OPERS selects Medicare Connector administrator
The Ohio Public Employees Retirement System has selected Extend Health Inc., a Towers Watson company, to administer the OPERS Medicare Connector.
The Connector will use Towers Watson’s OneExchange to provide retirees with access to plans on the individual Medicare market, one of several changes we adopted to offer more health care plan choices at affordable prices. The Extend Health Medicare exchange, acquired by Towers Watson in 2012, is now known as OneExchange and is the nation’s largest and longest-standing private Medicare exchange.
The OPERS Medicare Connector administered by OneExchange will begin operations in January 2016. It will provide all services required to operate the Connector, including helping our retirees enroll in an individual Medicare plan and managing the Health Reimbursement Account. OneExchange has enrolled more than 800,000 retirees for more than 300 employers.
The Connector will provide services for retirees who qualify for Medicare Parts A and B. It will offer Medicare supplement plans, Medicare Advantage plans and Medicare Part D prescription drug plans.
Retirees will receive personalized help choosing medical and drug plans to supplement traditional Medicare that best suits their needs by working with a licensed advisor.
By transitioning to the Connector, OPERS is offering retirees increased flexibility, more choice and an opportunity to save money while keeping the same or improved level of health coverage. The individual Medicare market has more than 50 million enrollees, which makes individual Medicare plans more affordable than group Medicare plans such as the OPERS plan.
Here is how the Connector will work:
- Based on the retiree’s service credit and age at which he or she enrolled in health care coverage with OPERS, we will deposit a monthly allowance into the individual HRA. About 98 percent of retirees will receive $337 or more each month.
- With the assistance of a licensed benefit adviser from OneExchange, participants will select a Medicare Advantage plan, often bundled with a prescription drug plan, or a Medicare supplement (Medigap) plan. If necessary, they’ll also choose a prescription drug plan.
- Participants will pay for health care premiums and expenses up front and seek reimbursement from their HRAs. The reimbursement can be arranged to be electronic, which will reduce the amount of time for receipt of payment. Using the HRA model allows us to give retirees their allowance on a tax-free basis.
The OPERS Medicare Connector open enrollment will begin in October 2015 for plan year 2016. Next summer, OneExchange will launch the enrollment communication campaign to our retirees and will facilitate educational sessions about the Connector.
We are planning additional communication regarding the Connector during the upcoming months.
You can read a news release about the selection of the Connector administrator by clicking here. A video of the announcement, featuring OPERS Executive Director Karen Carraher and OPERS Health Care Director Marianne Steger, is on our YouTube channel.
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.
How are you going to guide those of us who live out of state.
Wilda,
First of all, everyone who will be a member of the Connector will work one-on-one with a representative of OneExchange, no matter where the member lives.
We also are planning a lot of communication through our website, blog, newsletters, email and other methods during the upcoming year-plus.
–Ohio PERS
Extend health inc does not start till jan. 16 of 2016 but our benefits will end on 12/31/15. How do we get insurance right away for the year 2016.
Patricia,
Coverage through the Connector will begin Jan. 1, 2016, not Jan. 16, 2016. There will be no lapse in coverage. When your OPERS group plan ends on Dec. 31, 2015, your individual plan will start the next day.
–Ohio PERS
Congratulations on choosing the connector after a lot of hard work and thought has gone into it! It sounds like a really nice arrangement. I’m anxiously awaiting to hear what’s in store for those of us who will not qualify. Thanks for not forgetting about us!
What about those who were hired before 1986 and also have medicare part A & B?
Thanks, Liz
Liz,
Look for a blog and a video about that subject early next week.
–Ohio PERS
We have been told, if the amount of our allowance permits, that we can be reimbursed for our Medicare premiums. How do we get reimbursed? Social Security is auto deposited.
Joy,
Participants will be reimbursed through their individual Health Reimbursement Accounts, into which we will deposit your allowance amount each month.
–Ohio PERS
If the allowance deposited by OPERs is less than the cost of coverage for Husband and Wife, will the balance come directly out of our retirement account or do we make arrangements for the balance to be deposited ourselves? How will that work?
Tom,
We will deposit the allowance amount into the retiree’s Health Reimbursement Account, which may be linked to the retiree’s financial account. The retiree will first pay the premiums then seek reimbursement. Obviously, if the amount paid in premiums is more than the allowance, you would receive the full allowance in reimbursement. It just might not be enough to cover all of what you had already paid in premiums.
–Ohio PERS
Living out of state, how will the on-one-one work? Will state meetings be recorded and available?
Frances,
The one-on-one meetings will be via telephone, so it doesn’t matter if you are not in Ohio.
–Ohio PERS
I don’t understand why we actually have to speak with a live person, pertaining to which plan we want, and to discuss personal information with them (i.e. specific medications that we are using). Every year, we make a choice as to which health plan we want during open enrollment (including dental and vision). Therefore, shouldn’t we be given the same option to choose a plan to our liking? For those individuals who may have difficulty navigating through the process, they should be given the option of speaking to someone. However, it should not be mandatory across the board, as it somehow assumes that we can’t make the right decision for ourselves.
Nate,
Federal guidelines for Medicare are very strict about face-to-face enrollments. They encourage telephonic enrollments so that the dialogue can be recorded.
–Ohio PERS
As stated above, If “The OPERS Medicare Connector administered by OneExchange will begin operations in January 2016”, how will it help us decide on a plan during the period of Oct – Dec 2015?
Larry,
You will decide on a plan during October-December of next year. The coverage that you select during that time period goes into effect in January 2016.
–Ohio PERS
Is this an extension of the usual open enrollment period?
Ed,
It’s the standard open enrollment period for Medicare.
–Ohio PERS
Again what is going to happen with people who don’t have A and B Medicare?
Deborah,
We are posting a blog soon on that topic.
–Ohio PERS
I only had 10 years and a few months service when I retired am I going to be kicked out of PERS since several places it says 20 years service is needed to qualify for health insurance. If so will the money I am paying now for health insurance be added to my monthly pension check and not deducted from my monthly pension check.
Helen,
The new requirements of 20 years of service time at age 60, or 30 years at any age, apply only to non-retirees.
–Ohio PERS
As I understand it, the (approx.) $337 should cover monthly Medicare payments first and whatever remains covers the supplemental health care (i.e. Humana) and Rx. Some of were vested for the 10 years, but retired at 65 without 30 years. How will the years of service be scaled and when will we learn what we will receive?
S. Stone,
We will be sending out individual statements in early 2015 that contain the allowance amounts.
–Ohio PERS
I retired from Ohio University 1998, 41 years of service receiving PERS. I have worked parttime since retirement and paid into social security. I recently applied for social security and now signed up for Medicare A along with the Medicare B when I retired from OU. I have Humana Medicare Advantage.
Do I needed to sign up for Medicare Precription D and/or the connector?
Dorothy,
Our OPERS group medical and pharmacy coverage, administered by Humana and Express Scripts, will terminate 12/31/15. Humana and Express Scripts do have plan options available through the Connector. However, the plan’s coverage will not be the same as our current group plan. Some options (Medigap Plan F as an example) will offer better coverage than our current group plan through Humana.
–Ohio PERS
Am I reading this right, Humana Advantage is out? Under the new explanation, it sounds like I have to pay total cost per visit out of pocket and then be reimbursed. Is that a correct assumption?
When does the selection process begin?
James,
Depending on where you live, Humana is likely to be an option. The selection process begins next October, and you will have full information well before that on which providers are available to you.
