Open Enrollment 2020

It's that time of year – open enrollment. As you plan for 2020 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 2020 Personalized Health Care Open Enrollment Statement and Open Enrollment Guide by mid-October.

What's new in 2020

OPERS pre-Medicare plan participants

  • While OPERS continues to pay most of the cost for coverage under the OPERS Retiree Health Plan, administered by Medical Mutual, the full monthly premium will increase from $1305.96 to $1,379.59 for 2020. The full premium cost was raised to keep pace with increased costs.
  • Increased plan use contributed to the need to increase deductible, copay and co-insurance amounts. Also, in previous years, a $49 premium reduction was automatically applied to qualifying accounts in preparation for the Cadillac Tax. Since the tax is expected to be repealed, the premium reduction will not apply for 2020 and going forward.
  • The OPERS Retiree Health Plan continues to protect you financially by capping your annual in-network medical and prescription drug out-of-pocket costs at the ACA limit of $8,150. Please note, there is no out-of-pocket limit if you receive care from out-of-network providers.
  • NEW Medical Mutual Nurse Line, available 24 hours a day, seven days a week. Registered nurses can provide advice on when to seek urgent care, home treatments, understanding your medicine and how it works, how to make decisions about tests, medication and procedures as well as when to call a doctor and how to effectively communicate with them. Call the Medical Mutual Nurse Line at 1-888-912-0636.

Medicare-eligible Plan Participants

  • The base monthly Health Reimbursement Arrangement (HRA) allowance amount remains at $450. Your monthly allowance amount will remain the same as it was in 2019.
  • Via Benefits is now handling HRA processing in place of PayFlex. As a result, you may need to reset your communication preferences to opt-in to text messages and/or email notifications.

Medicare-Eligible Retirees

Review your plan

Review the 2020 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 2020 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 2020, 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 is available using the link below.

Health Care for the OPERS Spouse

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 2020.

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 2020 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 2020.

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 2020, 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.

2020 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 2020 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.

Health Care for the OPERS Spouse

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 2020 Open Enrollment Guide features plan information for Medicare and pre-Medicare participants in OPERS Health Care.

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

2020 Vision and Dental Plan Guide

The 2020 Vision and Dental Guide features vision and dental plan information for the upcoming year.


Frequently Asked Questions

Pre-Medicare Health Care and Prescription Drug Plan

Why did my monthly premium increase this year?

OPERS strives to keep plan premiums as affordable as possible every year through various cost containment measures like medical management programs and savings initiatives. Like most other plans in the market, OPERS experienced cost increases due to overall health care inflation and higher utilization of medical services. We analyze market trends and industry norms to strike a reasonable balance between premium costs and out-of-pocket costs. Certain plan features were adjusted for the new plan year including deductibles and copays to help reduce what would have been a larger premium increase.

Why did my deductible(s) go up?

The annual deductible under the OPERS pre-Medicare health plan will increase to $2,500 beginning January 2020. The prescription drug plan annual deductibles will also increase to $200 for generic and $400 for brand drugs. Plan costs continue to rise with health care inflation, especially with specialty medications and increased use of services. Increases like this also aligned the OPERS plan with industry peers and plans available in the pre-Medicare market. The average deductible under the Affordable Care Act plans exceeds $4,300.

What happens to my out-of-pocket expenses if I choose to go to a doctor who is not in-network?

Under the current OPERS pre-Medicare health plan, you do have the option to go to a doctor or hospital that is not in the extensive Medical Mutual PPO network. You will have more out-of-pocket expenses if you receive services from an out-of-network provider. You will be subject to a $5,000 medical deductible and higher overall out-of-pocket expenses with no maximum out-of-pocket. Less than 10 percent of our participants choose out-of-network providers. To find a provider within the Medical Mutual PPO network, call Medical Mutual or use Medical Mutual's online provider lookup tool (link opens in new tab).

Will it cost me more to visit my doctor next year?

When medically appropriate, it’s always best to visit your Primary Care Physician (PCP) first when you are seeking care. Your office visit copay for your in-network PCP will remain at $25 for next year. If your PCP is classified as a Medical Home your copay will remain at $15. Your PCP can help coordinate the care that you need between other providers. If you need to see a specialist, the copay for this in-network visit will increase from $40 to $50.

What alternative location do I have for non-emergency services?

If you have a minor illness or injury you think requires prompt attention and can’t reach your PCP, urgent care clinics and convenience clinics are good, and usually less costly, alternatives to the emergency room.

Urgent cares are walk-in clinics that treat medical conditions needing immediate attention-- but aren’t life threatening. These facilities don’t require an appointment and have average wait times. They’re a good option when your PCPs office is closed since they’re usually open on evenings and weekends. They are a great alternative to the ER for minor illnesses or injuries.

Urgent care clinic advantages:

  • Wait times are shorter—sometimes you can be seen almost immediately.
  • Clinic staff members are specially trained in treating minor injuries and illness, and they can immediately recognize if a higher level of care is needed and refer you appropriately.
  • Some clinics are open 24/7 and most others have extended hours (early morning, late evening and weekend hours).

An urgent care clinic can help with:

  • Asthma and wheezing
  • Minor back pain
  • Cold and flu symptoms
  • Ear or eye infections
  • Minor allergic reactions
  • Minor cuts or burns
  • Rashes or insect bites
  • Respiratory infections
  • Sore throats or bronchitis
  • Sprains or strains
  • Urinary and kidney tract infections

Convenience clinics are another good option for treating minor illnesses and injuries. These walk-in clinics are often located in drug and grocery stores and are staffed by nurse practitioners or physician assistants who can diagnose and treat many illnesses and write prescriptions when you're unable to see your primary care provider (PCP).

