on that question, but you can access the forms online.
–Ohio PERS
Mr. Pramik,
You say all of the forms are available online. This is not true. I called One Exchange last night 1-20-2016. There are only two (2), not three (3). The missing form is Recurring Premium Reimbursement Form which I have a copy of from my packet, but it has the wrong address for where to send it to. The one exchange representative looked and said it was there. But it does not show on you webpage and still is not there today 1-21-2016. I looked at the same webpage as the customer service rep said it was on. Thought you said in a previous post that this was corrected.
John,
It has been corrected. We’re not sure what Web page you’re looking at. We always refer to the OneExchange/OPERS website, or “portal.” Click on the link and scroll down to “HRA Information.” Not only is the form there, but all of the reimbursement forms have been edited to include the El Paso, Texas, address.
This incorrect address was corrected after an alert blog reader told us about it and we got in touch with OneExchange.
–Ohio PERS
OK! Michael. I see where the confusion is as to where to get the online reimbursement forms. All of the forms (3) needed are not in the same place. Some are on Towers Watson main web page and some are on the individual’s account webpage.
Put simply:
Reimbursement Form: on Towers Watson main page & individual account page.
Recurring Premium Reimbursement Form: only on Towers Watson main page.
One Exchange Recurring Medicare Part b Reimbursement: only on individual account page.
All these forms should be on each main webpage and the individuals webpage.
Please clear up this confusion to all retirees and make sure Towers Watson customer service reps know where to tell their callers where to find each form.
This would stop a lot of confusion and phone calls for those who have online access rather than wait for snail mail. Those who do not have online access will have to receive them by snail mail.
And for what it’s worth, the one form that I requested (not on-line at the time) via snail mail on January 7th, has still not arrived in may postal mail box.
I also ordered some forms , asking them to mail them to me, the first of January, haven’t seen them yet, told me there was a limit of five, I do have a copier, a lot of people (seniors) don’t. A lot of people can’t run them off the computer either.
Sorry, I meant to say that the recurring premium reimbursement form is NOT online as of today, January 28, 2016.
I downloaded the form yesterday.
Marc,
Hopefully you will see my response to Mr. Pramik for January 22, 2016 at about 5:20 pm. That’s how you can find each of the online forms. If you are on Facebook, send my a private message I’m easier to find than me finding you.
Well Marc (an Mr. Pramik).
As I said in the above comments, I requested the Recurring Medicare Part B Reimbursement Form on January 7. I was told it would be about 8 days. Well guess what arrived in the mail today? My form. Too bad is still has the wrong address as to where to mail it to. Geesh! No wonder everyone is complaining about this system. Maybe by 2017 they will get it right.
What is the right address, would like to know without having to call One Exchange again, who probrably wouldn’t know either, and sitting on the phone for an hour waiting listening to that horrible music is almost enough to sen one to the mental hospital. We sent a recurring form to a Texas address and was told they haven’t received it, but not to worry because they have a big backlog and not to send in another one because it might just mess them up. Geez, what are we suppose to do. So mad at Opers for what they have done to us.
Allen,
The address for the recurring reimbursement form is: OneExchange, P.O. Box 981155, El Paso, TX 79998-1155.
–Ohio PERS
We are able to set up automatic reimbursement through OneExchange for either the Medicare Advantage plans or the Medigap & Plan D plans, but why doesn’t OPERS do the same for those us continuing with the vision & dental coverage deductions direct from our pensions rather than making us download a verification letter monthly to submit to OneExchange? Submitting copies of medical bills, prescriptions, etc., is already burdensome & time consuming, and your failure to do this for those continuing this coverage thru OPERS just makes it more work!
Ron,
The reason is that the dental and vision plans are subject to termination during the year.
–Ohio PERS
So be it, I can live with not having auto reimbursement for my opers dental or vision plans but the reason does not make sense.. I can also terminate my medical part B or my prescription plan by not paying them, yet they are eligible for auto reimbursement.. Just another glitch I guess.
Can we please get a straight answer on whether our deducted dental and vision expenses can be reimbursed via the Recurring Premium process? I am seeing two totally opposite answers from OPERS!
January 26: In response to Marlene, who asked “In speaking with OneExchange regarding another issue, they told me that Dental & Vision insurance that is received outside OneExchange would be considered a recurring reimbursable expense. I told this representative from OneExchange that OPERS says it is not, while she insisted it was. Who do I believe?
The reply was: “Yes, it is. You can set up that premium as a recurring reimbursement by using the form on the OneExchange/OPERS website.
–Ohio PERS
January 29: in response to a question from Ron Shanbrom:
“We are able to set up automatic reimbursement through OneExchange for either the Medicare Advantage plans or the Medigap & Plan D plans, but why doesn’t OPERS do the same for those us continuing with the vision & dental coverage deductions direct from our pensions rather than making us download a verification letter monthly to […]”
Ron,
The reason is that the dental and vision plans are subject to termination during the year.
–Ohio PERS
Tom,
There was a misunderstanding regarding the original response. The fact is that you can’t use either auto reimbursement or recurring reimbursement for dental/vision care secured through OPERS.
The reason I gave the conflicting response is that I believed that the other member was asking about dental/vision secured outside the Connector and outside of OPERS. The question was unclear in that regard.
Sorry if this has caused confusion.
Here are the basics about dental/vision reimbursement:
You can set up auto-reimbursements for medical premiums for plans you enrolled in through OneExchange.
You cannot set up either auto-reimbursement or recurring reimbursements for dental/vision coverage that you secure through OPERS. You can get a receipt from us to submit for your current premium or for prior 2016 premiums.
You can set up recurring reimbursements for premiums of dental/vision plans you have enrolled in through the Connector.
You can set up recurring reimbursements for premiums of dental/vision plans (medical/pharmacy premiums as well) you have enrolled outside of OPERS or the Connector.
–Ohio PERS
I sent in a recurring form for vision and dental purchased through OPERS, along with a copy of the OPERS statement I was sent in late December telling me what will be deducted from my check for vision and dental premiums. According to my OneExchange website account, it looks like they accepted this as a recurring reimbursement for all of 2016.
Why do I feel like a guinea pig? This process is so cumbersome and so poorly explained that you should really find out how many people are being frustrated and upset. Have you considered a poll to find out where you have failed?
Donna,
Every winter we conduct a survey of participants in our insurance plans. The current survey is scheduled to be sent out in a week or so.
–Ohio PERS
I did not receive the survey to evaluate One Exchange. Let me tell you my recent experience. On Monday morning, January 18, because I could not get through by telephone to One Exchange, I entered the request for One Exchange to telephone me. I did not receive a call. Early Tuesday, January 19, I again attempted to reach One Exchange by telephone and after holding for a long time I made another request for One Exchange to please telephone me. I did not receive a phone call on Tuesday or Wednesday. On Thursday morning, January 21, I used sent a message via email to One Exchange with a message about my concerns asking for assistance. Just yesterday, Wednesday, January 27, I received an email reply telling me that my questions could only be answered by the Reimbursement and Funds department and that department is not accessible via email and I was given a telephone number to reach them and to press option 3. Option 3 does not connect you with a real live person but with 3 additional automatic recorded messages. After attempting 3 or 4 times to get beyond the recorded messages, I simply blurted out on the phone “speak to a representative” and then, ONLY THEN, did my phone actually get to a telephone line that let me know how terrible busy they are and would I please hold. I could continue with how poorly trained these individuals are but I suspect this will not pass muster to be printed on this blog.
Bet I don’t get one! So here are my suggestions:
Since buying my own insurance (it is a great plan — AARP, UHC, Plan F at a great price reimbursed to me by OPERS) I have spent — since January 1 — probably five hours on the phone each week “taking care of business.” Most of it on hold with One Exchange.
I hope OPERS will:
1. Have One Ex set up a call back system (giving a time, too) like OPERS now has.
2. Have them model their reimbursement process like — was it Aetna??? handled our reimbursements from our RMA. I got my first “manual” reimbursement (almost $370) in a timely manner, but it was a lot of work. And they had no way to check to see if they received it, and if it was legible, and all in order.
I think we all deserve better and I would like to get back to my retirement gig — writing — instead of overseeing One Exchange.
I think we would all like to get back to enjoying the retirements we worked so hard to earn.
In the FAQ for the HRA, do I understand it to say my dental and vision payments taken out of my PERS pension check are NOT eligible as a recurring medical payment? So do I need to wait several months –say April –to request payment for Jan, Feb, March? How can this not be a recurring expense?
Marlene,
The system can’t set up auto-reimbursement of OPERS dental and vision premiums because coverage can terminate for retirees and dependents because of eligibility reasons at any point during a calendar year.
And yes, you can save up several months’ worth of receipts and submit them all at once for reimbursement. Or, you can do that every month if you’d like.
–Ohio PERS
I was unaware that as a retiree, my dental and vision insurance could be terminated at any point during the calendar year. Are you saying OPERS could terminate the coverage or is that something I could terminate?
What is the process to get a “receipt” from OPERS for my dental and vision premiums when my check is automatically deposited?
I was told at a seminar last summer that OPERS was going to make the reimbursement process simple–requiring a form to be filled out once a year. I’m finding out that this is not the case. So disappointed.
Marlene,
We mean that the insured could terminate. And the Connector does provide for auto-reimbursement of medical premiums, as promised.
In order to receive reimbursement through your HRA, you will need to a file a reimbursement claim with OneExchange. When you submit this claim, you’ll need to attach a premium receipt/ letter from OPERS which serves as proof that you have paid the OPERS premiums. You can get this premium receipt by logging into your OPERS online account and printing a copy of the premium receipt/letter for the current month or any previous months beginning with January 2016. Reimbursements for premiums paid to OPERS are not eligible to be set up as a recurring reimbursement with OneExchange. However, you can request reimbursement for multiple previous months at one time.
–Ohio PERS
I’m not following the logic on my ability to terminate my dental and vision coverage as being a reason for them not to qualify as a recurring expense. I would also be able to terminate my Medicare supplement plan yet that is considered a recurring expense.
Am I able to electronically send these receipts in to OneExchange? I have no access to a fax machine.
Marlene,
Because it’s possible there would be lots of people ending coverage during the year. We are working to change that.
–Ohio PERS
my dental/vision was accepted by One Exchange as a recurring expense..they reimburse me automatically on the 1st of each month thus far.
Regarding the HRA reimbursement for dental and vision premiums, specifically where on the OPERS website do I find the “premium receipt/letter” that you advise us to print? If I open up the deduction screen, that will not print separately from the gross payment screen. And I don’t see any way to print prior months deductions either. I thought I was familiar with the OPERS website, apparently not.