–Ohio PERS
how much time will there be from the time we pay our ins. premium until we receive reimbursement
Thomas,
We are working to make this transition as smooth as possible, but we do not have that exact information yet. It is more than a year before the reimbursement accounts go into effect.
–Ohio PERS
What is going to happen for those of us who were hired before 1986 (I believe that is the correct year) and we did not pay into Medicare? I was told not to worry that we were “grandfathered” in. ????? Hope they are correct.
Carolyn,
We will have a blog and a video about that topic soon. The goal is to make the Connector available to you and others who did not pay into Medicare.
–Ohio PERS
Do those of us who did not go with the Humana coverage (and chose to enroll in regular Medicare A&B and related drug coverage) still get an HRA to use for uncovered medical expenses?
Gina,
Retirees who have currently waived our OPERS health care coverage must select a Medicare medical plan through the Connector to receive an HRA allowance.
–Ohio PERS
Trying to read what OPERS is doing, you will need 10 Philadelphia Lawyers to try and make sense of this Pie in the Sky. If the costs of Heath Care is becoming too expensive, most of the Blame can be Attributed to Obama Care. Why didn’t the 5 Pensions get Together which will Result in Lower Rates since the amount of People in it will increase with the other 4 Pension Systems. The only reason this isn’t done is that it seems someone isn’t getting money under the table. I tried reading it and couldn’t make any sense of it.
Fred,
Let’s make it clear, then. By working with a Connector administrator, who is OneExchange, we can offer better, more affordable coverage to our retirees.
It might seem surprising, but participants will be able to get better pricing in the individual market than we can receive in sponsoring a group plan, even if we were joined by other pension systems. If you consider pricing for the entire Medicare population compared to OPERS’ Medicare population, it makes sense that the overall group has more volume and can get better rates.
–Ohio PERS
OPERS is by far the healthiest of the pension plans. We should not want to join with the other plans. Accusing our fund managers of corruption, without any facts, is irresponsible and unfair.
Can you explain in simple terms how an individual is going to get a better rate than 5 pension systems can get since there will be Thousands and Thousands of people and the health company will collect millions and millions in premiums whereas a single individual can only offer the health company only his monthly premium. This just doesn’t make sense,
Fred,
OPERS will be one of 300 employers that OneExchange works with. Three hundred employers can get better group rates than five can.
–Ohio PERS
I regestered with one exchange in July and they said OPERS was not on their site yet, what do I have to do to complete the registration
Mary Jo,
That site is working now.
–Ohio PERS
Will we have to pay monthly maintenance or per transaction fees for the HRA bank account??
Jim,
Yes. But these fees are minimal ($2-3 per month), and will be deducted from a retiree’s HRA allowance.
–Ohio PERS
When do I choose my plan? I am currently medicare A&B anddd live out of state. I don’t know how to sign up for m new plan.and don;t know if I must return to Ohio to do so. Please let me know. I want to make sure my coverage will continue.
Ken,
Participants will choose their plans beginning in October 2015 for plan year 2016.
–Ohio PERS
How will this affect my wife coverage she is on Medicare but gets her insurance through my plan
James,
Spouses can be covered through the Connector, but keep in mind that we are gradually eliminating spousal allowances beginning in 2016.
–Ohio PERS
I take it we cannot actually enroll then, until “open enrollment” in October 1, 2015 for January 2016.
But I guess we can make our selections during the summer 2015 and have them ready for October 1?
I guess my concern is that I see a long wait on the telephone come October 1, to take care of the enrollment in our new plan?
Any way that we can make our selections and give them to the connector ahead of time to avoid this. I am not Mother Teresa (-: and hate pushing robot buttons, waiting on hold, getting disconnected (-: then starting the process over again.
I guess if this is my biggest concern, you have done a great job and I thank you. JA
JA,
You can certainly do your own research before next October. And, both us and OneExchange will be communicating with participants well before then regarding some of the details.
–Ohio PERS
If the connector is only for employees who have Medicare Parts A & B, what happens to employees who were only or mostly State Employees only and so do not have the 40 credits of Social Security to get Medicare Part A? It sounds like they will not be eligible for the connector. If they are not eligible for the connector does that mean their insurance costs will be much higher than those who have Parts A&B? If so, how much is the projected difference? My husband and I were both state employees and so we each have our own insurance. He has minimal credits and will be 64 in January. Probably at this point could not physically (fairly severe degenerative disk disease from being an equipment operator) work long enough to get his 40 credits that we didn’t know we would need. I am 8 credits short of my 40. Is it worth it financially for him to push himself for those credits? Is it worth it financially for me to try to find a job and work another 2 years? Thank you for this information.
Barb,
Please read the PERSpective blog early next week. We will be posting a blog that will answer your question about those who do not qualify for premium-free Medicare Part A coverage.
–Ohio PERS
Is there any information yet of how the Connector will be handled for the retirees whom only had Public employment and do not qualify for both Medicare A and B?
Also, I retired with 30 yrs. of service (at the age of just shy of 48) and will be turning 65 next year. How is the HRA calculated and applied.
Bill,
We will be providing an answer to your first question next week in the PERSpective blog.
Retirees who qualify for the HRA will learn of their individual allowance amounts in early 2015.
–Ohio PERS
I worked as a Public Employee from July5,1986 to April 1 ,2001 going on OPERS DISABILTY DUE TO A RARE FORM OF CANCER….there are few experts in the field but I very lucky and blessed to find one at Ohio State and have been going to see this expert since Sept 2001 all these years with cancer in my liver .I was being treated medically wrong here in Cincinnati until I found the expert
She and Ohio State all out of network ..but thanks to medical plan [Humans Medicare Advantage ] I’ve stayed alive longer with my expert’s help
my question with so few years in as a public employee ,I’m one of the 2% who WON’T GET 337..00 INTO HRA??
I wish to continue seeing my expert at all costs even if I have to pay lots more ,lose my house etc
will I be able too continue seeing my Carcinoid Cancer Expert at the James Cancer Hospital at Ohio State ? I think under the Jan 1,2016 OPERS plan I will be considered at 20 years yes??
In any case thanks much to OPERS for all the medical coverage I’ve had !
Daniel,
Those are the types of questions that you need to go over with the licensed benefit adviser next year. We can say that you should learn what your monthly allowance will be sometime in early 2015 — we will be providing that information for each participant.
–Ohio PERS
What happens to those of us that worked entirely under OPERS and did not work under social security? I worked 41-1/2 years and only 3 years under social security , not long enough for Medicare A eligibility.
Geraldine,
We will have a blog on that topic very soon.
–Ohio PERS
Correct me if I am wrong but I understood these allotments would be enough or nearly enough to cover spouses. What about spouses? I retired thinking I could provide for her
Charles,
If the retiree has money left over in his or her account, spouses can be covered.
Please read our other blogs on the Connector, and check out opers.org, for more information.
–Ohio PERS
How will Spouses be treated , or will they be on their own ??
William,
Spouses are eligible to be covered by the Connector, but remember we will begin phasing out allowances for spouses beginning in 2016.
–Ohio PERS
I am a spouse my husband died in 1987 and he had opers and then I worked parttime will I be cut in 2016?
Eileen,
The allowance for spousal insurance is being reduced by one-third next year, then another third in each of the next two years.
–Ohio PERS
Would it work if I set up a special checking account to pay for the health care up front as you said I would be doing and then have my direct deposited reimbursement from you go into this account?
It would be at the same credit union as my OPERS retirement check goes, but would be a separate checking account for the medical payments only.
JA,
Yes, that would work.