A convenience clinic can help you with:

  • Sore throat or bronchitis
  • Allergies
  • Ear infections
  • Cold and flu symptoms
  • Urinary and kidney tract infections
  • Pink eye
  • Various vaccinations
  • Minor back pain
  • Flu shots

If you receive treatment from an urgent care or convenience clinic, don'''t forget to schedule a follow-up appointment with your PCP to discuss the course of treatment prescribed and see if any further instructions are needed.

What do I do if I don’t know if I am having an emergency?

When you’re ill or injured, quick treatment is your top priority. But unless you think your problem is immediately life threatening, it’s best to call your primary care provider (PCP) before heading to the emergency room (ER). Your PCP can discuss your symptoms and tell you where to get the right care.

Medical Mutual offers a Nurse Line® which is a 24/7 resource giving you access to registered nurses trained to help you make decisions about a health issue, including whether you need to visit a doctor or emergency room (ER). If you aren’t clear on where to go for care, the Nurse Line® is a great place to start.

When should I go to the Emergency Room (ER)?

The Emergency Room is a facility found in a hospital, providing 24/7 care in case of emergencies and acute care without an appointment. ER visits for non-emergency symptoms may result in long wait times and significantly higher out-of-pocket costs compared to visiting non-emergency locations. The copay for emergency use of the ER is $250 compared to $550 for non-emergent use of the ER.

Examples of emergencies: *Heavy bleeding, major broken bone(s), sudden changes in vision, chest pain, major cuts and burns, severe head injury, shortness of breath, spinal injury and sudden trouble speaking.

How will I know if my ER visit was considered an emergency? (post visit)

Your EOB will display a $250 ER copay if the emergency room visit was deemed emergent or a $550 ER copay if the emergency room visit was deemed non-emergent. If you called Nurseline and the Nurse advised you to seek care at the Emergency Room, you will always be assessed the $250 emergent ER copay.

What can I do to lower my out-of-pocket costs this coming year?

There are several ways to save on your out-of-pocket medical and prescription drug costs.

  • Using a primary care physician who is classified as a medical home will not only save you money on your copays, but they can help you coordinate your care.
  • Choosing generic medications or brand medications that are on the formulary may help you save as well. Talk to your doctor about what prescription is most appropriate for you and if a formulary brand or generic would work.
  • Many preventive services like an annual routine physical and flu vaccines are covered at 100 percent. These services are designed to help identify or even avoid longer term health issues and may help you save on your overall health expenses.
  • In general, making good health choices like eating properly and exercising daily may help keep you healthier and may help you avoid some of the costs of continued care.
Will I be spending more on my prescription drugs next year?

OPERS strives to control health care expenses for you as much as possible. A key contributor to rising costs is prescription drugs. Specialty drugs are especially costly, accounting for upwards of 60 percent of OPERS’ total prescription drug cost and increasing more than three times the rate of inflation. To help control OPERS’ costs for all prescription drugs, the portion of prescription drug costs paid by OPERS in 2020 will change. Read your open enrollment materials to see what changes may affect you.

Medications may move from a preferred (formulary) list to a non-formulary list. In this case Express Scripts, the prescription drug plan administrator for the OPERS group plan, will provide notification so you are aware of potential cost differences and provide possible alternatives. Using generic medications, when appropriate, choosing a medication that is on the preferred list (formulary), and taking advantage of drug manufacturer coupons, if available, may help save you some expense.

Medicare-eligible Participants

I enrolled in a medical plan through Via Benefits and receive a health reimbursement arrangement allowance. My spouse is under age 65 and enrolled in the Medical Mutual plan. Can I reimburse her Medical Mutual plan premiums from my health reimbursement arrangement?

Yes, you can submit her plan premiums and you will be reimbursed up to the available balance in your health reimbursement arrangement. You can receive reimbursement for her Medical Mutual plan premium and for both of your OPERS vision and dental plan premiums, if enrolled. Please submit a Recurring Health Reimbursement Arrangement Claim Form (available through your Via Benefits online account) along with your OPERS Health Care Premium Receipt (mailed to you in mid-December and available through your OPERS online account).

As a spouse, can I enroll in a Medicare plan outside of Via Benefits?

When you enroll in a plan through Via Benefits, they provide ongoing support for HRA management, carrier claim resolution and Medicare plan questions. Should you choose to enroll in a plan outside of Via Benefits, you will not have access to these services. Please note that if you enrolled in a 2019 plan through the Connector, you will remain enrolled in that plan until coverage is canceled.

Optional Vision and Dental Coverage

Where can I find dentists in the MetLife provider network?

More than 75 percent of dentists statewide MetLife are in the MetLife network. You can locate a MetLife network dentist by accessing the dentist search tool at metlife.com. Using a network dentist will lower your overall dental expenses.

What are the benefits of getting a routine eye exam each year?

Routine eye exams are an important part of your overall health. Eye exams can help with early detection of eye problems and they can assist with identifying more complex health issues like diabetes and hypertension. And under both the OPERS high and low option vision plans your in-network, routine eye exam is at no cost to you each year.

Re-employment

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

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

Pre-Medicare – Coverage for those re-employed in an OPERS–covered position is identical to the Medical Mutual plan for those who are not reemployed, so no action is necessary.

Medicare-eligible – In order to receive your health reimbursement arrangement allowance, you must be enrolled in a medical plan through the OPERS Medicare Connector administered by Via Benefits. Your existing group coverage will terminate.