John,
There’s a “Requestable Documents” panel at the bottom of the home page of your online account. In that panel, there’s a link for the premium receipt, just like there is for the income verification Letter. For now, there’s only one month available for receipt request. In the future, it will still allow you to go back to January 2016, but more months will be included.
–Ohio PERS
Logged onto OPERS could not find premium receipt/letter for the current month to print off,Went to documents not there.
John,
There’s a “Requestable Documents” panel at the bottom of the home page of your online account. In that panel, there’s a link for the premium receipt, just like there is for the income verification Letter. For now, there’s only one month available for receipt request. In the future, it will still allow you to go back to January 2016, but more months will be included.
–Ohio PERS
Thats the 1st I and others have heard that,one exchange when talking to them last week assured me that my open enrollment statement opers sent retires would get me reimbursment for my wifes premium.So I faxed all in last week as instructed.I guess I will need to start over again.
Actually the insured can terminate any premium, yet they can be set up as a recurring reimbursement but not opera dental .
Printing out and submitting monthly statements for vision and dental reimbursement makes no sense. This is a recurring expense. This creates more paperwork for retirees. OPERS should not expect all retirees to have a computer, computer skills, printer, fax machine, scanner, etc., and to spend their time creating and printing documents on the OPERS website and filling out multiple forms on a monthly basis. We do appreciate the non taxable allowance but the reimbursement process and lack of knowledge in regard to OneExchange employees and their printed material is an unacceptable burden on retirees.
Will this fund reimburse me for what I pay for medicare to Social Security?
Frank,
Yes. We addressed the question of Medicare Part B premium reimbursements in our recently published HRA frequently asked questions.
Here’s the answer to that question: First, pay your Medicare part B premium to Social Security. Once your premium is paid, you will receive or you can request (either by phone or online) a proof of payment letter. Once you have your proof of payment from Social Security, request a Recurring Reimbursement Claim Form from OneExchange. Submit this form along with your proof of payment letter from Social Security. If you receive the $31.81 premium reimbursement from OPERS, please be sure to subtract this amount from the total premium. You can request reimbursement only for the amount you paid, not for the portion reimbursed by OPERS or another source. You do not need to send proof of the portion you are being reimbursed by OPERS; just indicate it on the form.
–Ohio PERS
I don’t understand the proof of payment letter from SSA.. They send me an invoice for my premium and i have a bank statement showing that I paid that amount to them. Isn’t that proof enough without contacting SSA every month for a letter?
Tim,
You do need the letter, which you can get by calling Social Security. You do not need to submit it every month. You can use the recurring reimbursement form on the OneExchange/OPERS website to have it paid regularly through the end of the year.
–Ohio PERS
I see that OneExchange now has a dedicated “Recurring Medicare Part B Reimbursement Form” – great, only about a month late, and it even has the correct (El Paso) mailing address! However, the form can apparently NOT be use for Medicare Part D, which many of us must pay in addition to Part B. In fact the instructions state “Medicare Part B is the only premium allowed on this form.” So why not Part D, since it’s paid right along with Part B and the monthly amount is stated in the same notification letter from Social Security that documents the monthly Part B premium.
I filed my Recurring Expense Form online several weeks ago, and since it was “non-Med B specific” I included my monthly Part D expense. A subsequent conversation with a person at OneExchange indicated that my application “looks OK” and was in process – but to not expect a payment before the end of February, at which time I will have paid Medicare over $500 for 2016.
Incidentally, the last paragraph of the instructions erroneously refers to a “Proof of Income” letter, which I assume is actually the “Proof of Premium” letter listed as required third party documentation. My letter does not call itself anything, so there will undoubtedly be some confusion. It would have been much better for OneExchange to have provided a clearer description of the letter, e.g. “the letter you received from the SSA advising you of your 2016 Medicare premium amount.”
what is the letter we ask SSA for? what should it say? One exchange advised me that since the premium wasn’t paid by deduction from a soc. security check, i could not use the recurring form. I do not receive a ss pention. It makes it very confusing when opers. tells us one thing and One Exch. says differently.
Tim,
We were told to have members send an award letter, or a proof of income letter.
–Ohio PERS
If you pay your SS quarterly because you do not receive a SS pension, then you have to send a Reimbursement form into One Exchange after you have paid each premium each quarter. They will not set you up for recurring if you pay your Medicare B yourself, only if it comes out of a SS check. My wife they put on recurring, mine is not. I get my Medicare B through her SS, since I worked for the state nearly 30 years . CMS will not give you any letter and neither will SS, unless you maybe call your local office. I called the 800 SS number and the CMS number many times trying to get the letter I needed. At the local office for SS for me, I finally found someone to makeup a letter for me, which state the amount I have to pay each month (Proof of Premium) and the amount billed me and the amount they had received from me and the date they received it for January, February, and March. (Proof of Payment) I am guessing I will have to do this each month, since this letter only shows this quarters payment. Call my local SS and ask for this letter because the only other proof for payment we could give them would be to wait until the next bill comes which shows how much your last payment was, or by sending in your checking or credit card statement proving you paid it. I told One Exchange that I did not feel comfortable sending in my checking account or credit card statement because it had a lot of other private information that they didn’t need. Of course he assures me the information would be safe (hahahaha) but he told me that if I wanted to I could send the statement and black out everything on the statement except my name, date, account number ?, and the posting of my payment on the statement.
Social Security tells me they have no clue what I need when I tell them about the letter you tell me they can give me
what do we need from social security to prove our Medicare B premium? A proof of Payment or a proof of premium ? I am getting mixed messages.
Allen,
Here is information from our website, in a question-and-answer section regarding the HRA:
First, pay your Medicare part B premium to Social Security. Once your premium is paid, you will receive or you can request (either by phone or online) a proof of payment letter. Once you have your proof of payment from Social Security, request a Recurring Reimbursement Claim Form from OneExchange. Submit this form along with your proof of payment letter from Social Security. If you receive the $31.81 premium reimbursement from OPERS, please be sure to subtract this amount from the total premium. You can request reimbursement only for the amount you paid, not for the portion reimbursed by OPERS or another source. You do not need to send proof of the portion you are being reimbursed by OPERS; just indicate it on the form.
–Ohio PERS
I called both Medicare and Social Security yesterday, waited on hold for Social Security for two hours, and I was told by them there is no such thing as a Proof of Payment letter, nor a proof of Premium letter. They said they would try to send me something to show what I pay (same letter I already sent to One Exchange) but other than that they didn’t know what I was talking about. I told them Opers was instructing us to first pay our premium and then get a proof of payment and to be prepared for others to call. They have no idea what we need.
Looked all over online, at Social Security, there is no place to request the letter either
I relied on your information about requesting a proof of payment letter online and signed up for an account on the SSA website only to discover that this site has no provisions for such a request. I’ll have to call. What a disappointment. Seems like I’m spending an inordinate amount of time on the phone due to all these changes. Further, when I called OneExchange today to question their instructions for completing the Recurring Medicare Premium Reimbursement form (i.e.: monthly amount must match the amount on supporting letter), I was told I had to send in a copy of my letter from OPERS showing the Medicare Reimbursement of $31.81. This is contrary to what was stated in the recently published HRA frequently asked questions. These are examples of the many miscommunications we retirees have received throughout this whole process. When will it end? Thank goodness I still have a few wits left but I’m running out of patience. I can hardly wait to complete a survey about this new system.
Can you explain why monthly payments for dental and vision insurance premiums deducted from my benefit payments are not eligible for automatic reimbursement from my HRA, as a recent Q&A from OPERS stated? It’s certainly an inconvenience to have to go online to our OPERS account every month, open and print a report listing these payments, complete an HRA application, and transmit all to OneExchange. It’s the same amount every month, would seem to be a natural for automatic reimbursement!
Incidentally, I was pleased to see that OneExchange has set up automatic reimbursement for my Medicare B and D monthly payments – now anxious to see how long it takes for the direct deposit to show up since I’ve already paid January and February.
Tom,
The system can’t set up auto-reimbursement of OPERS dental and vision premiums because coverage can terminate for retirees and dependents because of eligibility reasons at any point during a calendar year.
While we can understand that participants would want to receive reimbursement immediately for medical expenses, it’s not necessary to request that every month. You can wait several months, for instance, and submit all the receipts at once.
–Ohio PERS
I’m not waiting for 2 or 3 months to submit a request for the current month and previous months if you have each months OPERS Healthcare Premium Receipt available online at the first of each month. Why wait? My premium has been paid and I want my reimbursement as timely as possible. I too think this should be an auto reimbursement. If Dental and or Vision is terminated for some reason, and you have already taken my premiums from my pension check before you knew it was terminated, then the insurance company owes a refund to you and you in-turn would owe me a refund. If Towers Watson already reimbursed me for premiums I was not entitled to, then I owe them, who would then credit it back to you. This is basic bookkeeping 101 that goes on everyday between banks, retailers. companies and the like to reconcile funds with regard to overdrafts, under charges other clerical errors.
Keep reading John, and you’ll see that OPERS now says we CAN use the Recurring Reimbursement form for dental and vision! See Michael Pramick’s response to Marlene on 1/26, four days after he told you it can’t be done. Now if they’ll just make it possible for those of us to pay Med B and D premiums directly to Medicare to be treated the same as folks who have the premiums deducted from their SS benefit and use the Recurring Reimbursement form (which OneExchange tells me can’t be done), I’ll be a happy camper!
Tom,
There was a misunderstanding regarding the original response. The fact is that you can’t use either auto reimbursement or recurring reimbursement for dental/vision care secured through OPERS.
The reason I gave the conflicting response is that I believed that the other member was asking about dental/vision secured outside the Connector and outside of OPERS. The question was unclear in that regard.
Sorry if this has caused confusion.
Here are the basics about dental/vision reimbursement:
You can set up auto-reimbursements for medical premiums for plans you enrolled in through OneExchange.
You cannot set up either auto-reimbursement or recurring reimbursements for dental/vision coverage that you secure through OPERS. You can get a receipt from us to submit for your current premium or for prior 2016 premiums.
You can set up recurring reimbursements for premiums of dental/vision plans you have enrolled in through the Connector.
You can set up recurring reimbursements for premiums of dental/vision plans (medical/pharmacy premiums as well) you have enrolled outside of OPERS or the Connector.
–Ohio PERS
I sent in a recurring form for vision and dental purchased through OPERS, along with a copy of the OPERS statement I was sent in late December telling me what will be deducted from my check for vision and dental premiums. According to my OneExchange website account, it looks like they accepted this as a recurring reimbursement for all of 2016.
I was told yesterday by OneExchange that we can have our Medicare premium recurring reimbursed.