–Ohio PERS
I must be really stupid! I thought that we would be reimbursed — hypothetically now — for a hypothetical $200 per month Medigap policy and a 100 per month hypothetical Part D drug policy. I envisioned paying up front for the Medigap and also for the Part D. I envisioned getting reimbursed $300 for these two combined……and out of this reimbursement, I further envisioned taking the $300 March reimbursement and paying for the $300 April coverage!! I envisioned not being out any money this way.
Now I have learned that the $300 reimbursement can only be used for health care coverage (not as I envisioned it, tho) or my doctor co-pays.
Not being ungrateful, here, but I see myself paying $3600 a year for my hypothetical coverage and of the $3600 that I will get reimbursed — only being able to use those funds for the few drugs I take and the few doctor visits I have to endure yearly.
I will be reimbursed….but I cant use the money except when I see the doctor.
JA,
It’s fairly simple. You pay the premium. You then are reimbursed for that premium. If money is left over, you can use it for qualifying medical expenses.
–Ohio PERS
After I submit receipts showing I have paid $200 for my January Medigap policy and $100 for my January Part D policy — the company will deposit $300 into my checking account at the credit union of my choice and I can spend that $300 on whatever I wish?
Right or wrong?
JA,
The allowance dollars will be deposited into an HRA account in the retiree’s name that both the retiree and spouse can use to reimburse themselves for plan premiums, Medicare B premiums, and other out-of-pocket health care costs.
–Ohio PERS
When do we sign up for appointment. I am assuming that it will be sometime after October, 2015. Also, my husband and I are both retirees and on medicare part A, B and D on Humana Advantage, will we be able to do out appointments together? Will this be in an office or our home?
Gail,
We will cover all of those types of details during the coming months. You’ve still got a full 12 months before the earliest time that you will work with a OneExchange adviser.
–Ohio PERS
If I am to understand your OPERS Medicare Connector Plan: 1. The participant will have monthly allowance into the individual HRA account each month. 2. The participant will have to pay “up front” for his/her Pemiums and Expenses, and then seek for reimbursement from his/her HRA account. Concerns: Participant to pay for Expenses “up front”: It would be Highly Impossible for me if Expense include paying ” up front” for office visits, lab work, ultrasounds, xrays, surgeries, outpatient surgeries, hospital expenses, etc. Please define/elaborate on Expenses that has to be paid “up front”
TK,
We are talking about paying the monthly premiums up front, then being reimbursed for those through a Health Reimbursement Account.
–Ohio PERS
Hello!
I just read that the company Tower Watson, now know as One Exchange, has had problems with the BBB since 2011, with 17 customer complaints in the past three years. The BBB said that six of the complains have closed within the last 12 months.
The problems with the company was with their products and services along with reimbursing the customer
Why was this company chosen? It looks like this company has changed its name a number times.
Rosalyn,
The company known as Extend Health has been operating these exchanges for quite some time. They were acquired by Towers Watson, which is now branding the service OneExchange.
–Ohio PERS
I worry about two things:
I will be carrying pre existing conditions to the new insurance coverage. Will they be accepted?
Will I be able to find a RX plan to go with the supplement that will cover expensive oral cancer drugs?
Jere,
As long as you select a plan during our open enrollment period in fall 2015, you cannot be denied coverage. That includes prescription drug plans.
–Ohio PERS
I am anxiously awaiting the one-one with a connector for my Husband next year
How will a licensed benefit advisor from OneExchange get in touch with me or them with me?
MaryAnn,
Next summer OneExchange will send information kits to eligible participants. Then, they’ll call the participants to schedule an enrollment appointment over the phone. Enrollment will take place during October, November and December. We will be providing much more information about this next year, but that’s basically how it will work.
–Ohio PERS
I assume that I will have to write 3 checks a month (for the medigap, for the prescription plan and for the dental plan) and then am I to submit payment receipts from all three? I assume there will be delays in my receipt of my reimbursement. Can you approximate the time?
Barbara,
We do not have that kind of detail yet on reimbursements from the Health Reimbursement Account. But they will be forthcoming as the Connector nears full implementation, which is not until January 2016.
–Ohio PERS
When I am selecting my plan next fall, my wife will only be 64 and not eligible for medicare. Will the adviser be able to assist us in determining a plan that is best for both of us or will she need to wait until April of 2016 (her 65th birthday) to contact the connector? And for that matter since I am the retiree and she is the spouse, will she even be able to use the connector?
Also have evaluations of anticipated traffic been done to ensure that adequate numbers of advisers are available to handle the many questions? I would sure hate for this to become another Affordable Care Act website fiasco.
Jim,
We addressed issues of usage during our negotiations with the Connector administrator. We are confident that OneExchange will provide great service to our retirees.
Regarding your other question, retirees have to be in the Medicare program in order to qualify for usage of the Connector. Spouses will have access to the Connector, but remember that beginning in 2016 we will begin to gradually reduce and then eliminate the spousal allowance.
–Ohio PERS
How does the payment process work? You indicate that we will pay upfront (to whom?) and then bill someone (?) for reimbursement. What I have read so far does not clarify the mechanics.
Rudolph,
There will be much more communication relating to the details of the Connector well before next fall, when retirees can begin selecting their plans. But briefly, each participant will have their premiums deposited by us into an individual Health Reimbursement Account. Participants will first pay their premiums and expenses, then seek reimbursement from the account.
–Ohio PERS
I do not understand why we cannot chose and why you will not reimburse us if we do.so?
I have in my town an excellent group who have access to hundreds and hundreds of
great Medical supplemental plans.
Carol,
Our requirement for retirees to receive an allowance is that they secure their coverage through the Connector. OneExchange will provide access to dozens of plans, and we do not want another broker steering retirees toward plans that might pay the highest commission. The benefit adviser you will work with is not paid by commission.
I am a spouse of a deseased member and will turn 98 yrs of age in Nov. 2014. Will I still receive the pension I do now? I have very limited funds to support myself. Will I be able to afford this? Very worrisome for me.
Martha,
Your pension will not change. We are talking about changes to our health care coverage. And that will not change for spouses in 2015. However, beginning in 2016, the spousal health care allowance will begin to be reduced until 2018, when there will be access to coverage but no allowance.
–Ohio PERS
We live in farm community and I go to fortwayne for medical care.Will we need to pay out of pocket each month? I would prefer to receive letter along with my E-mail. I will need assistance from some one in order to understand . I, go to Va to live3-4 months what about use of the connector.?
Joan,
Many of the details of your health care plan will depend on the company you select to provide coverage. A large majority of Medigap plans, for instance, do not have physician networks. So policy holders would be able to use any provider to takes Medicare.
–Ohio PERS
I will be 65 march next year do you sighn me up . or do you have to call me
Allen,
Next summer OneExchange will send information kits to eligible participants. Then, they’ll call the participants to schedule an enrollment appointment over the phone. Enrollment will take place during October, November and December. We will be providing much more information about this next year, but that’s basically how it will work.
–Ohio PERS
I’m disappointed and getting confused here. As a 30 year and out employee, I was always informed that PERS would provide medical insurance for my family as an employee and after retirement. That was a major factor for me, looking for the future.
I know times change and medical expenses have become a burden for all over the years, but this “Connector” thing appears to not have had any foresight of the overall picture. Many of the “life-long public servants” don’t qualify for Medicare A&B because our employment had an expressed “We will provide medical coverage upon and during your retirement”.
As an additional item, why are we covered as a PPO rather than a HMO?. PPO’s allows “balance billing” (anybody who contracts with a “in-service provider”, but not employed as an employee of the hospital/center can bill individually for everything above covered charges This should be addressed and corrected. (IF one goes to an in-network hospital and is forced to see Non-Hospital-Employed( “contract Dr.’s”), you have no choice in an emergency to say “Are you on my plan??”.
