Qualifying for Coverage
As an OPERS benefit recipient, you may only receive primary coverage from one of the five Ohio retirement systems (OPERS, STRS, SERS, OP&F and OHPRS). If you or your spouse qualifies for retirement under another Ohio retirement system, you may not waive coverage under that system in order to make OPERS your primary health care coverage. You must continue coverage under the other retirement system, but may elect OPERS as secondary coverage.
If you are eligible for health care coverage from more than one OPERS benefit, you may choose the account that provides the lowest cost, but you cannot be covered under more than one account at a time.
If you retire with at least 20 years of qualifying OPERS service credit and have reached age 60 (or reached any age with 30 years of qualifying service credit), you can apply for the OPERS health care plan. If you do not qualify for medical/pharmacy coverage, you can still enroll in the optional dental and/or vision plan if you receive a monthly OPERS pension benefit. If your benefit effective date is prior to Jan. 1, 2015, you were only required to have ten years of qualifying service credit to enroll in the OPERS health care plan.
Only the following types of service credit apply to health care eligibility: Contributing service, certain qualifying Ohio Retirement System transfers, interrupted military (USERRA), unreported time and restored (refunded) service.
Contributing service credit for health care is accumulated only if the member earns at least $1,000 per month. Partial health care credit will not be granted for months in which less than $1,000 is earned. Qualifying credit of less than $1,000 per month earned prior to Jan. 1, 2014 will continue to count toward health care eligibility.
Members receiving a disability benefit that became effective prior to Jan. 1, 2014, will have continued access to the OPERS health care plan based on the annual review and approval of their disabled status.
Members receiving a disability benefit that is effective on or after Jan. 1, 2014, will have access to health care coverage for the first five years of their disability based on their continued eligibility and receipt of a disability benefit during that time. Health care coverage for disability recipients will continue past the first five years only if: 1) the recipient meets age and service retirement requirements or, 2) the recipient enrolled in Medicare, due to a disability, prior to the end of the five years and prior to reaching age 65.
A previous disability retirement based on a different condition will not qualify a new disability benefit application for an exception to the five-year rule.
Disability recipients covered under the Original Disability Plan will follow the guidelines above for determining access to health care. However, Original Disability recipients will be required to meet health care age and service requirements at age 65 to continue access to OPERS health care coverage. Medicare will become primary coverage at this point unless the recipient is in an exclusion period for Medicare due to certain medical conditions, such as End Stage Renal Disease. For more information about Medicare eligibility and enrollment please visit medicare.gov or read about it in OPERS' Understanding the Basics: Medicare and OPERS Connector Basics Guide.
If you die while you are still working, your dependents who are eligible for a monthly benefit may be able to enroll in our health plan if the recipient of the survivor benefit meets the definition of an eligible dependent. If you have a benefit effective date after Jan. 1, 2015, you must have at least 20 years of qualifying OPERS service credit and have reached age 60 (or reached any age with 30 years of qualifying service credit) prior to your death for your dependents to be eligible to enroll. This provision will change in future years.
- Learn More: Eligible Dependents