It’s no different than medical and rx medical preimums, which could also be paid or not paid. Makes no sense. But One Exchange can’t even get the other stuff straight. ???? They have this backlog and have incoming mail just sitting there not even downloaded into their system. Wonder how many months and how many times we will have to call them to try to get our money? Feeling so sorry for all the seniors out there unable to take care of all these problems.
Once the recurring Medicare is set up by One Exchange, will we see it in our account page on One Exchange, like we can see our Health Insurance premiums are set up for reimbursements? That is one of the questions I ask the Funding Dept when I finally got through to them, “How would I know they had set it up” and the representative I spoke with didn’t know and told me to call back again in 7 to 10 days to see if they had received it and were working on it. Got to be kidding. Took we several times to get to funding this time.
I fully expect that eventually this system will begin to reimburse our xpenditures from our available HRA funds. But I can tell you that this initial months delays are presenting a financial hardship to me and I imagine many others. My HRA will NOT be enough to maintain the level of care I had. My HRA will actually decrease by over $90 per month in the course of the next two years. That will make my situation worse. My new prescription plan covers my existing at an increased monthly cost of nearly $80 and that alone necessitates my having to discontinue taking one of my heart medications (Zetia) against the advice of my physicians. I simply cannot afford the medicine any longer. OneExchange essentially says I should have chosen differently and I will have to wait till next year’s cycle. They were the ones that steered me towards this insurance SilverScripts and did not make the continuation of my old coverage (ExpressScripts) available. So I will cut my Zetia in half for the next three months and quit. It is all I can do.
Douglas, I hate to hear this. If one exchange was as good as they claim in directing you to a plan the best fits your need and budget, it sounds like they did a very poor job. The benefit of going through One Exchange is that the plans they can make available to you are usually much cheaper than what an individual can obtain directly from an insurer or other insurance broker simply due to volume. My wife was on a particular drug that Express Scripts offered. However they stopped covering it. So she had to go with another prescription company that would cover it. She is also paying less premium now than express script originally charged at the time. This drug availability and cost is a sore point throughout the United States.
I went online printed out the form and filled it out and faxed it to them and had my refund in my checking account in a week.
some of us, I bet most of us , don’t have a fax
Your very lucky. I mailed mine on 1/19/16 and they cant even tell me if they have received it. They said I had to wait at least 15 days from the time it was sent.. Sure wish I had access to a fax.
Cheryl, I felt your pain. Then I went and bought me a all – one- printer w/ fax. It’s much easier. Less stress than waiting on Uncle Sam’s Postal Division. Be Blessed.
Michael Pramik, we need a forum for infrequently asked questions. We need a place to discuss specific medical issues. I have read posts of retirees concerned about the cost on infusion rheumatoid arthritis medications. Some retirees have found a solution to their problem, but the information is not readily available to others, who share the problem. I have also read concerns about insulin and expensive medications like Zeita, but I haven’t read any solutions. That doesn’t mean that retirees haven’t found a solution. Readers are much more likely to post complaints than solutions. If we had a location to post questions and save solutions, We would be encouraged to help each others and be able to find solutions to the problems that we encounter. I use thread based forums in other places on the internet to find solutions.
Ed,
Thanks for the suggestion. We’re going to discuss how this might be possible to set up.
–Ohio PERS
I am sure this isn’t what you want to hear, but these are things that you should have checked in to before you started shopping around for supplement or advantage plans. I did and found that one of the meds I was taking, in place of the remicade infusion, would no longer cost me $30/mo. Instead, it’s about $1400+ per month until I get through the donut hole, at which point it’s still almost 6 times what it was under the previous OPERS plan. But, OPERS sent out mail telling those affected that the remicade infusions are covered by Medicare Part B at a very reasonable charge, depending on what supplement or advantage plan you subscribe to.
In my case, I just quit taking the medicine about 6 wks. ago. However, there are programs out there that will assist with the cost of medications, if you qualify financially. Most, however, won’t help if you’re on Medicare.
As I have read from others the important factor is where you have your infusion, if you are not in an advantage plan. (Advantage plans have different rules.) If the doctors office or a hospital provides the infusion, it s covered under Part B and only the $146 copay applies. If you have home infusion or get the infusion at a drug store, it is not covered by Part B. I do not take this drug, but I have heard that it can be crippling and painful to not have it. If you Google the drug name and Medicare, you should get a more complete explanation of the requirements for Part B coverage.
We mailed in our first reimbursement form on Jan.3rd,received it in checking account on Jan.20th. Not a bad turn-a-round time. The easy way to get forms is to print them on your printer and make as many copies as needed,
Douglas Kulow, We have the same problem with my husbands Silver Script plan. For us the high cost drug was Welchol. We talked to my husbands cardiologist and changed his prescription to something less expensive. Perhaps you could try that. Even with that change, the costs will be around $600 a year more with Silver Scripts. But that is better than falling into that doughnut hole and having to pay thousands more. I was told by our advocate that Silver Scripts was the least expensive plan for us. I would hate to see what the other plans are charging.
I was all ready to sign up for the silverscripts plan, low premium etc. Then I called them and checked on my copay costs and they were much more than other plans. I ended up choosing Coventry First Health Part D, prem $33.90/mo but co-pays are less. You might check them out.
I am disappointed with the whole process with One Exchange with the reimbursement process. I had the understanding that the vision/dental was to be an automatic reimbursement. I think OPERS should automatically mail out a monthly statement when they deduct any medical expenses from our benefits. We should not have to make these calls/online requests to numerous agencies or providers for statements to fax/mail to anyone!!!!!!! It takes entirely too much time to make these calls, be put on hold, wait to be called back, find the correct website, the correct link and on and on. I saw let’s put pressure on OPERS to change this process!!!! And I am mad because my Rx are more costly under my new Rx-Silver Script. This will take more phone calls to figure out this one too. I plan to voice my opinion at my next OneExchange seminar.
I will have to re-do two more forms because of bad mailing address and the necessary documentation required which was not explained. I have had problems getting in touch with a one exchange rep and when I finally did she acted like it was an imposition to answer my questions. This has been a very cumbersome method and many will not be able to deal with it. I’m not an agent and am very dissapointed to find out that I’m expected to be one.
This medical insurance has been my worst nightmare. Spent hours on the phone setting it up
and now not receiving claims paid. It’s one big headache. Kudo’s whoever dreamed this plan up.
Called one exchange today talked to Amanda she told me faxes were running two weeks before uploading
Great!
Yes, I was told a couple days ago by Funding that they had a big backlog and to wait another 10 days before calling them back to see if they have even received my form, which I had to mail because I don’t have access to a fax machine.
Words like ‘connector’ and ‘one exchange’ made this whole transition sound absolutely wonderful and easy to do….big difference between fantasy and reality. I paid my January 2016 premium in Dec. 2015; however, when I inquired about reimbursement, I was told my insurance company had not notified them of my payment; Not so, according to my insurance representatives
Tough and stressful transitioning…. Big difference between fantasy and reality.
I was given the same response by OneExchange. This was not true according to my insurance company.
I paid a total of $ 147.06 for my Health and RX premium. My reimbursement from HRA was only $ 147.06 . WHY?
Why did I not receive my spouses reimbursement at the same time?
Thanks for your quick response, I appreciate it.
Linda,
There was a programming delay that has affected some spousal reimbursements. That has been addressed, so the reimbursement process should be done on a more-regular basis in the near future.
–Ohio PERS
I was told reimbursements won’t come until March, one representative told me the first of march and would probrably come for two months, anther representative told me it could b late March, on our account I have two one for health ins and one for an rx and then my wife has one for an advantage plan. The only one of our plans reimbursed thus far was my health plan a few days ago but not my rx plan or my spouse’s plan at all.
In speaking with OneExchange regarding another issue, they told me that Dental & Vision insurance that is received outside OneExchange would be considered a recurring reimbursable expense. I told this representative from OneExchange that OPERS says it is not, while she insisted it was. Who do I believe?
Marlene,
Yes, it is. You can set up that premium as a recurring reimbursement by using the form on the OneExchange/OPERS website.
–Ohio PERS
So now my dental and vision premiums that are deducted from my OPERS pension CAN be put on the recurring reimbursement form? …and this form can be filled out just one at the beginning of the year?
Marlene,
No, it cannot. You can’t set up either auto-reimbursements or recurring reimbursements for dental/vision coverage that you secure through OPERS. You can get a receipt from us to submit for current premiums or prior 2016 premiums.
I’d like to explain why I initially gave you conflicting information. First, I’m going to reprint your original question:
In speaking with OneExchange regarding another issue, they told me that Dental & Vision insurance that is received outside OneExchange would be considered a recurring reimbursable expense. I told this representative from OneExchange that OPERS says it is not, while she insisted it was. Who do I believe?
When I read this, I interpreted (and perhaps the OneExchange representative did as well) that when you said “received outside OneExchange,” you meant that you had secured the coverage outside of the Connector and outside of OPERS.
However, now that I see you are referring to coverage you bought through us, the correct answer is that you can’t set up auto reimbursements or recurring reimbursements for those premiums.
–Ohio PERS
Why do we retirees have to be the middle man in this process? Seems to me it would be a much smoother process for the retiree to contact OPERS once a year, asking to be reimbursed for our dental and vision and then have OPERS submit the paperwork to OneExchange. How hard would that be?
Marlene,
The participant is not the middleman. You can save up your receipts and submit them once, at the end of the year and be reimbursed all at once. Your suggestion introduced a third party into the process and makes that party the middleman.
–Ohio PERS
Michael
This answer to Marlene is the opposit of what you told her on January 22. No wonder people our confused.
Lee,
Thanks for pointing that out. I mistakenly believed that she was talking about dental/vision coverage secured outside of both the Connector and OPERS.
Here are the basics about dental/vision reimbursement:
You can set up auto-reimbursements for medical premiums for plans you enrolled in through OneExchange.
You cannot set up either auto-reimbursement or recurring reimbursements for dental/vision coverage that you secure through OPERS. You can get a receipt from us to submit for your current premium or for prior 2016 premiums.
You can set up recurring reimbursements for premiums of dental/vision plans you have enrolled in through the Connector.
You can set up recurring reimbursements for premiums of dental/vision plans (medical/pharmacy premiums as well) you have enrolled outside of OPERS or the Connector.
–Ohio PERS
Bingo!
THOUGHT YOU SHOULD KNOW WHAT I WAS TOLD TODAY…
Called OneExchange today inquiring as to why only one (1) of my drug plan premiums was reimbursed and the other was not. The premiums were paid on the same date, to the same company, for both me and my wife, as separate transactions.