Please address these issues.
Bill,
Check the latest blog listing. We are trying to provide access to the Connector to those who do not qualify for cost-free Medicare Part A coverage.
–Ohio PERS
You didn’t answer Mr. Ken Harrington’s concern, if he would have to return to OH to sign up for insurance. I, too, live out of state. I thought we would be able to contact the Connector on-line or by telephone, and it hadn’t occurred to me that I might have to return to OH. Would you clarify that for Mr. Harrington, and me, and anyone else who doesn’t live in OH now? Thank you.
Helene,
Enrollment will take place by telephone during October, November and December.
–Ohio PERS
Will we have a choice of an in person meeting with the Connector or is it mandatory by phone, computer etc. In person would be so much better.
Carol,
The enrollment sessions with OneExchange representatives will be conducted by phone at a time that you will schedule with OneExchange.
–Ohio PERS
How do we get the one on one to help us decide whats best in this {looks like a real mess] health insurance I worked 31.5 years for the state of Ohio, no social security. Now what?
Doyle,
All participating retirees will have one-on-one enrollment sessions with OneExchange representatives. They will be conducted by phone at a time that you will schedule with OneExchange.
–Ohio PERS
Michael, best of luck on what promises to be a very busy year for you.
I have said this previously on the blog, but will elaborate today. It is not the content but the process I have trouble with, and I suspect this is true for a number of my colleagues. You are asking retirees, who find access to healthcare vital to their physical and financial health, to depend on a process I (and doubtless many others) find less and less trustworthy with each passing day – the telephone. Most of us grew up certain that the phone would work and we could fix problems using it with some immediacy. Over the last decade or so using the phone has become less likely to work and less likely to connect to a human. Land lines are gone – we have to have working batteries or a modem. We are put on hold by nearly everyone, including OPERS, and are told a wait time, sometimes minutes and sometimes hours. With luck, we eventually get an amorphous human, who has only a first name, and whom we cannot call back. For someone my age, this is extremely Orwellian and does not result in trust. I have already invested in a new phone system just in the hope I can contact OPERS next fall. To be dependent for healthcare sign-up on two or so phone calls feels like being sucked into a mudhole, with the rescuers saying they will throw the rope, but only twice. I can tell you today exactly what healthcare products I want, but am terrified no one will answer the phone. Please help me (all of us) with this.
Linda,
OneExchange will set up a one-one-one phone session appointment with our retirees. That appointment call will be initiated by you, and the adviser will talk to you at length about possible plan choices.
–Ohio PERS
Michael, I guess what I’m hoping for is some alternative means of connection with the Connector. It is scary to have the outcome completely dependent on making a phone call, even if it’s one I am to initiate. How about an Internet backup? Or even better, by mail? I don’t need a long conversation – I am already pretty sure what I’m going to want, and I have a year to do research.
Linda,
Our participating retirees will have to make their selections by phone.
–Ohio PERS
Being impaired of hearing phone conversation is very frustrating. Health Care is very important and must be well communicated at best in writing. I hope you can address my concern. Thank you.
Okay, so phone it is. I notice One Exchange has a website and you can set up an account. Would it be helpful to do this so we can explore what they may plan to offer or tell us? Would it be better to wait until January when they are officially part of the OPERS system? I have already explored their website without setting up an account and see the Humana Medigap I had intended to ask for is not one of their presently listed options.
Thanks, Linda
Linda,
We recommend waiting until 2016, as plans can change. There will be ample opportunity next year to select a plan or plans.
–Ohio PERS
OPERS said allowances will be deposited into a HRA beginning in January 2016. The retiree’s allowance will continue, while the spouse’s allowance will be phased out to zero by 2018. We will need to pay the premiums directly to the insurance company.
OPERS also said the retiree can sign up for automatic reimbursement through the Connector (to speed up the time lapse between payment & reimbursement). Will the spouse be allowed to sign up for automatic reimbursement? At least thru 2018? Please clarify.
And please clarify how any extra funds in the HRA will be released? (I will need those to help pay for my wife’s premiums.)
Robert,
Retirees and spouses will both be allowed to sign up for auto reimbursement because they are each selecting individual Medicare Plans. The allowance dollars will be deposited into an HRA account in the retiree’s name that both the retiree and spouse can use to reimburse themselves for plan premiums, Medicare B premiums, and other out-of-pocket health care costs.
And yes, participants need to first pay the premiums. The retiree will then need to complete an authorization form that will indicate which eligible dependents’ claims can be reimbursed from the HRA. Remember, the HRA is tied to the retiree’s bank account so the reimbursement will land in the retiree’s bank account.
–Ohio PERS
When you say that Extend Health ( an exchange) has operated for quite some time, how long in years do you mean? Then Extend Health was absorbed by Tower Watson which changed it’s name to Exchange One. It is my understanding that the word Exchange evolved as a result of the Affordable Care Act as a way each state would be able to register uninsured persons for the government health insurance program. Since the ACA has only been operational for two years through the states, I am wondering where this company got their experience for counseling us in selecting the appropriate Medicare supplement plan for each of the OPERS members
John,
OneExchange’s private Medicare exchange has been operating for 9 years.
–Ohio PERS
I retired with 30 yrs in OPERS and took a reduction in my monthly payment so my husband could continue insurance with OPERS, if I predeceased him. In 2016 you will begin to gradually reduce and then eliminate the spousal allowance. Will the reduction I took to allow him to continue insurance be reinstated?
Connie,
That will not change, but the pension benefit also will not change.
–Ohio PERS
My husband is covered for medical/drugs under my plan as my spouse. Will we also be able to get counselling for him for a new carrier?
Should we consider transitioning to a private plan now since my and his plan will be going up for 2015 or hang in there until Oct. of 2016? It seems so confusing and I don’t know where to start to research another group.
Sharon,
We can’t provide guidance for individual situations through the blog. You can give us a call at 800-222-7377.
–Ohio PERS
My wife and I are both Medicare A & B enrolled in the current PERS health plan for Medicare retirees. When we go on a connector plan and if the allowance is not great enough to cover the cost for both my wife and I, will the balance automatically be taken out of my monthly pension? My wife does not receive a PERS pension. She is on my plan. Thank you.
Tom,
Members would pay on their own for any coverage they choose that the Connector allowance does not cover. It would not be deducted from pensions.
–Ohio PERS
There will be thousands of calls in the enrollment months. What are you going to do about jammed phone lines and wait times in the hours rather than minutes. Can a retiree walk into the Columbus office and talk to a real human other than getting into the phone jam?
Robert,
The telephone enrollment session is set up by appointment. You won’t have to wait on hold.
–Ohio PERS
I hope to retire in May 2015. I am 68 yrs. of age and will have over 20 years of service when I retire. I already have Medicare Part A, for hospital only. When I retire, I understand that I will have to select my Medicare Part B/C within 8 months. I’m assuming I cannot continue to use my United Healthcare. So, I would have to set up a call with the Medicare Connector within that 8 months if I wish to have help selecting a Part B and C coverage, correct? This service would be less expensive for me than going through the private sector to select a Part B and C, correct? I don’t understand how it will work, if I choose a Part B/C provider through the Connector. Can you explain this more?
Mary,
These are the types of questions you’ll be able to ask the Connector next year for your coverage that will begin in 2016. They will help our retirees customize coverage and choose the options that are best for them. For questions about your coverage between May and December 2015, give us a call at 800-222-7377.
