Open Enrollment 2019

It’s that time of year – open enrollment. As you plan ahead for 2019 health care coverage, it’s important to know key information, such as open enrollment dates and action steps to take as a Medicare or pre-Medicare retiree.

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Check your mailbox!

Those eligible for OPERS health care coverage will receive a 2019 Personalized Health Care Open Enrollment Statement and Open Enrollment Guide by mid-October.

What's new in 2019

Subsidy changes for Medicare-eligible and pre-Medicare plan participants

  • OPERS is not extending the annual $300 health reimbursement arrangement deposit for Medicare-eligible retirees into 2019. The subsidy was provided for three years (2016-2018) to help offset out-of-pocket costs due to the Medicare prescription drug coverage gap.
  • Pre-Medicare participants will receive a monthly $49 premium reduction to help offset costs, $25 less than in previous years.

OPERS pre-Medicare plan participants

  • Pre-Medicare plan participants will see a higher cost share in the monthly premium amount due to an increase in medical claim costs. Additionally, plan design changes were made as a result of an increase in use and price, impacting deductibles, co-insurance, copays and out-of-pocket maximums.
  • Pre-Medicare spouses must pay the full monthly premium of $1,305.95.

Optional vision and dental plans

  • Plan adjustments reflect changes in marketplace standards and inflation.

Medicare-Eligible Retirees

Review your plan

Review the 2019 plan details provided by your insurance carrier and look for any changes in premiums and plan design. Evaluate the prescription drug formulary as these sometimes change from year to year. Some plan changes (Medigap) may require medical underwriting.

Keeping your current plan?

If you have reviewed your 2019 plan details and do not want to make changes, no action is needed. Your plans will automatically carry over into next year.

Optional Vision and/or Dental coverage

If you would like to adjust optional vision and/or dental coverage, or cancel coverage for a dependent for 2019, call OPERS between Oct. 15 and Dec. 7.

If you would like to add coverage for yourself and/or dependents, complete the Health Care Open Enrollment Change Form included in your packet.

Spouses

Spouses continue to have access to health care plans through the Connector and will remain enrolled in their selected plan until they cancel coverage. Should your spouse choose to look into other coverage options, a list of resources are available on opers.org.

HRA Reimbursement Reminders

Automatic Reimbursement

If you previously set up automatic reimbursement for plan premiums and you do not change plans, these arrangements will continue into 2019.

Changing medical plan carriers?

Automatic reimbursement does not transfer over between carriers. Check to see if the new carrier offers automatic reimbursement. Note that reimbursement timing varies by carrier.

Recurring Claims

Recurring premium claim forms for 2019 Medicare Part B and OPERS vision and dental premiums as well as recurring reimbursements for medical and/or prescription plans need resubmitted each year to the administrator. OPERS will mail a copy of your Health Care Premium Receipt in mid-December. This receipt needs submitted to establish recurring premiums that are deducted from your OPERS pension benefit.

Things to consider

  • Have you had a change in health or medications?
  • Is your primary care physician still accepting Medicare?
  • Have you moved, or has your insurance carrier closed your plan?
  • Are your current premiums outside of your budget?

If you answered yes to any of these questions, you may want to explore other available plan options through the Connector.

Other insurance companies and brokers will send materials and try to call you. Remember that you must maintain your current plan enrollment or enroll in a new plan through the Connector to receive your health reimbursement arrangement allowance.

Pre-Medicare-Eligible Retirees

Continue your coverage

If you would like to continue your current coverage, there’s no need to take action. Current plans will automatically carry over into 2019.

Optional Vision and/or Dental coverage

If you would like to adjust optional vision and/or dental coverage, or cancel coverage for a dependent for 2019, call OPERS between Oct. 15 and Dec. 7.

If you would like to add coverage for yourself and/or dependents, complete the Health Care Open Enrollment Change Form included in your packet.

Re-employment

If you are pre-Medicare and re-employed in an OPERS-covered position, you may participate in the Pre-Medicare Re-employed Plan, administered by Medical Mutual.

2019 Income-Based Discount

The OPERS Income Based Discount Program is designed to help qualified benefit recipients pay for their participation in the OPERS medical plan. More information about the program can be found in the 2019 Open Enrollment Guide.