OneExchange (Kevin) said “OPERS IS DELAYING SPOUSE REIMBURSEMENTS AND HOLDING UP THE FUNDS”. Additionally, I told Kevin several times that I was having a very hard time understanding him, thought his microphone was too close to his mouth. At times his voice would cut in and out. Kevin, said OneExchange was having an “audio problem” and nothing could be done.
George,
Thanks for sharing your experience on the PERSpective blog. We’re not holding up funds. The truth is that there was a programming delay that has affected some of these reimbursements. That has been addressed, so the reimbursement process should be done on a more-regular basis in the near future.
–Ohio PERS
This is the problem , we ask questions and we get two of the story, One Exchange says one thing (I have come to think they do not know what they are talking about) and Opers tells us something else? All we know is we sit and wait wondering how many times we will have to call to get things straight, or will they ever be straight? I also have had people at One Exchange I could not understand. Contacting customer service at One Exchange doesn’t help either, guess what they tell you, please call in again. Sure we have all the time in the world! Thanks Opers, thanks a lot!
Allen,
If your comment is about the spousal reimbursements not coming in at the same time as those of the members, it’s like we explained: There was an unforeseen programming delay that caused this. It has been fixed, and the reimbursements should not be delayed in the future.
–Ohio PERS
No , not about spousal reimbursement. I received my health insurance reimbursement but not my rx reimbursement. I also cant get straight answers concerning my recurring forms for medicare b for myself and my wife. I sent all i could send. I contacted SS also. One Exchange cant tell me anything. Whether its even received. If the forms i sent are correct , if i will know because it will show up on my account screen when it is set in place for me. So tired of all the hassle!! Reading these comments and comparing to my horrible ecperiences i’ve had with One Exchange and seeing some of the answers you Opers give others. We are getting all kind of mixed up messages, just think of all the retirees who cant do this trying to grt ghe correct answers and complying. I too am running out of steam! Calling and calling over and over again and submitting and resubmitting. Its nonsense. Its a requirement to have medicare a & b. So we shouldnt have ro jump through hoops to try to get reimbursed.
Allen,
You did not indicate in your comment what you were talking about. We had to guess.
Regarding the Medicare Part B process, it’s on our website:
First, pay your Medicare part B premium to Social Security. Once your premium is paid, you will receive or you can request (either by phone or online) a proof of payment/proof of income letter. Once you have your proof of payment from Social Security, request a Recurring Reimbursement Claim Form from OneExchange, or find it on the OneExchange/OPERS website. Submit this form along with your proof of payment letter from Social Security. If you receive the $31.81 premium reimbursement from OPERS, please be sure to subtract this amount from the total premium. You can request reimbursement only for the amount you paid, not for the portion reimbursed by OPERS or another source. You do not need to send proof of the portion you are being reimbursed by OPERS; just indicate it on the form.
–Ohio PERS
Seems like everyone is having similar issues with OneExchange, Opers and their insurance co. OneExchange tells you one thing, the insurance co tells you something else and OPERS says they have no control over either situation.
What a terrible way to treat retirees. OPERS should take responsibility for this mess they created. All we are asking is a convenient way to get reimbursed for what we are due.
By the way, I do not have hours to waste trying to get a call through to OneExchange only to get different answers every time.
On 1/25/2016, I received a Deposit Advisement from OneExchange which notified me that my health premium reimbursement amount had been deposited into my checking account on 1/21/16. I verified that the deposit had indeed been made. However, the reimbursement amount was $2.00 less than the January premium payment I had made. I contacted OneExchange on 1/26/2016 to explain the shortage. The representative finished my opening statement, telling me “it was short by $2.00”. The representative told me that many others had experienced the same shortage, and that there were problems with the carrier’s data files and that the cause was not known at this time.
I asked if I could file a claim to recover the $2.00, and the representative responded with, “it’s only $2.00.” I replied that “$2.00 is $2.00” for one on reduced income and that when I paid the full premium amount as required, I understood that I would be reimbursed for the full amount, not less. The representative’s tone was clearly to discourage me from submitting a claim, telling me, to the best of my recollection, that it would be “hard to do” and “could be complicated”.
I intend to file the claim because we were told that we would be reimbursed for costs such as this. I understood that OPERS paid OneExchange a hefty amount for its services, which was to include supportive customer service. However, for me, the promise of customer support became abhorrently emaciated after my conversation with OneExchange today.
R,
Some Connector participants initially have seen a difference in what they paid and what they were reimbursed. The reason is that some insurance carriers offer various discounts that many times are not calculated until after the first premium payment is made. Examples of these discounts are customers making electronic payments, receiving a family discount or paying with a credit card. The difference is typically accounted for with your next premium payment.
Sorry it took a while to get to the bottom of this. Members should receive what they are due.
–Ohio PERS
I paid for my RX Aetna premium for the whole year of 2016 at $301.20. Received the reimbursement of $25.10 which was for only one month premium. Why am I not reimbursed for the total amount?
Christine,
We don’t have access to that information. Call OneExchange at 844-287-9945.
–Ohio PERS
So many problems with the One Exchange, Ihave so much trouble getting through and when I do I never get a correct answer. Yesterday when I called about the recurring forms, and it took me four trys to get anybody, they could not really answer my questions, they said they did not show my form had reached them yet either, and I mailed it on Jan 11th. They tell me they have a huge backlog. Why? This is our money being held up by their backlog and they can’t even answer questions. I have had so much trouble trying to get my spouse and I questions answered from the very beginning. We are not happy at all with this program. When I called and was told that our recurring form hadn’t arrived, why didn’t she ask me if I sent it to the right address, until reading this now, I didn’t know there was an address problem. Now I will have to check again! Great!
I hear you! I sent my form on January 7th to the Nebraska adress that was on the form only to learn those were old forms. The new forms have an El Paso address. I was assured my forms would be forwarded to El Paso. I called OneExchange yesterday and they have no idea where my form is and they don’t want me to resubmit. OneExchange even asked me when it was forwarded! ! How in the world would I know that? They keep saying it will take 8-10 business days to process. When I asked 8-10 business days from when, she hesitated and said, I guess from today. Ugh! This process is so frustrating…a total 180 from how things have been run by OPERS in the past.
I have received my auto-reimbursement for my medical and prescription premiums. However, my wife’s premiums have not been reimbursed. I have verified that both of us are signed up for auto-reimbursement on the OneExchange site. Is there any reason for this delay?
Don,
There was a programming delay that has affected some of these reimbursements. That has been addressed, so the reimbursement process should be done on a more-regular basis in the near future.
–Ohio PERS
In mid January, a One Exchange representative told me that the Recurring Reimbursement form was the appropriate form to use to request reimbursement for my OPERS-sponsored vision and dental premiums. I completed that Recurring Request Form and mailed it in on January 11. A few days later I learned through the OPERS FAQ’s and other resources that it is NOT the correct form. I have not yet been contacted by One Exchange regarding a denial of my request due to the usage of an incorrect form, Today I called One Exchange again and asked the representative if I should submit those requests on the regular Reimbursement Form or wait for One Exchange to act on my original (incorrect) request. The woman told me that “from what she knows,” the Recurring Claim Form is the correct form to use, because it’s the same cost every month. I told her that this is contrary to the advice given by OPERS. She didn’t sound very convincing, and I asked her to put me on hold so that she could confirm that with a supervisor. She did put me on hold and returned shortly thereafter. She said she “asked around” and everyone is telling their customers to use the Recurring Reimbursement Form for their OPERS vision and dental premiums. So what do I do now? Follow the instructions from OPERS or follow the instructions from One Exchange?
JMC,
It is our understanding that you cannot set up auto reimbursement or recurring reimbursements for your OPERS dental and vision coverage. You can, however, submit monthly requests, or save a few and submit them all at once.
–Ohio PERS
I used the recurring form for my dental/vision along with the receipt I printed from Opers website and also the yearly statement from Opers showing what it would be each month that I received the end of last year, showing it paid and I was reimbursed for just January only, and for February I just sent in the claim on a regular reimbursement form for February with the letter I printed from Opers saying it was paid and they paid me then also for one month. So I have done both forms and both times they paid for one month each time. They did not set me up for recurring for dental/vision. That is why I sent the recurring form in January. Just my experience sharing with you.
Calling Social Security to get Proof of Payment Letter for my Medicare B Premiums for jan, feb, and March since my canciled check, bill , and bank statement and letter from medicare saying what my cost for Medicare B will be in 2016 isn’t enough proof. My wait time is 1 hour and 15 minutes. This is like the fourth time I have tried to get through. Sad Situation!
Does anyone else find it strange that for years OPERS reimbursed Med B with NO monthly proof of payment, but now we have to jump through hoop to get a single reimbursement for our payments? And OneExchange insists we can’t use Recurring Reimbursement if we pay our Med B premium directly!
Good Luck with getting that receipt from Social Security, I have to pay mine by mail also, quarterly, January, February, and March.. I had to wait on line for Social Security to answer for 2 hours..I was told that they would try to send something out to me but they really had no such form as a proof of payment and told me what I had should be enough, I explained it wasn’t. It has been a couple weeks now and I still haven’t received anything from SS. I fgure they plan to wait until our next bill statement, where april, may, and june is due, and on that statement it shows what you paid already for Jan., Feb, and March. I complained to One Exchange and told them I had contacted SS and told them what SS said, they said they were sending my recurring claim which they first denied to their R & R dept for investigation. So many different answers, nobody knows what they are doing. My wife’s who pays her medicare B thru her SS check they excepted right away and denied mine because I pay by mail, due to the fact I get my medicare B thru my wife’s SS, I do not get an SS check, I worked for OPERS for nearly 30 years. Again I say thank you OPERS, thank YOU for such a mess.
Allen,
This is how OneExchange explained this situation to us:
Connector participants who have their Medicare Part B premium deducted from their Social Security check receive an award letter. It states the amount that is deducted on a monthly basis, and it serves as both proof of coverage and proof of payment; no further documentation is needed. These participants may use the recurring reimbursement form for their Medicare Part B premiums. They will need to resubmit a recurring reimbursement form on a yearly basis.
Connector participants who pay Medicare premiums on a monthly or quarterly basis need to provide proof of coverage and proof of payment, and submit both using a standard form from OneExchange. The reason is that the statement they receive from the Centers for Medicare & Medicaid Services does not indicate coverage for an entire year — only for the relevant month or quarter.
Several options are available for proof of payment for these participants. They include canceled checks, copies of bank statements showing payment of the named premium, credit card statements indicating payment of the named premium, or a statement from CMS showing they have provided payment for the months in which they are seeking reimbursement.