–Ohio PERS
–Ohio PERS
Thank you for the recent info/video pertaining to those retirees that do not qualify for the part A Medicare.
I, like many retirees, am concerned about the dropping of spousal coverage as proposed for 2018. This is a complete turn around from the” implied/understood” retirement package that was a basic of deciding to become a public employee. It was understood that PERS would provide coverage upon retirement for myself and my spouse. To me, and I assume many retirees, find this unacceptable as proposed.
Understanding that health care costs have gone up, retirees have seen reduced medical coverage over the past few years. The PPO coverage needs to be addressed and changed to a HMO. Last year’s insurance coverage wiped out my annual 3% pension (inflation) increase and leaves me in a poverty level, where I could stay up with inflation at a minimal.
What is this “Connector” going to do for us older retirees?
Should we start looking into the Affordable Care Act (“Obamacare”) to see if we can get better coverage? Maybe I’m just an” Old Guy” whom was sucked into the PERS promises, but I am concerned about the medical coverage that you now present. We gave our years of service with the idea that upon retirement, we would maintain medical coverage for ourselves and spouses.
How do you expect the retirees to pay upfront for medical charges that will be reimbursed within an un-given time frame? This HRA (?) plan is not acceptable. We should be able to see our MD’s as needed and not have to pay out-of-pocket upfront with no guidelines of our coverage at any time. In 2018, spouses will have ZERO coverage and that’s not what we assumed upon employment.
Many retirees live on their monthly retirement and are not able to procure other other income. What do you want us to do? Our “stated/implied, understood” benefits have been taken away and need to be addressed. Even though you state that there is /was no guarantee to provide medical coverage to the retirees and spouses, it was directly implied and PERS has been doing so for years. This is not fair to the retirees without additional compensation.
In summary, I see the need to curtail the cost of medical insurance, but why are you “sticking” it to the retirees that gave their lives for the public sector? Our retirement payments were earned over the years and the aspect of medical care was a main point of staying in government employment. The future retirees have had many changes to their retirement plan, but those retirees that are still with us should not be penalized for those future retirees.
I trust that you will support the existing retirees and take a look at what you are proposing. This is not a fair assessment for medical coverage of the past valued employees and the assumed/implied factor that all would be insured during retirement.
Bill,
Thanks for your commentary. We understand that many of our retirees have chosen health coverage for spouses, but the truth is that that coverage is not mandatory according to Ohio law. Whatever is stated, the only rules that govern our operations are those spelled out in Ohio Revised Code Section 145.
–Ohio PERS
Please stop using “Plan F’ as an example of how it is better than the current Humana plan and offers the best coverage overall. I’m under 65 and on disability. I can’t get a Medicare supplement policy F or any other supplement in Ohio. That is also true in 25 states. People under 65 on Medicare will be forced to choose a Medicare Advantage Plan. Less coverage for money because of age and disability (which caused less years of service so a lesser subsidy) sounds discriminatory to me.
Will Aultcare be offered as a Medical plan for my wife &/or myself? Also, Humana/ Medical Mutual,
AARP? Has One Exchange contacted Doctors, Pharmacies, Labs/ Specialists to provide services
to retirees>
Art,
It’s too soon to determine which regional carriers will be offered as part of OneExchange’s roster. As we draw closer to fall 2015, we should know more about which ones will be and what outreach, if any, will be made to providers.
–Ohio PERS
Why isn’t OPERS using OSHIIP, rather than a broker, to assist retirees in choosing a plan? OSHIIP is free to consumers, unbiased, and has been assisting with Medicare plan selection for years. They can provide telephone or face-to-face assistance.
Joan,
The Ohio Senior Health Insurance Information Program, or OSHIIP, is a fine resource on Medicare. It’s administered by the Ohio Department of Insurance and is funded by a federal grant and by the state of Ohio. But it is not a Medicare exchange. Still, our members can call OSHIIP with questions at 800-686-1526.
–Ohio PERS
Thanks for your reply regarding OSHIIP. How is a Medicare exchange different than using OSHIIP for assistance to compare and choose a Medicare supplemental plan and part D plan or Medicare Advantage plan?
Joan,
Think of OSHIIP as a consultant who can give you information only. The Connector will help direct you to make a choice.
–Ohio PERS
I received a RMA statement from OPERS administered by Aetna. Is this the account we are going to be reimbursed from for our supplemental health insurance payment deducted from our pension monthly? We are now going to get a direct deposit payment for submitting a claim starting in November for this account. Now if this is not the account and there will be some direct deposit of our health insurance payment reimbursement, are we going to be put through the inconvenience of having to submit a paper claim every month to get our money back? And are we going to be able to use the same direct deposit bank as we use for our pension check without filling out a new form?
Robert,
Currently, retirees receive wellness incentives for participating in various wellness activities. However, our Medicare retirees will no longer receive wellness incentives effective Jan. 1, 2015. Those financial incentives are deposited into a Retiree Medical Account (RMA). Retirees are able to use those funds for other out-of-pocket medical expenses, but the retiree does need to incur the expense first, and then seek reimbursement.
Once the OPERS Medicare Connector is in place, retirees will need to pay their eligible expenses (copays, premiums, Part B premiums, etc.), and then seek reimbursement. The retiree will have different options to receive their reimbursement depending on the type of expense — premiums can be auto-reimbursed (money would be automatically deposited into the checking/saving account) whereas a “one-off” expense (copay) would need to be submitted electronically or via paperwork.
We are still exploring how any remaining balances in the retiree’s RMA could be rolled over to the HRA.
–Ohio PERS
While I am at it, is there going to be some record of the phone call and the decision I make for my supplemental insurance choice. If there is a problem, what record will I have to refer to? I am very sure of what choice I plan to make and this call should not take long. I would just like something in toe form of a confirmation.
Robert,
Yes, the conversation will be recorded for our members’ benefit.
–Ohio PERS
Please explain the monthly maintenance fee connected to the RMA accounts.
Thank You
Sharon,
The monthly fees will be $2 or $3 and will be deducted from retirees’ HRA balance.
–Ohio PERS
Your press release states “The OPERS Medicare Connector administered by OneExchange will begin operations in January 2016.” This sounds fine to me (the retiree), because I will become Medicare-eligible upon reaching age 65 in August 2016, and the Connector will be timely to guide me through the options. However, my spouse is already Medicare eligible in January 2015, and I presume we will have to choose between options (Medigaps or Advantage plans) BEFORE January 1, 2016 (in all past years the date to communicate our health care plan choices is October 31). How is that supposed to work if the OPERS Medicare Connector “will begin operations in January 2016” ???
Daniel,
Eligible Connector participants will work with a personal adviser to choose a plan from October through December 2015.
–Ohio PERS
If not retired and have 14 years of service, are we eligible for the connector if we are still working
Denise,
The Connector is available only to retirees enrolled in Medicare Parts A and B.
–Ohio PERS
Will a spouse of an OPERS retiree have to undergo medical underwriting when we change to the Medicare Connector in 2016?
Fran,
We answered that question in our recent Health Care video. Please click on this link to watch it.
–Ohio PERS
What are the licensing requirements for a licensed benefit adviser?
George,
Benefit advisors are licensed to sell health insurance and life insurance in their resident state, as well as any other states for which they perform enrollments. They complete all carrier certifications in the states where they are licensed and are appointed with every carrier that OneExchange offers in those states.
–Ohio PERS
Will retiree’s have the option of choosing a Part D plan on the exchange and a Medicare supplement plan off exchange? Will they be able to use their HRA for both coverages?
