Eligible Dependents

Retirees enrolled in the OPERS health care plan may also enroll an eligible family member. In accordance with Ohio Administrative Code 145-4-09 and Section 152 of the Internal Revenue Code, retirees receiving a monthly age and service or disability benefit may only enroll:

Spouses (including surviving spouses) not yet eligible for Medicare

Eligible spouses under age 65 are eligible to enroll in the OPERS Retiree Health Plan administered by Medical Mutual. The amount that OPERS pays toward the cost of this coverage is being reduced through an annual allowance to $0 by 2018. As a result, some retirees may decide the premium to cover a spouse not yet eligible for Medicare in 2017 is more than they can comfortably afford. There are a number of options available through the Health Care Marketplace, commonly referred to as Exchange plans. Another site that provides coverage and cost comparisons for a variety of carriers is ehealthinsurance.com. Additionally, depending on income level, some may qualify for substantial help from the federal government to pay for a plan via the marketplace. See below Resources for additional guidance.

Meet Colleen and Ken

Colleen, 61 and Ken, 59 are eligible for coverage under the OPERS Retiree Health Plan. Colleen is an OPERS retiree and Ken is an eligible spouse. Colleen’s monthly premium is $118 and, with the allowance reduction, Ken’s premium is $710 per month in 2017. The total of the two premiums is more than Colleen and Ken have allotted for health care coverage monthly.

There are a number of alternate coverage options available including Ken’s own employer or retiree coverage and Exchange plans available via the Health Care Marketplace.

Resources for Colleen and Ken to learn more about non-Medicare health plans include:

Healthcare.gov Healthcare.gov (Exchange plans) - research plan options available on the open market
Ohio Department of Aging Ohio Department of Aging - learn about services and resources available to non-Medicare and Medicare recipients
Ohio Department of Job and Family Services Ohio Department of Job and Family Services - learn about assistance programs such as Medicaid
The Ohio Department of Insurance The Ohio Department of Insurance - tap into helpful resources such as an informational toolkit, COBRA and ACA information and much more
Ehealthinsurance.com Ehealthinsurance.com - research affordable health care plans and shop for what’s available online
Ohio’s Best Rx Ohio’s Best Rx - sign up to save on prescription medications, print a discount prescription card, locate a pharmacy and compare prescription drug prices.
OneExchange OneExchange Website – learn about the administrator of the Connector and why they are an important resource for you post enrollment
Independent broker plans - research available plans with your local independent insurance broker

The Ohio Department of Insurance website offers a toolkit specifically designed for Ohioans seeking health insurance due to a reduction or termination of employer coverage. Ehealthinsurance.com provides coverage and cost comparisons for a variety of carriers.


Other Considerations

Participants in the OPERS health care plan receiving a monthly benefit as the surviving spouse or beneficiary of a deceased retiree or deceased member may only enroll those dependents who would have been eligible dependents of the deceased retiree or member as defined on this page.

It is the retiree’s responsibility to notify OPERS, in writing, within 30 days of the date his or her dependent fails to meet eligibility requirements. Failure to notify OPERS could result in overpaid health care claims for which the retiree will be responsible.

*OPERS does not subsidize monthly health care premium costs for an eligible spouse if he or she is under the age of 55. These spouses may enroll in the OPERS health care plan but must pay the full health care premium. If your spouse is enrolled prior to turning age 55, the month your spouse reaches age 55, OPERS will again subsidize a portion of his or her health care premium. Subsidization of spousal coverage will change in the future years. This under 55 spouse rule does not apply to spouses of disability recipients, spouses with early Medicare or any spouse who is receiving a benefit as the surviving spouse of an age and service retiree (joint and survivor annuity) or as the surviving spouse of a deceased working member (receiving a survivor benefit). These rules are subject to change.

Medicare Spouses

Eligible spouses over age 65 and enrolled in Medicare Parts A and B can enroll in an individual Medicare plan with the help of OneExchange. The amount that OPERS gives as an HRA allowance will be reduced through an annual allowance reduction. By 2018, spouses, including surviving spouses, can enroll in coverage through OneExchange, but will pay the full cost of the plan. However, many Medicare-eligible OPERS retirees will find they have sufficient allowance dollars remaining to pay for a spouse’s premium.

Meet Jane and Marty

Jane, 70 and Marty, 72 are both retired and enrolled in Medicare Parts A and B. Jane is an OPERS retiree and Marty is an eligible spouse. They will both use the services of OneExchange to separately enroll in an individual medical/prescription drug plan.

As the OPERS retiree, Jane will receive a monthly allowance deposited into a Health Reimbursement Arrangement (HRA). She can use the funds in her HRA toward the monthly premium for her coverage. If, after paying for her coverage, she has dollars remaining in her HRA each month, she can use those dollars toward the cost of Marty’s premium and/or any qualified out-of-pocket expenses. As a spouse, Marty is also eligible for a minimal HRA allowance in 2017. This allowance will be reduced to $0 by 2018.

If Jane and Marty would like to explore other coverage options or learn more about Medicare plans, they can utilize the following resources:

OneExchange OneExchange Website – learn about the administrator of the Connector and why they are an important resource for you post enrollment
Medicare Medicare - discover everything Medicare, from signing up and changing plans to reviewing coverage, searching doctors, hospitals, providers and more
Ohio Senior Health Insurance Information Program  (OSHIIP) Ohio Senior Health Insurance Information Program (OSHIIP) – research resources dedicated to assisting with Medicare questions
Ohio Department of Insurance Ohio Department of Insurance - Consumer Services - tap into helpful resources such as an informational toolkit, COBRA and ACA information and much more
The Ohio Department of Insurance The Ohio Department of Insurance – tap into helpful resources such as an informational toolkit, COBRA and ACA information and much more
Department of Aging Medicare Fraud Reporting - Ohio Department of Aging - read about fraud prevention and protect yourself from predators
Ohio Department of Job and Family Services Ohio Department of Job and Family Services - Ohio Medicaid - learn about assistance programs such as Medicaid
Ohio Department of Health Ohio Department of Health - tap into various resources aimed to improve your health and create a better quality of life
U.S. Department of Health U.S. Department of Health & Human Services - Office of Inspector General - read about and listen in on what advocates are doing in the health care fraud and abuse law space, basics of compliance programs and much more.

Child(ren)

In order for a child to be eligible for coverage, the child must be under the age of 26 (regardless of enrollment as a full-time student or marital status). Coverage may be extended if the child is permanently and totally disabled prior to age 22. This means that the child is not able to work in any substantial gainful activity because of a physical or mental impairment, which has lasted or is expected to last for at least 12 months. Evidence of the incapacity is required and is subject to approval by OPERS.

Participants in the OPERS health care plan receiving a monthly benefit as the surviving spouse or beneficiary of a deceased retiree or deceased member may only enroll those dependents who would have been eligible dependents of the deceased retiree or member.

It is the retiree’s responsibility to notify OPERS, in writing, within 30 days of the date his or her dependent fails to meet eligibility requirements. Failure to notify OPERS could result in overpaid health care claims for which the retiree will be responsible.