–Ohio PERS
Tom, my sentiments exactly! All this paperwork back and forth seems so unnecessary. Why in the world would we stop paying our Medicare Part B premiums and jeopardize our entire health care coverage? Is this a requirement of the HRA process or just something peculiar to OneExchange? There has to be a better and easier way!
And after all the time I waited, over two hours actually, they said they don’t send out proof of payments, they didn’t know what I would need that I didn’t already have, he made the comment that One Exchange must be new at setting this stuff up and not know what they are doing. His comment not mine, but I concur.
I was very surprised when One Exchange and OPERS said we can get a proof of payment letter from social security. The federal government is trying to reduce paperwork, not add to it. I didn’t think social security would be thrilled about sending out all these letters, and I am not surprised that they won’t provide one. I wonder what One Exchange and OPERS will accept as proof of payment. I surely hope they won’t refuse to reimburse for Medicare Part B premiums because we can’t get the letter they want from social security.
After making numerous calls to CMS and Social Security and getting the same answers from them that they do not provide such a paper for us, I was directed to my local Social Security office, where he gave me a statement that gives all my information, the amount of Medicare B I have to pay and the amount I was billed and the date my payment was received for January, February, and March. I have to pay quarterly and IF you have to pay quarterly then you CAN NOT file for recurring Medicare B (I got that from a One Exchange Supervisor) but you have to file quarterly as you pay on a regular reimbursement form. I called the local SS office to request what I needed and he mailed it out to me that day and I received it a few days later. The guy I spoke with at SS did tell me he did not know why people were being directed to social security. I just mailed it to One Exchange and I believe it should meet their requirements.
Interesting, the form for recurring premium is on the One Exchange website TODAY, January 29. It was NOT on the website yesterday. Yesterday, January 28, we used the form entitled “Reimbursement Form” and above that title, we wrote “Recurring” for our Medical Mutual monthly premium. Further we did attach the first statement of the Medical Mutual premium we received in December and paid in December. (1) Will that be acceptable? (2) Should we print the recurring premium form available today and resubmit the Medical Mutual premium reimbursement request? I cannot put myself through the frustration of trying to reach the person with whom we spoke yesterday in Reimbursements and Refunds this afternoon to confirm that they have received our 13 page FAX sent yesterday afternoon. We are thinking of also putting an entire copy of the material we FAXED yesterday into the postal service via either priority mail or express mail. But I worry this will only add to their, not my, confusion. (3) should we also put our already FAXED material into the USPS?
Madeline,
You’ll have to ask OneExchange if that form is acceptable to them.
If you fill out the request using the correct form, which is available on the OneExchange/OPERS website, that will work.
–Ohio PERS
This One Exchange thing is the worst thing I have ever had to deal with….I went back and forth between One Exchange & Humana for two weeks to get the paperwork I needed to send in a recurring reimbursement form…. I was advised at enrollment not to do automatic reimbursement because it takes longer. If they would have told me what I needed from Humana and Coventry I would have requested it long before January.. I have yet to receive the correct paperwork. I cant believe I didn’t receive a a welcome package (of sorts) with this information, Not so much as a notification that they would be debiting my account (some type of statement). Humana says they send it to One Exchange around the 10th of every month….WOW this is my account!!!! I cant figure out why I have to send them what they already have. So not only are we out the premiums we paid in January but close to $300.00 for out of pocket deductibles for generic & brand drugs. We just found out today I can no longer get my insulin because the wellness program has stopped and there is no generic insulin available any where, To get brand is around &180.00 per month. What are you doing to us? The extra $300.00 dollars that you put in our RMA account to offset some of these problems should have gone to our bank accounts not One Exchange…This is just the saddest thing ever for retirees.. Looking forward to the survey that we’re supposed to be receiving soon…not that it matters.
Exactly how I feel, so they send out a survey, they don’t care! Another waste of our time!
I pay my Medicare premium from my checking account by a monthly deduction. All I receive from Medicare is a monthly statement saying how much and when it will be deducted. I sent in a recurring reimbursement form with a copy of my Medicare January statement to OneExchange. I also requested recurring reimbursement for my vision and dental that is through OPERS. As documentation I sent the notification I received from OPERS stating what my retirement income will be and what deductions will be taken. According to OneExchange website they accepted the OPERS statement for 2016 dental and vision reimbursements, but only accepted the Medicare reimbursement for January and denied the rest of 2016. When I called yesterday I was told that if I resubmit the form along with the January statement AND my January bank statement showing that it was deducted that this would suffice for all of 2016. I faxed it this morning but I don’t believe it. If that were the case, why would they have accepted January’s? This is not something I should have to request every month. It is a monthly payment that is the same dollar amount. As someone who once worked in a comptroller’s office, OneExchages website bookkeeping is the screwiest I’ve every seen.
Judy,
Here is how OneExchange explained this situation to us:
Connector participants who have their Medicare Part B premium deducted from their Social Security check receive an award letter. It states the amount that is deducted on a monthly basis, and it serves as both proof of coverage and proof of payment; no further documentation is needed. These participants may use the recurring reimbursement form for their Medicare Part B premiums. They will need to resubmit a recurring reimbursement form on a yearly basis.
Connector participants who pay Medicare premiums on a monthly or quarterly basis need to provide proof of coverage and proof of payment, and submit both using a standard form from OneExchange. The reason is that the statement they receive from the Centers for Medicare & Medicaid Services does not indicate coverage for an entire year — only for the relevant month or quarter.
Several options are available for proof of payment for these participants. They include canceled checks, copies of bank statements showing payment of the named premium, credit card statements indicating payment of the named premium, or a statement from CMS showing they have provided payment for the months in which they are seeking reimbursement.
–Ohio PERS
As of today, as the OPERS retiree, I have received reimbursement for my medical supplement premium, prescription premium, dental and Medicare Part B premium amount. I submitted my husband’s Medicare Part B premium and dental premium with documentation by fax on January 4, 2016 at the same time I submitted mine. I’m sure documentation of payment for his medical and prescription premiums are at One Exchange waiting to be entered and paid. His data for reimbursement is nowhere in the One Exchange system. I called One Exchange in mid January and the rep said nothing was showing that his Medicare Part B or dental premiums had been sent to them. I faxed all the forms and documents pertaining to his claims again, but nothing is entered. I have noted other retirees blogging that their spouses payments have not been received. What is the specific problem and if known when will this be resolved?
I called One Exchange again today, 2-5-16. The funding representative said she still does not see my husband’s reimbursement form/documentation for Medicare Part B premium or the dental premium in their system. I faxed this on 1-4-16 and then again on 1-21-16. The rep told me to wait until next Wednesday, 2-10-16 and call back, as it might take up to 14 days for them to upload the faxed documents into the system. She also verified the fax number I used, which obviously was correct as they received my documents that were faxed as the same time my husband’s were faxed the first time. Is this problem of finding the faxed data still a programming issue that has been noted previously? I mentioned that I could mail the documents or refax, but the rep said this would only confuse the data entry personnel.
After submitting my last blog comment, I checked One Exchange website again. Finally, my husband’s data was entered (although they could not locate anything this morning when I called). Here’s hoping after all of the calls/delays, submissions of payments and reimbursements for all OPERS retirees will go more smoothly.
Ginny,
There was a delay in initial spousal premium reimbursements. But we can’t say for certain what is specifically happening in your case. We recommend checking again with OneExchange: 844-287-9945.
–Ohio PERS
We just move from one problem to another with OneExchange. First, they don’t have enough trained staff to get people enrolled, then in a lot of cases the enrollment process and systems were flawed, now the reimbursement has problems. It’s not like PERS and OneExchange didn’t know how many retirees would go through the process. Someone really dropped the ball on this, unfortunately it is the retirees that have to suffer.
is the Medical Mutual insurance premium for my special needs Medicare dependent eligible for automatic reimbursement or do I have to file a Recurring Premium Reimbursement Form?
My premium payment has been auto reimbursed but not his. One Exchange gave me 2 different answers…(no big surprise)
Thanks.
Trying to correct HRA accounting error. Have called OneExchange three times and given three different answers. I incorrectly submitted an ongoing monthly claim for my Medicare B premium ($104.90). I received one reimbursement payment for January. I realize my claim is too high by $31.81. I was instructed to submit a new claim for $73.10 which I did. I was also instructed to send a note explaining problem and a check for the $31.81 to Pay Flex in El Paso TX on 1/19/16. They cashed the check but have not corrected the accounting. WE need to be able to talk directly to them to address accounting issues. One Exchange can not fix the accounting problems. Please provide us with contact info direct to Pay Flex. Thank you
Don,
You still need to call OneExchange first, but you can ask the OneExchange representative to transfer you to a representative at PayFlex if OneExchange cannot answer your question.
–Ohio PERS
When you call One Exchange, you can choose option 3 to talk to funding, that is Pay Flex
If you are on automatic withdrawal of premiums and automatic reimbursement of premiums you may want to double check you withdrawal/deposits to make sure the figures are the same. I have been trying to help a friend whose figures do not match–reimbursed less than quoted/withdrawn amount and have not been able to get a straight answer from Towers Watson as to why the discrepancy–sent a e-mail to them and the reply not helpful and now I can not find the link I located to e-mail questions and concerns to them. Why is not a link to e-mail posted prominently on the Towers Watson or OPERS website?
Also– is anyone else frustrated with the small print on the EOP’s given this group may have trouble seeing such small print as a result of changes in eyesight that occurs as we get older? Hopefully the customer service will improve as we go forward.
Marilyn,
In some cases insurers provide discounts for a variety of situations, such as online payments, etc. We have heard that in some cases these discounts were not reimbursed the first month. It’s our understanding that the missing reimbursements will be applied toward future premiums.
–Ohio PERS
I submitted a comment regarding a $2.00 shortage in my January medical premium reimbursement. Apparently OPERS has withheld it from public view. My comments were pale in comparison to others I have read, regarding OneExchange.
R,
Your comment wasn’t withheld. We just didn’t have enough information to answer it until today.
–Ohio PERS
OneExchange has been a disaster in every way since my initial contact with them. I don’t feel the were at l
All prepared for OPERS retirees. Long waits to speak with someone, inaccurate answers and difficulty understanding some of the representatives. I spoke with someone from customer service today who was rude!
What I meant to say was not at all prepared for OPERS retirees.
It has been stated in this blog that vision and dental premiums deducted from OPERS pension can not be set up for recurring reimbursement. However both my wife who has a separate OPERS account and my account have been set up for the year by uploading the recurring claim form and the OPERS Benefit Change Notice showing the deductions from vision and dental.