Josh,
Participants in the Connector must use the Connector in order to receive their allowance.
–Ohio PERS
My Dad is a surviving spouse, my deceased mother was the retiree. What is to become of his benefits?
My parents specifically chose the retirement plan that reduced her monthly payment but gave the surviving spouse healthcare benefits.
Melinda,
Your dad’s pension benefit will not change. Regarding health care coverage, spousal coverage for health care is changing. Beginning in 2016, the monthly allowance will be reduced by a third. In 2017, the allowance will be reduced by another third. In 2018 the allowance will be zero, although spouses are permitted to elect coverage in 2018 and 2019 if they pay the full premium.
–Ohio PERS
Thanks for a great program. I worked mostly on SS my time and was not aware of the Windfall Act. I was devastated when I lost 66 % of my SS I had planned on. This sure helps take the sting out of it. I would have had to buy my own Medigap Policy if I had retired under SS. This is one great program and all employees should be grateful. i had 25 under SS and 15 with Opers.
My mother is the spouse of a deceased retiree, I was wondering what is the full premium cost–she has Humana Advantage?
Cheryl,
That information will be sent to your mother in the 2016 open enrollment kit, due out in early September.
–Ohio PERS
This is the most confusing information I have ever received. The material tells you to complete your personal information online at your website (www.medicareoneechange.com/opers) but that site does not provide that option. The site reads only for retirees and mentions nothing about retiree spouses who are eligible for medicare. The material and site do not work hand in hand. I’m not impressed. My work history was with insurance benefits for a major private manufacturer, and if I’m confused, I feel very sorry for those who must be trying to determine how this is all going to work. I have been to one meeting, which was useless and plan to attend another in August with hopes that things will be clearer by then and some help will be available.
The longer this goes on, the more complicated it gets. I hope I am wrong, but it is looking more like the Obama Care rollout.
If you look on Utube OPERS has the complete series of releases for the new Healthcare, Look under OPERS Healthcare
I agree, this is the most confusing thing that I have addressed. We retirees were “promised” life health coverage insurance as a part of our employment for ourselves and our families… maybe not written as “law”, but it was presented and understood as a retirement benefit to retire from public service. I have used this as a basis to retire from OPERS. Now you are taking away spousal coverage and changing the rules.
Bill,
You’re correct that health care is not written in Ohio law, and that is the only set of rules we must follow. As we’ve stated, we provide health care as discretionary coverage.
–Ohio PERS
What is fair is fair. I just got off the phone with a representative of One Exchange and things could not have gone smother they have all the OPERS information about you and they will have questions to ask concerning the establisment of your appointment so you should be prepared.
Have a list of your meds and the dosage as well as your Medicare Card handy. They need information from that card.
They need to verify some things with you after that but nothing you cannot answer.
My representative was Jason and he was knowledgeable and helpful. He was from the call center in Utah.
I have my appointment and the registered councilor who you talk to during you appointment will have all the information that you provided on the first call.
If the rest of this goes as well things won’t seem as formidable. I am really encouraged.
Just remember to have the information ready before you make the call and hopefully it will go as smooth as mind did.
Robert,
Thanks for your comment. We have high expectations for the Connector, and we believe your experience will be the norm.
–Ohio PERS
I have been trying to get on the website since it went live and get nothing but a blank screen.i wanted to check out the website before the 13th and got through then with the message to go live on the 13th but nothing since what could the problem be? thank you
Edward,
We have tested it, and the website seems to be working fine.
–Ohio PERS
Mr. Pramik thank you for your reply but I may not asked the right question..after you type in the web sight info google gives several options if you could just direct me to the right web sight I would be grateful…do I click on the log in ..one exchange or is it another ? thank you in advance..i just don’t want to get on the wrong site..
Edward,
Click on this link to go to the OneExchange OPERS portal.
–Ohio PERS
thank you for your reply.. you are appriciated
Who did this for the retirees before? I was quite happy with their abilities and support.
John,
The Connector replaces an OPERS-sponsored group plan.
–Ohio PERS
Thanks for your reply. Could you tell me why this was done?
Thanks,
John
John,
There is a wealth of information on our website about the Connector, which we’ve been talking about for more than two years. Click here for the basics.
–Ohio PERS
Where can I find this HRA formula that appears to be based on age when you first started retirement and years of service? I retired at the age of 47 with 30 yrs. of service. Does this mean that I only get 77%? Or does the full 30 yrs of service count as 100%?
Bill,
About 98 percent of current retirees will transition to a 75 percent allowance level, which is about $337 per month.
–Ohio PERS
This whole change is quite confusing. I know that this “Connector” doesn’t come into play until 1/1/16, but I am at a lost. I go into Medicare at the 1st of September and have been assigned to Humana Medicare Advantage for the next 4 months with no option of coverage, then I have to re-do everything and get on the connector. I live in Florida and we have no “in network” information in my zip code, however after talking to OPERS and Humana, they say to just select a doctor and ask if they bill by Medicare assignment. If it’s a “yes”, then I’m covered.
Is this Connector going to cover us in Florida? I am concerned because the Medicare rates down here appear to be much higher than in Ohio. I don’t believe that the reimbursement account took in consideration out-of-town retires and should be addressed, let alone the costs associated with non-network providers. Yes , I understand that I will have no idea of my future coverage, but as a retire of OPERS, you need to address the costs of “Out-of-State retire’s” coverage.
Bill,
Yes, the Connector will cover residents of all states, but you are right in that rates can vary by state.
–Ohio PERS
Thanks for the response, but I am wondering if any consideration was given for our additional costs to those whom have moved out of state. I plan on joining the Medigap plan F plus part D, but need some options of out-of state coverage. My main concern is that I can have reasonable coverage in and out-of-state. You need to post the proposed Connector costs and a list of providers so we can compare it to Medicare on the private market. The HRA is an incentive, but really something that should be awarded to any retiree no matter where they purchase their Medicare. We really don’t have an option to prepare for the future.
I just completed a time and date for the sign up, but I cannot seem to get any definite answer as to costs of each option. so I can compare with outside companies, also My wife was no where to be found , so there was a new page added for her, it took a special link for spouses….
I can’t find the location where I can record my personal profile. According to my info this page is supposed to be here…………where is it? Please advise as I would like to get started on this now.
Thank you.
Virginia,
Click on this link. Then click on the “Start your personal profile” link in the top-right corner of the page.
–Ohio PERS
If a retired OPERS Employee goes back to work part time, with no insurance available through the employer. will they still be eligible for insurance coverage with the new plan?
Susan,
Yes. The general rule is that if the employer offers coverage, you have to take it. If none is offered, then use one of our coverage types.
–Ohio PERS
My Mom is the spouse of the deceased retiree. She has numerous concerns regarding her health care coverage as do myself and my sister who are both nurses. Our biggest concern and question is why this is all being done via phone? My Mom, like most seniors, is hearing impaired. She wears hearing aids but has major difficulty hearing on the phone and expecting her to listen to her options when it could have and should have been provided in print would have been the best option. She does not have TTDY. Even with one of us listening on the phone with her would be most confusing and stressful for all parties involved. Also, with this being done over the phone, what safeguards are in place for human error? In other words, if my Mom chooses a certain plan, how is she to know that the plan she chose is actually the plan the operator from OneExchange chose for her as well?
Also, are we to understand that her health care coverage will no longer be a choice as of 2018 since she is the spouse of a deceased retiree?