Spouses

Spouses who remain enrolled in the pre-Medicare plan will be responsible for the full cost of OPERS health care coverage. As a result, you may decide the premium to cover your pre-Medicare spouse is more than you can comfortably afford.

Open Enrollment Resources

Health Insurance Marketplace (link opens in new tab) | 1-800-318-2596

Ohio Department of Insurance Consumer Services (link opens in new tab) | 1-800-686-1526

Ohio Department of Aging (link opens in new tab) | 1-800-266-4346

Ohio Department of Medicaid (link opens in new tab) | 1-800-324-8680

Via Benefits (link opens in new tab) | 1-844-287-9945

Open Enrollment Guide

The 2019 Open Enrollment Guide features plan information for Medicare and pre-Medicare participants in OPERS Health Care.

Q3 Retiree Newsletter

The Fall Retiree Newsletter includes high-level details of changes in plan design, premium amounts and general reminders.

Educational Seminars and Webinars

OPERS offers a number of in-person educational seminars, webinars and recorded presentations tailored to the specific needs of OPERS retirees.

In-Person Seminars

Online Webinars

2019 Vision and Dental Plan Guide

The 2019 Vision and Dental Guide features vision and dental plan information for the upcoming year.


Frequently Asked Questions

Why are premiums increasing?

The cost of medical services continues to rise and the use of these services continues to increase causing premiums to increase.

If you decide the premium to cover your spouse not yet eligible for Medicare is more than you 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, you may qualify for substantial help from the federal government to pay for a plan via the marketplace. If an outside plan is selected, you are still responsible for canceling OPERS spouse coverage as it will not automatically terminate. As you weigh your options, please keep in mind that while participants are being asked to share more of the costs, most of the plan costs will still be paid by OPERS.

How do I terminate coverage for a dependent or myself?

You can complete the Health Care Open Enrollment Change Form or call OPERS to cancel medical, prescription drug, vision and/or dental coverage. The most efficient way to make these changes may be to call OPERS at 1-800-222-7377.

I enrolled in a medical plan through the Connector and receive a health reimbursement arrangement. My spouse is not yet eligible for Medicare and enrolled in OPERS Retiree Health Plan. Can I reimburse their plan premiums from my health reimbursement arrangement?

Yes, you can submit your spouse’s plan premiums and will be reimbursed up to the lesser of their full premium or the available balance in your arrangement. You can also receive reimbursement for both of your OPERS vision and dental plan premiums, if enrolled. Please submit a Recurring Health Reimbursement Claim Form to Via Benefits, available through your Via Benefits online account, along with the OPERS Premium Receipt, available through your OPERS online account.

What happens if I cease being re-employed in an OPERS-covered position?

OPERS must receive notification from your employer before we can officially change your status from re-employed to not re-employed.

Pre-Medicare
Coverage for those re-employed in an OPERS–covered position is identical to the OPERS Retiree Health Plan for those who are not re-employed. If you are enrolled in the Pre-Medicare Re-employed Plan, OPERS automatically adjusts your enrollment to the appropriate plan when your employer notifies us of your termination of employment, so no action is necessary on your part. 

Medicare-eligible
In order to receive your health reimbursement arrangement allowance, you need to be enrolled in a medical plan through the OPERS Medicare Connector administered by Via Benefits. To enroll, contact Via Benefits at 1-844-287-9945.

As a spouse, will my OPERS Retiree Health Plan coverage automatically cancel for 2019?
No. If you do not want to continue coverage for 2019, OPERS must receive a phone call or the Open Enrollment Change Form requesting cancellation of coverage.
As a spouse, can I enroll in a new Medicare plan outside of the Connector?

Choosing a plan outside of the Connector is an option. Remember, when you enroll in a plan through the Connector, they provide ongoing support for online account management, carrier claim resolution and Medicare plan questions. Should you choose to enroll in a plan outside of the Connector, you will not have access to these services, nor will you have access to automatic or recurring reimbursements.

Please note that if you enrolled in a 2018 plan through the Connector, you will remain enrolled in that plan unless you cancel the coverage.