My wife also has had her medicare premium set up for the year by uploading the recurring claim form, the monthly Notice of Medicare Premium Payment Due showing the deduction from the bank account, and the OPERS Benefit Change Notice showing partial reimbursement. My account however, has been denied twice uploading the same forms. I added a bank statement showing the medicare deductions on my third attempt on 1/23/2016 and am hoping for the best. Interestingly, my wife had a recurring reimbursement for the year set up for $19.01/month she didn’t even ask for.
M,
Thanks for the input. We understood that you could not set up recurring reimbursements for dental and vision coverage you bought through OPERS. It looks like your experience was different, however. We are looking into this issue.
–Ohio PERS
It’s probably a mistake, like them paying me by accident for Medicare B payments I make myself thru CMS quarterly. They paid me for the whole year, then took it back. Sure wish I felt One Exchange and Pay Flex were capable of making intelligent and correct decisions with our money. This far they have proven they can’t.
We faxed Medicare Premium statement proof and Recurring Premium Reimbursement Form January 14 to the Fax Number provided online. We kept checking online and did not see any transaction. After 2 weeks we called them to check on it. Representative told us we needed to submit the Recurring Form again. We did that 2 weeks ago and as it stands now we have 3 claims listed on their web site for the same Medicare Premium bill.
We called them on 2/1/2016 to ask about the same claim being listed 3 different times. The Rep on the phone could not tell us anything. So we are in limbo as what to do next.
We did find out this is not Towers Watson One Exchange handling this. It is a company called Pay Flex. There doesn’t seem to be any organization as they don’t even send an acknowledgment email to advise that they received your information and if they need any additional information before they can process.
This is the first time I have ever heard about Pay Flex. I attended several seminars and read everything that has been sent out. Why were we not told about this?
Judy,
Pay Flex is a third-party payment processor that OneExchange has hired. They were supposed to work behind the scenes to facilitate reimbursement.
–Ohio PERS
Pay Flex is definitely not behind the scenes, we are directed to their page when we need forms from our account, it says we are leaving One Exchange, also when we call customer service they send us to funding, even their customer service complaints aren’t handled by the same people. You never know who you are talking to or who you need to talk to! But Pay Flex is making mistakes and is no more knowledgeable than One Exchange! And our SS numbers, and bank statements, and account information seems to be going all over the place, which makes me question the security of all our information also.
Allen,
Thanks for the input.
–Ohio PERS
My suggestion and what I do now: Call One Exchange and ask to speak to a Supervisor, the customer service people who answer the phones do not know the answers!!!! Now you may have to wait first for a customer service rep, and then for a supervisor but at least there is a better chance that you MAY get someone to help you!
Tips for those retirees concerned about the HRA rules as they apply to vision or dental premium reimbursement. Stop complaining about the HRA rules. Complaining about the HRA rules will not change the rules. Stop calling One Exchange customer support and asking them what the rules are. Just because you get a customer support person to disagree with OPERS (Mr. Pramik), doesn’t mean that the rules have changed. Everyone, who comments on this site has a computer and internet service. Go to your OPERS account, find the HEALTH CARE PREMIUM RECEIPT and print it to a PDF file. Save the file where you can find it and under a name you will remember, like HEALTH CARE PREMIUM RECEIPT for January 2016. Next go to your One Exchange account and file an electronic HRA reimbursement claim. File the claim as a reoccurring premium reimbursement. Upload the PDF file as documentation. The worst that will happen is that you will only be approved for one month. I have heard of these requests being approved for monthly reimbursements. It will take up to 10 days for your claim to be processed. You can check often on the website to see if your claim has been approved (no waiting on the telephone). The first indication that your claim has been approved will be an alert on you Dashboard that a payment is scheduled.
the rules are very important to understand. payflex rules are not set in stone and seem to fluctuate with the clients situation. there should be somebody in the oneexchange/payflex to explain individual problems. apparently ed you have figured it out (good for you), but others are having problems.
I just got off the phone with social security. They do not have PROOF OF PAYMENT LETTERS. Please direct us as to what is needed for reimbursement for monthly medicare payments. Would the S.S. Benefit Amount form be sufficient?
Jean,
Connector participants who have their Medicare Part B premium deducted from their Social Security check receive an award letter. It states the amount that is deducted on a monthly basis, and it serves as both proof of coverage and proof of payment; no further documentation is needed. These participants may use the recurring reimbursement form for their Medicare Part B premiums. They will need to resubmit a recurring reimbursement form on a yearly basis.
Connector participants who pay Medicare premiums on a monthly or quarterly basis need to provide proof of coverage and proof of payment, and submit both using a standard form from OneExchange. The reason is that the statement they receive from the Centers for Medicare & Medicaid Services does not indicate coverage for an entire year — only for the relevant month or quarter.
Several options are available for proof of payment for these participants. They include canceled checks, copies of bank statements showing payment of the named premium, credit card statements indicating payment of the named premium, or a statement from CMS showing they have provided payment for the months in which they are seeking reimbursement.
–Ohio PERS
They accepted the SS benefit yearly form for my wife and she was set up with no problem, I pay my medicare b quarterly and after sending in recurring forms to them twice, they mistakenly reimbursed me for the whole year, so after sitting and calling back over and over this morning I finally got a supervisor Lucas who tell me this. Yes they made a mistake, I shouldn’t have been reimbursed at all, my bank statement and bill from medicare wasn’t good enough proof to prove I paid for January, February, and March. So I should wait until I get my next quarterly statement for April, May and June and that statement should state I paid for jan, feb, and march. He also told me that CMS payments that are paid by the individual and not taken out of SS (which I don’t get) CANNOT be set up for recurring and we have to submit a statement each quarter (3mos) or whenever we have proof we pay (which by the way, after calling medicare and SS, neither can send us anything). Like I was saying they paid me by accident for the entire year draining my account and so now I have a negative $1265 on my account, so I owe them and so the claims I sent in won’t be paid like for my vision because I have a zero balance and HE (the supervisor) explains that they go on something called a ROLLBACK and are paid as funds become available. However the next few months of monthly deposits I get from OPERS will be theirs until they get their money back where they messed up our account.
Allen,
It looks like they shouldn’t have reimbursed you for the whole year. But what is the downside to them giving you extra money now but not making the other reimbursements until the account is “caught up”?
–Ohio PERS
The “downside” Michael is that OneExchange is very likely to eventually catch their error and demand repayment! So my advice to Allen is to not spend that advance payment. Clearly various folks at both OneExchange and OPERS have different understandings of the reimbursement process.
This whole fiasco would be laughable were not so many good folks being unable to receive reimbursements from the funds in their accounts. Clearly OPERS was sold a “bill of goods” by OneExchange with respect to the company’s capabilities.
AMEN
That is what they originally told me, not to pay and let my account catch up but they changed their mind, sent me a bill requesting payment for the amount they sent me, so I sent them a check in fear , I guess. Then now I have claims coming thru not being reimbursed cause they haven’t applied that check yet to my account. When they do apply that check to my account then they will owe me, my fear is I will have to fight for it, and all their mistake. Such a headache!!!
Where do you get the award letter!!! the only letter available on the SSA website (VERIFICATION LETTER) was rejected by Oneexchange!!!!!!!!
Diane,
You can set up an account with Social Security and access it that way.
–Ohio PERS
Ohio Opers. No you cant set up account to get a letter from SS not only have i mentioned it several times but so has several people. I have set up an account with SS. The info isnt there. Have you tried it. Well try it! Ss says they are clueless i called their 800 number many times, getting NO WHERE! I also called CMS and finally they told me to call my local SS office. The guy made me up a form that i sent in and am praying it works this time. We arent stupid people. These problems we are having are REAL! Opers needs to get us some REAL answers!
Allen,
You can use your coupon from Social Security that shows what you’re paying, or your annual statement from Social Security as well.
–Ohio PERS
What OPERS has done to its retirees is totally outrageous. My elderly aunt is a victim of this travesty and its accompanying joke of letting an incompetent outfit like OneExchange manage her health care.
To her determent, she had to let a OneExchange representative choose her plan. WRONG! They did a very poor job.
So now she is locked into this plan for a year?
Why can she not change?
1. My aunt is 81 years old and insulin dependent diabetic. She put in over 30 years with the system.
2. My aunt can not afford internet and would not be able to understand it. There is no one close by to help her.
3. She does not own nor never will own a computer, copy machine or fax machine.
4. It’s a hardship for her to get to the doctor and grocery but she does it. Her prescriptions were delivered but now that is in jeopardy. She prides herself on still being independent however trips to copy centers and the extra expense and worry caused by this whole mess are out of the question.
5. She has been waiting three weeks for a reimbursement form but thank God I found this website and can now send her some.
6. Her plan says auto-reimbursement available. So how does that happen for her? I know. “Call OneExchange”, so she can be even more stressed waiting on the line for hours and still not get help.
Aunt Bee,
The instructions on how to apply for auto reimbursement were sent to all Connector participants after they signed up for coverage. They’re contained in a booklet called the Getting Reimbursed Guide on the OneExchange/OPERS website. You don’t have to call OneExchange to apply for auto reimbursement.
–Ohio PERS
Have the surveys been mailed? I have not received one. When can we expect them?
Marlene,
We conduct an annual survey regarding the open enrollment process that took place the previous year. We just got the results back from that, so that survey is over. Not all retirees receive the survey. It’s a random sampling of those who participate in our health care coverage.
–Ohio PERS
Will the results of the survey be made public?
Marlene,
Thanks for asking. We have published some of the results in the past, so it’s possible. But the survey is mostly about OPERS’ role in the open enrollment process of the previous year.
–Ohio PERS
Just called One Exchange Funding Dept. (Christy) about why I haven’t been reimbursed for my AARP RX Coverage which was set up at my initial enrollment call and when I go to my account at One Exchange on line it shows that it is set up for auto reimbursed. They cannot answer my question in funding and transferred me to customer service, saying maybe someone there turned it off, so they transfer me and I wait and wait and finally get customer service, I ask the guy (Tyler) who can’t seem to answer anything I ask, then when he sees I am getting upset, then he says our account is mixed up with someone elses, Anyone get that yet? So Mad here!!!! Then he after answering many more questions sometimes the same question many times to prove I am who I am, he tells me yes he sees that we are set up for reimbursement ,but has no idea why we haven’t been reimbursed but give it a couple months ????? Why would someone elses name pop up with our account number? I had ask Funding when I spoke to them this morning why my spouses recurring claim for medicare B premium had been paid for January and February but it doesn’t show that is set up for recurring, and mine was denied? They will send mine to R & R they call it, to investigate because when they look it looks like all the papers I mailed in are in order and what I should have sent. So Fed UP! I can’t tell you how much. When I was talking to customer service (Tyler) he doesn’t even know what I meant by a recurring form, so he looks up to see if Medicare B premiums are even reimbursable? What a joke this One Exchange is… Opers needing money for a nervous breakdown here!