I also have a concern because of a magnet you provided in one of you packets regarding Avoiding Medicare Fraud and Identity Theft. One of the first things it mentions is to not give your Medicare, Medicaid, or SS# to anyone who calls you. Well, in this day and age where so many companies and even our government is getting hacked into, how do we know that the phone numbers and information won’t be hacked and the person calling may not be who you think it is? What are the safeguards for such an event?
I think that so much money was spent in mailing pamphlets and stickers, folders, crossword puzzles and magnets and the money could have been spent by sending the information for the choices for people to read and consider in their own time and not by feeling pressured to make a decision on the phone and especially a decision you are not sure about because you can’t hear!!!
Sincerely,
A Concerned daughter
Becky,
Medicare rules require us to conduct this registration over the phone for the exact reason you cited — so a recording can be made which will reduce human error. Your mother will initiate the call to OneExchange. That way you will know it’s actually OneExchange — they will not call you to conduct the enrollment call.
The call can take as long as you want, and you don’t have to select coverage on the first call. Also, you can research 2016 Medicare plans via the OneExchange OPERS portal.
Spouses will still be able to access coverage through the Connector in 2018, but OPERS will not provide an allowance at that time.
–Ohio PERS
We are lost on what to do to get from point A to point B on this! First need to choose to stay or change coverage by Oct. 31, 2015. I am on Medicare Part B only with Express Script, no eligible for part A. Myself and wife ineligible for Social Security and both of us are disabled. I am over 65 and she is under 65. Now the Interim is to expensive for me and her coverage has doubled! We can’t afford either one now….how will I ever pay for part A upfront, before reimbursement? Does the Connector help find insurance coverage for my wife? Does the Connector know a way to stay with the Connector for me and still be able to pay for my coverage? Can we both keep our vision and dental plans as long as we want…years? We miss out on public assistance by $89.00 a month. We don’t qualify for any assistance and we are medically in debt for life because of our disabilities….help us or give us a direction to follow for this assistance. Thank you! October 31, 2015 will be here for our decisions so fast!
Gabriel,
Members who did not qualify for premium-free Medicare Part A coverage will become eligible to join the OPERS Medicare Connector next year, not this year. For these members, we will continue to provide our group Medicare plan through June 2016. You will need to enroll in Medicare Part A from January through March of next year and after that choose a plan through the Connector.
Also, we will continue to offer dental and vision plans. If you have any questions, contact us at 800-222-7377.
–Ohio PERS
8Oct.15…Called one exchange for Sandys phone sighup/ins.enroll…11am….its now 1:30…still on hold…have been disconnected 3 times…talked with 6 different “agents, 2 supervisors…still cant get signed up…now on way to 3rd supervisor…they all want to go back to start because intial agent did not load info of selection into computer cart for transfer….what a zoo …now on hold again….they have no clue ….we feel so much better about our benefit security right now
I want to receive a listing of all health options for OPERS retirees. Health and scripts. Please email Thank you.
Christine,
Please refer to your open enrollment guide, or give us a call at 800-222-7377.
–Ohio PERS
I thought there was a way that all medical and drug costs would be paid automatically by the Connector; am I wrong?
Also, I am VERY confused about HRA and where I can ask it to be automatically deposited – I get SS benefits in my checking account every month but also use checking to pay other household bills, etc. My bank no longer acts as a “trustee” for HRA’s. Do I need to set up a checking account at another bank only for HRA deposits? Please advise. Thank you. Jackie
Jackie,
You can set up automatic payments for recurring expenses such as premiums. OneExchange should have your bank information if you are receiving direct deposit of your pensions. Once you choose a plan, you will receive a “Getting Reimbursed Guide” that details exactly how the HRA process works.
–Ohio PERS
I am a visually impaired widow of a deceased retiree.
I am very upset that the only way to compare the
Health care plans is go to the One Exchange website,
Which, according to the site, is not disability accessible.
The site says the disabled can only call an advisor
And you are dependent on trusting what they select
Which is discrimination against my having access to this information.
On behalf of my fellow retirees we had to file a complaint with the Better Business Bureau because OneExchange cannot handle the volume of calls. We need more contact personnel and hours of service in order to meet the mandated timelines.
I don’t see why many seem to be having problems. We’ve all have been aware of the change for over a year. I pre-scheduled an appointment when enrollment opened and made my contact as scheduled. I must be a lucky one… 1 call… 1 contact…DONE!
Seems to me that many have waited and are now in the rush and overloading the system. Maybe following OPERS directions would have eliminated your problems.
Both myself and my sister are nurses but my sister is much more knowledgeable regarding insurances so she scheduled the call for our Mom who is the spouse of deceased employee of PERS. she scheduled the call and the person with whom she spoke with not only gave her wrong information numerous times, but as they were nearing the end of the call, my sister was cut off. She eventually was able to callback and get things straightened out but it was very time consuming and difficult. Our Momi is hearing impaired and this system just does not meet the needs of those with disabilities. I don’t care what the State requires and what you are doing because it is at the very minimum. It is not Face to Face and the entire process is absurd.
I also took care of mine when enrollment opened but it took the people that I dealt with a great deal of time to match a new insurance plan with the one that I had and was happy with. I spent over 8 hours all together with the connectors. They were extremely polite and patient — I don’t know how they could do that 8 hours a day – it seemed very stressful on both ends.
Mine took about 2 hrs., but was satisfied. Living in Florida, the costs are much higher for “Florida Blue”, but talking to the rep, I found Walmart drug coverage for about $18/month. I only take schedule 1 and 2 meds, but also need to use “epiPens” for wasp/bee stings and to get coverage for the epiPens, the drug coverage would have skyrocketed to $140/mo. With my coverages, it will be much cheaper for me to go to a walk in clinic to get treated.
Even though the HRA will cover my costs, OPERS dumped on the retirees dropping spousal coverage. I don’t see how they can break an understood medical coverage retirement benefit that has been promised and provided for 45+ yrs. They state that a new “CadillacTax” is the reason, but have said nothing about what will happen if the Tax is repealed.
All I know now is that within the next 2 yrs., my net retirement will be reduced about 30% because they dropped spousal coverage.
Bill,
OPERS has never said that we changed spousal coverage because of the Cadillac tax. We changed spousal coverage in order to preserve meaningful health care coverage for members who contribute to our system. Also, health care coverage is not a statutorily defined benefit of OPERS membership.
We also have said, and you might have just missed it, that we will take any changes to the proposed Cadillac tax into consideration when we set premium rates and out-of-pocket expenses for 2017.
–Ohio PERS
I thought that this program was very poorly planned and would never be able to accommodate all of the retirees. Many older people do not use of enjoy using the computer to educated themselves and the amount of written material mailed to each of us was ridiculous. The money spent on that alone could probably have provided jobs for state employees to provide us with personal sevice as we’ve had in the past.
Privatizing jobs is certainly not the answer to economic problems. Having good directors, supervisors, and employees is what is needed. Believe me, people are available and willing. I enjoyed my state job and worked very hard. It was the lack of good supervision that was the problem. Having directors who know nothing of the are to which they are being appointed by the governor is a primary problem. Persons most qualified to perform the duties required should be the the prerequisite, not political appointees who know the “right” people.
We are having trouble finding out how to get our refund back from silver script they dont tell one exchange that they received our payment. What do we do?
Herbert,
Likely submit a claim to OneExchange. The forms are on the OneExchange/OPERS website.
–Ohio PERS
The response given to the question about getting reimbursed on Silver Script is incoorect. In signing up ,Silver Script was listed as giving electronic information to One Exchange on payment. It seems not even OPERS knows what is happening and should research these answers before answering. Further these contractors leave a lot to be desired. OPERS needs to hold their feet to the fire or withhold contract payments.