The One Exchange seminar to review funding/reimbursement – worthless. It was more of an apology tour for poor customer service (believe us upper management knows and we are working on it) instead of an information packed agenda with useful information about eligible vs not eligible items under Section 213(D) of the Internal Revenue Code. Their call center wait times are too long; the consistent mantra of we are backlogged is tiring; their inability to tell you whether or not they even received your documents sent to them by standard US mail does not exist; where something is in the system either can not be told to you or does not exist; knowing that if you ask the same question of multiple representatives that you will get multiple/conflicting answers – frightening; their EOP statements give you an array of choices on why your reimbursement claim was denied (pick which one you want), tell you to refile; but, fail to tell you which part of your submitted documentation was rejected (you just have to guess because a follow-up call for clarification does not work because they do not know); their request for multiple filings of a single Durably of Attorney document because the representatives in Funding and Reimbursements apparently do not have access to an all exclusive screen somewhere in the bowels of One Exchange which houses the DPAs on it; and, they can not even figure out where a package of information, requested by them to be sent Overnight USPS at a cost of $22.95 by me and received and signed for by them at 11:45 A.M. 1/22/16, the very next day after their requested I send it – no record on their end of where it is (trail goes cold with the USPS delivery certification at the reception desk) and still no idea what happened to package within OneExchange/FlexPay – some 17 days later. Package contained documents and a personal check which they requested. It just disappeared. Gone, Gone With The Wind. No big deal to them. But, they keep sending the Overpayment Notification – you owe me money. And, this time the address for the check is different than where it was sent just 17 days ago (the address they gave to me). Your follow-up call to them after a lengthly explanation – cause you never talk to the same person twice – and the notes on our previous conversation are sketchy at best – is don’t worry just ignore the notification. It will work itself out. I believe it would have been easier to get an audience with the Pope than it has been to get a Supervisor within One Exchange to address this ongoing problem. One Exchange and PayFlex are individually and collectively a nightmare.
I filed for reimbursement of my eye and dental received through OPERS on a recurring reimbursement form. This was done before I read all the comments saying it couldn’t be done this way. I have been waiting for it to be denied so I could resubmit it monthly using the proof of payment form on my Opers page. Was very surprised when One Exchage approved it for the year. Sounds like Michael Pramik is given bad information just like the rest of us
I wonder if it just depends on who at OneExchange is processing the paperwork we send in. I did the same thing you did, Shirley, and it was approved. I know a couple of other people who did the same and were also approved for the year.
I would not get to excited. They approved and paid me for a year for Medicare B then ask for it back saying they made a mistake. The One Exchange/ Pay Flex workers need more training. Good Luck !
I know of another retiree that is getting her OPERS vison and dental payment reimbursed monthly using the recurring reimbursement form.
Lucky you. Mine was denied and I have to submit my OPERS dental and vision monthly.
How do we get our Health Care Premium Receipt from OPERS for February? It is not on my Documents list as of 2-9-16. I called OPERS, but got tired of being on “hold”. I can’t send a request to OneExchange without it. This whole thing is a nightmare!
Bruce,
You have to look under “requestable documents” and not under your document history. Click on “Health Care Premium Receipt,” and you can request premiums for specific months.
–Ohio PERS
I filed for premium reimbursement (on paper by snail mail) for January on 12/22/15 and received the funds on 1/5/2016. I set up automatic payment, premium reimbursement and Med B reimbursement beginning with the 2/1/16 premium payment. I have not received any reimbursement. I finally got through to Oneexchange. Apparently you get your reimbursement quickly if you file with paper and snail mail than if you have electronic payment and reimbursement. The reason told to me “The automatic reimbursement is done by a third party and there are more steps” (paraphrase). I have a hard time believing that that an electronic paperless process takes more time than paper. I hope that these deficiencies get considered by the OPERS Board when this contract gets evaluated or renewed.
I submitted my requests for reimbursement for 3 of our plans early in January by using the request for reimbursement form & marking it for monthly reoccurring payments along with scanning the invoice to a PDF file for each policy. Submitting the form & invoice went smoothly & within 10 days the reimbursement was deposited in my checking account. I could not manually submit the invoice for my husband’s medical plan as I did not receive an invoice as the payment is automatically deducted from the checking account. I requested an invoice, but never received it. In Feb. I once again received the reimbursement for all of our policy payment, altho the one is a month behind the others as it was for the Jan. payment. So other than waiting for reimbursement for Feb. for the one policy, I am up-to-date. Sounds as if I have had a better experience that a lot of other people, at least with the reimbursement for premiums. We have not used the medical insurance so hopefully the coverage will be adequate.
Faxed my wifes premium receipt from opers 2 weeks ago no action on it yet.Dont feel like calling one exchange again but may have to.Wonder what type of answer I WILL GET THIS TIME.
Read a lot of the printed comments . I have had many of the same issues with One Exchange. They were either poorly trained or not trained at all I have been given so many conflicting answers to my questions. I have spent 20 hrs on the phone with them 3 hrs again today They are a total disaster to deal with . Why did OPERS do this to its medicare population . None of you have had to deal with them I am out of patience with them. Their phones are also an issue Trouble understanding them as the calls are broken up . This has happened to me 3 times in past 3 weeks. One exchange has said they are having problems with the phones How long do we have to put up with this? Where did you get these people? If you had to deal with them you might understand all the frustrations you get to read from the retirees They are an injustice to all who have to deal with them Elizabeth Ogrady
I am having problems with diabetic needles and test strips, not to mention the very high cost of my insulin. When I was enrolling in OneExchange Drug plan, I was told OneExchange that what I was looking at may not be correct. The Tier levels had not been updated to OneExchange, oneexchange “excellent?” advisor was using Social security. I never understood what that meant. OPERS did a fine job of encouraging me to stay well and enjoy retirement by providing a VERY GOOD Health care plan. Wish I could of stayed with that one. Plus support.
Any case, my Pen needles and Test strips are another $150 for suppply more I have to spend, not to mention that I hit the doughnut hole in my first January drug order. I have called all social security, Humana, silver Scripts the pharmacist and any one I can think off. What is suggested to solve the diabetic coverage problem?
thanks
Allan,
We mentioned a few options in our recent video on prescription services. We also recommend talking with your physician.
–Ohio PERS
My Medicare payment is deducted from my social security. I submitted this to one exchange with the proof letter from ssa. The claim was denied. The reason for denial was that I needed to submit the annual ssa letter showing current Medicare premiums for 2016. SSA states there is no such letter. I have spent over six hours on the phone over the past two days getting nowhere!!!!
Diane,
Have you tried submitting a Benefit Verification Letter from Social Security?
Here is information from Social Security about what this letter is and how to get one:
Benefit Verification Letter
If you need proof that you are receiving Social Security benefits, Supplemental Security Income (SSI), and/or Medicare, or that you are not getting benefits, you can request a benefit verification letter online. This letter is sometimes called a “budget letter,” a “benefits letter,” a “proof of income letter,” or a “proof of award letter.”
What is a benefit verification letter? It is an official letter from Social Security that you can use as proof of your:
income when you apply for a loan or mortgage;
income for assisted housing or other state or local benefits;
current Medicare health insurance coverage;
retirement status;
disability; and/or
age.
You have to create an account with Social Security to access this letter. You can do so through this link.
-Ohio PERS
Michael, Could you please explain what “M” ‘s input was–as I reviewed all the blogs and was unable to connect any inquiries or imput info to your answer to “M” on 2/25/16.
thank you.
Jim,
It has been restored and now is contained in the comment section of the blog titled, “OPERS posts answers to HRA questions.”
–Ohio PERS
Michael,
You may want to look at the information IBM provided to its employees last November, since it appears OneExchange was something of a headache to “Big Blue” too:
http://ibmrac.com/One%20Exchange%20reimbursement.pdf
I found the instructions “instructive,” but not available on my account since my HRA will not begin until July. If you post this be certain to mention that the IBM link to the form has the Omaha mailing address, and from what I have read this has been superseded.
I can verify that OE was definitely a headache to many IBM retirees, although my husband’s experience was not as bad as many others. IBM switched all of the retirees over to OE in 2014, so by the time my husband signed up in 2015, some of the problems had been worked out.
I have to say that IBM was not nearly as helpful as OPERS in trying to help with any problems encountered. Once IBM transferred your information to OE, as far as your HRA being set up, you were basically on your own. I believe the information you posted above that you found on the OE website was actually posted by a retiree who has taken it upon himself to help anyone having problems with OE. He has become the “go between” with IBM and OE, only because he was persistent in solving these issues. It was all handled very poorly by IBM.
Mary
I sent a suggestion to OneExchange that they post what exactly (medicare, medical, pharmacy, dental, vision, etc.) the reimbursement or deny is for on their History of Reimbursement page. Just the dollar amount is confusing. My dental and pharmacy premiums are for exactly the same $ amount. Because of this my February reimbursement for my pharmacy, which should be automatic, was denied because they said it looked like it had already been reimbursed. Speaking as someone who once worked in a comptroller’s office, their bookkeeping system is incredibly confusing.
Couldn’t agree more!
As a follow-up, my March prescription automatic reimbursement was denied; as was February’s. I e-mailed OneExchange and was told it was the same problem as Feb. My dental and prescription amounts are the exact same dollar amounts. Told me they would take care of it this month but that I would once again have to call to try to straighten it out. Don’t know why I have to spend so much time straightening out their mistakes.
Not retired yet, but it sounds like OPERS has let down our retired folks. I feel truly sorry for our retirees who have to deal with OneExchange.
I sent a Benefit Verification Letter from my account on the Social Security website and the reimbursement was denied. As for a proof of payment letter from Medicare it is nearly impossible to contact somebody at Medicare that acknowledge that that can be done. I was told they don’t give proof of payment letters. In addition, if you pay for your Medicare by check, Medicare processes written checks electronically which means the check writer has no access to the cancelled check because there is no cancelled check. So I guess somebody at OPERS needs to talk with Payflex about what needs to be done and disseminate that information to members to eliminate the confusion.
Mike,
We are working with OneExchange to settle this issue. Look for a PERSpective blog on this topic once we have an answer.
–Ohio PERS
You would think that OneExchange and PlayFlex would have had experience with all of these scenarios since they have had clients in the past. Sometimes I feel like they have never done this before.
The information passed on about getting the benefit letter from SSA is totally inaccurate as well as the fact that you can get one online! SSA still says that there is no such letter. What are we to do now? The last conversation I had today with ONEEXCHANGE ended with them saying there is nothing more she could do! What kind of answer is that? OPERS retirees deserve better than what we are getting!
Diane,
We are aware that the information supplied to us by OneExchange about Social Security verification is inaccurate. We are working with OneExchange on a solution. Expect to see a blog on this subject when we do settle this issue.
–Ohio PERS
Has anyone out there gotten the. 2016 award letter. From SSA? If so what does it look like?
I finally got one from my local SS office. He made it up to show both proof of premium and proof of payment. Showed I was eligible for Medicare B and the date I became effective It also showed what my premium was for January, February and March and then it showed that they had received payment for January February and March. I sent it to them more than two weeks ago but have not heard one thing about it. There is no way that with all the information on there and with Social Security letterhead it could be wrong. So frustrated with One Exchange/Pay Flex. It was the third time I had tried submitting the form to them for Medicare B for me. The first time they denied, The second time they paid me for the whole year and then took it all back. Now this time I have heard nothing. In an attempt to get this last form from Social Security of a Proof or Payment, proof of premium, I made at least four calls to the 800 number for Social Security and three calls to CMS, all telling me there was no such thing that they could give me. Finally CMS told me to contact my local SS and maybe they could help me, and although the guy at my local SS office wasn’t sure what I needed he made the form up with all the information I needed on Social Security letterhead. Still waiting now after sending that form, that can’t possibly be wrong. Really frustrating.
And another thing I wanted to mention is that One Exchange DID set me up for recurring dental/vision for the year. ?? Whether it is right or wrong I don’t know ? I sent them a claim for January and I sent them a claim for February but when I seen on here that someone had sent in a recurring claim form for their dental/viosn and a copy of the early statement from Opers then I did the same and apparently it was accepted. But I did not have to send in any claim for for March, because of March 1st they automatically paid my Dental/vision back to me .
Allen,
Are your dental and vision insurance through OPERS?
Michael Pramik has said OPERS dental/vision CANNOT be considered a reccurring reimbursed medical expense.
Marlene,
That is true, for now, anyway. We are working toward possibly changing this in the future.
–Ohio PERS
Michael,
That would be a welcomed change!
Yes, my dental/vision is through Opers
Yes my vision/dental is through Opers. I sent them the annual letter from Opers showing the expense comes out monthly. Thus far mine is reimbursed on the first. My first one though for January I had to submit the letter from the Opers website .
One thing has become obvious to me: One Exchange and OPERS don’t have the same understanding of the HRA operation. Despite OPERS’s assertions that Med B and D paid directly to Social Security and the OPERS dental and vision payment deductions cannot be treated as recurring expenses, I have been reimbursed for three months of such expenses despite filing only for January. Perhaps I simply lucked into the right individual at One Exchange when I also filed a Recurring Reimbursement Request form, and I did manage to obtain a brief personal letter from a manager at Social Security stating my monthly premiums for 2016 to accompany the form, Based on my experience I encourage everyone to file the RR form. The worst that could happen is its rejected, but you may just save yourself the effort of multiple filings.
These inconsistencies on OPERS dental/vision reimbursement by One Exchange is frustrating…..some are lucky enough to have had their initial request for recurring reimbursement (RR) accepted. When I filled the RR form out last December, mine was rejected. I need to submit the request for OPERS dental/vision every single month! Such a hassle!
Marlene — we are exploring ways to adapt the dental and vision premium reimbursement process.
– Ohio PERS
For me, I did get the recurring Med B reimbursed on the recurring although I pay quarterly myself, but after they paid me and they paid me for the whole year, not month to month, they then ask for their money back, took awhile to get my account straight although it was their fault not mine. I now am back to submitting my Med B which I pay quarterly to them every three months. I did get a letter from SS stating how much I pay (proof of premium) but they don’t want to give me a proof of payment letter so I have to wait until my payment shows up on a checking account statement to get my money back, since my check is deposited by CMS electronically. You are right, it all depends on who at One Exchange gets ahold of your claim. So many untrained employees there. How does it make you all feel to think of them having all your private information like your SS #, checking account number, etc. What a mess it would be if we are ever the recipient of a credit theft. I don’t like it at all!
I called the SSA Benefit Coordination and Recovery Center (800/772-1213). They mailed me a form SSA-2458, Report of Confidential Social Security Benefit Information with Box 10 Other checked and stated, “Currently enrolled in Medicare Part B. Premium effective January 2016 is $121.80.”
I have not tried to send this is to payflex yet so I do not know if it will meet their requirements. I hope this helps. My Medicare is automatically deducted from my checking account so I do not even have a check image to submit.
I’d like to know if this form works to get recurring reimbursement. Please let us know.
It looks like the letter I got from my local SS office worked for the PayFlex for the quarterly Medicare B., stating when I became eligible, the amount due for Jan, Feb, and March , and the date my premium was received for Jan, Feb, and March on the SS letterhead. However I guess I will have to bother the guy at the local SS office every three months after I pay my premium to get this letter again. There has got to be a better way!!!
You may not need a letter every three months. I pay my Medicare monthly by automatic withdraw. I sent in my January “bill” with a reimbursement form and was reimbursed. I plan to just send these bills in every three months. That is what friends who pay theirs quarterly are doing.
That would be proof of premium but not proof of payment.
Yes. But when I sent in January’s without further proof it was reimbursed. I think they are making it up as they go along.
Couldn’t agree more
There are rarely “images” of checks that have cleared the bank because they now clear through ACH, (Automated Clearing House). So, if you write check to a person you will probably see an image. But, if you write a check your health insurance company, a government agency, etc., no image will appear in your bank statement.
I would like to know how people are getting statements/bills from Medicare. They stopped sending them to me several years ago. I just send them my payments every month.
They send me a bill (statement) every three months and I then send them the payment. They send the statement (bill) to me about two weeks before it is due and the payment covers the next three months. That statement shows how much is due and the time period it is due for, but that same statement also shows that they received your last payment and the time period that last payment was for. You ma be enrolled possibly in a paperless option, not sure, but maybe if you call Medicare and tell them you need a paper statement (bill) each time because you are using it for reimbursement then they could change you to the paper statements that are mailed to you.
Where does the money come from that is deposited in the HRA?
Linda,
It originates from the Health Care Fund, a separately invested pool of money from our retirement funds. You can read more about our funding in this blog.
–Ohio PERS
3/26/2016
Just got a letter from One Exchange basically saying:
1. they know they have problems and they are trying to fix them
2. they are going to charge administrative fees ( first I have heard of this)
3. the OPERS transition and use of this Medicare Connector was one of the largest of its kind
( were we not told by OPERS that their exhaustive search for a vendor to serve as our Connector
led to One Exchange who now seems to be saying this is bigger than they can handle?)
4. For more info and help, keep going to the same sources for help. ( How does that fix the
problems we are experiencing?
The accounting system used and shown on the One Exchange and Payflex sites is confusing and
hard to understand. Further we need to be able to talk directly to Payflex to fix accounting errors. Talking to OPERS and One Exchange only adds to the confusion and inability to correct errors.
Totly agree. First i heard of the fees too, notice how they drop it on us by ssying they won’t charge us for January, February, and March. How about April through December though? One thing though, you can talk to PayFlex. Just call the One Exchange number and when their recording comes on hit option 3 for funding. That is Payflex.
The administrative fee was revealed to us in one of the meetings later in last year.
Well some of us are disabled and unable to make meetings that were scheduled to far away from where we ive, I watched the videos and read everything that came in the mail. I seen nothing about the fees.
I retired in june 2014 ( Although I was young, I was eligible to retire) due to health reasons. I am about to be only 59 in August, when do I need to do the medicare part B stuff or any other stuff??? I just get my pension from the city of cleveland out of which my medical, dental and vision are deducted. I am unsure at what age I have to do what. Can you help me?
elaine
Elaine,
Medicare is for those 65 and older.
–Ohio PERS
My wife gets Medicare, she is disabled, she received ss disability for two years and then she qualified for Medicare, and they automatically signed her up for it. Contact the SS office to see if you qualify or when you would qualify. If you are not receiving SS disability then you may not qualify until age 65. I’m not sure though, i’d give them a call to find out.
P.S. my wife was in her 50’s when she started receiving Medicare
I agree with Gail. I have read the FAQ’s. My forms were sent in January. I have received little response to them. When I call the CS rep is very nice but has little information. They say my paperwork has to come from another area.I have sent request in for a rep to call me and it does not happen. If I could speak with someone who knows the process or what else I might need to send in would be very helpful. Thank You
JAL,
We have forwarded your comment to OneExchange, and they should be in contact with you.
–Ohio PERS
In watching the recent video posted on the PERSpective blog, it now appears that OPERS dental and vision can be set up for recurring reimbursement. I’m glad it appears they have worked that out.
Let me say that I am somewhat computer savvy and finding the Recurring Reimbursement form on the One Exchange website took a little digging. The video didn’t really explain how to find that form at the OneExchange site–flashing that screen for a second or two. Also, I have been unable to print out my healthcare receipt from the OPERS website. Perhaps this is because I have already submitted my healthcare receipt each month (Jan-May). I will have to resurrect a old receipt that I have saved to mail in.
I can only imagine those retirees that become lost/frustrated when trying to navigate the process. The videos are a great start….I just think they need to be a little more thorough on the process.
Marlene,
You’re right. That was a pretty quick edit of the line you need to click on to access the Recurring Claim form. If you go to the OneExchange/OPERS website, you will find it as the first link when you scroll down to HRA Information.
–Ohio PERS
I wonder if you have started any changes that will affect retirees in terms of the supposedly upcoming changes in healthcare…….I am one of the people who have never had any problems with One Exchange/OPERS except my medigap insurance premium reimbursement has taken MUCH longer the past three months……..and I need it……..thanks
Elaine,
Like you, we are watching closely what is happening in Washington on the health care front. No one is sure yet what changes will be made to the Affordable Care Act or when those changes will go into effect.
Julie, Ohio PERS
Is there a timeframe during which someone must submit documention for a specified year in order to receive HRA? In other words, can you submit all your documentation at the end of the year 2016 and what’s the timeframe for acceptance of the year 2016 going into the following year (2017)? In other words, will you still accept documentation re 2016 for HRA and for how long into the current year? Thx so much
Thank you for your question. There is not a timeframe for when one may submit expenses. For example, you can submit for reimbursement now for expenses incurred in 2016 as well as 2015. Keep in mind that you may only receive reimbursement for eligible expenses incurred under your plan coverage that was selected through OneExchange (if you did not have plan coverage selected through OneExchange in 2015 those expenses would not be eligible for reimbursement).
If you have further questions, please submit a question to OPERS through your secure online account, or give us a call at 1-800-222-7377.
Thanks,
OPERS