Robert,
Those who have been reading our blog for any length of time might recall that we have said on numerous occasions that participants in the Connector should submit paper claims the first month or two when also applying for auto-reimbursement.
–Ohio PERS
In reviewing the HRA instructions it says that you can file manually to expedite the reimbursement. In looking at the manual form I see that in addition to the bank payment documents you must submit, you must submit a copy of the premium notice. Medical Mutual, by letter notified those with bank accounts that our first payments will be electronically transferred the 6th of January. So no premium notice to submit.
So now if I submit a claim, it will have the bank info and not premium notice. It is set up to fail.
Could you have made this anymore difficult. You will suggest I go back to Medical Mutual to request a copy of something they have not issued. Really…and do I want to spend 40 minutes on hold with your subcontractors One Exchange and they have a subcontractor deciding who will or will not get reimbursed and when. They really are not up to par in dealing with your concerns.
I think this whole manual request procedure should not have been required if you set up the automatic reimbursement procedure. The good retirees of OPERS are going to go literly crazy when their reimbursements are delayed. I can only hope I am wrong!
Robert,
OneExchange does recommend uploading receipts and other documentation to expedite reimbursement processing. I guess they are assuming that health care providers are able to provide proof of payment.
But you state that “this whole manual request procedure should not have been required if you set up the automatic reimbursement procedure.” And, indeed, it is not required. It is offered as a way to expedite the initial reimbursements.
–Ohio PERS
This whole reimbursement procedure is turning out to be a nightmare. It surely was not thought out by OPERS. If they really care about us retirees, they would be diligently working to make this right for us.
As I have said, the reimbursment issue is going to become a nightmare based on the requirements of documents that don’t exist. Medical Mutual informed me that they do not issue receipts for payment and since am on a automatic withdrawl there is no premium notice. If they do not take the copy of the check of electronic withdrawl receipt the bank gives you on your online banking this is going to be a cluster. What say you OPERS!
Robert,
You can 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.
–Ohio PERS
Thank you for the information wherein I can printout a premium receipt letter from my OPERS website account. I have searched the site and either it is not there or I have missed something. Can you be more specific. I am assuming you are speaking of a confirmation that I have paid the premiums for my medigap and pharmacy insurance. Thank you.
Robert,
There’s a “Requestable Documents” panel at the bottom of your online account homepage. In that panel, there should be a link for the premium receipt, if it’s applicable to you. There should be new receipts each month.
–Ohio PERS
Many of these instructional points are becoming lost in the mass of information we all have received regarding One Exchange and other topics. Just last week I received a box of papers 1 and 1/2 inches thick full of “books” to read from my advantage plan carrier. Keeping up with all this material, newsletters, mailings, blogs is difficult not to mention overwhelming.
I am extremely perplexed with OPERS and One Exchange. It appears as if they are totally unaware of what each is doing. I am a OPERS member that has been also assisting my fellow church members who find this whole process confusing. As I garner info, I try to pass it on when I have an understanding of what is going on but lately, It’s futile as I can’t get straight answers from these awesomely polite people on each end that know nothing. One agent at OPERS stated that they have weekly meetings and my question had never come up but she would be sure it was tabled at the next meeting. I feel this was poorly executed, especially regarding reimbursements. Many of us did not have extra money lying around to pay up front and wait 4-6 weeks to be reimbursed. We were told that there would be an allotment of $300 for the next three years to help make this transition easier for us. Well it hasn’t been easy. I am waiting on approx. $300 which is a portion of my mortgage money. OPERS would have done better just paying our first premium at least the first month. I can only hope and pray that it pans out as many of the members are not computer savy, have no one to really explain things to them. It is really a mess at this point.
One Exchange is totally disorganized. They cannot talk on phone, cannot understand names, (A=apple, S=Sam…) nothing. Giving us lip service on spouse account and we are unsure if we will ever get reimbursement. No paperwork followup to clients. No idea approx. date of funds withdrawl from our checking. They claim it may take 3 months to get reimbursed. How confusing is that? And are they collecting interest on the $400-$500 they are holding back. I, the primary, got my automatic reimbursement 12/23/15, way sooner than they described. But, no one can verify my spouse is even in the system as one rep even said he was “not authorized for funding”!!?? What? We both have BCBS cards, both first checks cashed, but HE is lost somewhere in a loophole. The biggest problem is no verification, unable to find us in their system, unable to answer questions (other than the don’t worry about it, your covered) blurb. All we want to know is IF my spouse is in the system. Honestly, these ppl sound like they do not know which end is up. Talked to 5 different people — got no where.
YES, WE WORRY. HEALTHCARE AT OUR AGE IS IMPORTANT. WE DON’T LIKE COMPLICATIONS AND WONDERING IF AND WHEN OUR ACCOUNT HAS A MEDICAL WITHDRAWL, OR WHEN IT WILL BE REIMBURSED, WITHOUT CONFUSION OF FOR WHAT MONTH. OPERS has dropped the ball and won’t talk to us about One Exchange any longer.
Very dissapointed!! Sure hope it levels out as we were hours on the phone with no concrete results.
I have found OPERS and one exchange are too not very knowledgable about thisSilver Script plans. My prescription cost is going up over $ 400.00 per month. I’ve found I cannot use coupon or special program from drug companies to off set the rise in cost. Last year it cost $130.00, this year almost $505.00, then even higher when I get shoved in the Doughnut Hole, even the extra $300.00 and $150.00 is not going to help, when the Doughnut Hole.
I’ve found get your Doctor to keep you in the hospital , your drug are free then. (What kind of life would be)
Don’t be hard of hearing, One Exchange does not care about that Disability! OPERS only cares just a little!
I’ve had to help three OPERS retiree in the 70 to 80 years old just too seek help, they did not know what the change was going to do them or cost.
Now I am making a decision eat or buy prescription, I think I will eat and die happy!
Its really disappointing that us PERS contributors go the royal shaft on this health care. Pers new the medical fund was in trouble years ago and allowed pers retirees to retire …rehire ..and keep pers medical benefits while working at their old jobs. These so called double dippers retiring at thirty years at 66% of their average salary, rehire at their old rate of pay in turn equals 66+100=166%…not bad considering they were saving the employer health care costs at the expense of retirees, their dependents and future retirees and their dependents. Many years ago I called PERS and questioned this practice…I was told the double dippers earned those benefits and deserved them. Do we deserve this nightmare after years in public service. Most of us employees stayed working in the public sector fo the benefits and most worked two jobs due to the low wages. Do we deserve this…I think not. I am a current 32 year public servant how can we retire?
Mark — re-employment is cost neutral to OPERS.
– Ohio PERS
this form of reimbursement is so confusing and its now July 2016 and only thing I get back is when I pay siver scripts and florida blue cross after I pay them! that leaves all my rx out of pocket plus my dental and eye ins that I still have with OPERS! why is it so hard to do? also payed out of pocket for dentist and some co-pays to Drs! someone needs to make this easier ok? I do not get social security either, although using my ex wifes SS number for medicare! I was lied to when SS added up my credits from others I had worked for before I worked for Cuyahoga county for 30 years! I did pay into SS but some employers were corrupt and didn’t pay it! I need answers ok year is going fast and I will be 80 soon and live alone in florida with no help at all! also talked to diff connetors and everyone tells me something different! HELP
july
Robert- I’ve forwarded your concern to OneExchange and they have further questions. They will be calling you within 48 hours to review your account. Thank you for bringing your concerns to our attention.
-Ohio PERS