OPERS Medicare Connector Health Reimbursement Arrangement

A Health Reimbursement Arrangement, or HRA, is an account funded by OPERS that provides tax-free reimbursement for qualified medical expenses. The monthly allowance deposits can accumulate from month to month and, unlike most flexible spending accounts, the balance will roll over from year to year. OneExchange administers the HRA.

How to use your HRA

The HRA is provided to eligible retirees for reimbursement of qualified out-of-pocket medical expenses incurred by you or your qualified dependents.

For example, you may seek reimbursement of premiums (e.g., individual Medicare Advantage or Medigap (Medicare Supplement) plan, Medicare Part B, dental and vision) and other out-of-pocket expenses as defined by the IRS including medical and prescription drug copays and co-insurance.

Note: The HRA holder must sign all reimbursement forms.

Questions about your HRA?

Consider registering for an OPERS How to Use Your Health Reimbursement Arrangement seminar near you.

It's the perfect way to get the HRA information you need straight from OPERS professionals.

Eligibility

To be eligible to receive the HRA, you must be:

  1. Currently eligible for OPERS health care coverage as a primary benefit recipient
  2. Enrolled in both Medicare Parts A and B
  3. Enrolled in an individual Medicare medical plan through the OPERS Medicare Connector (administered by OneExchange)

The HRA administrator sets up the account after the retiree is enrolled in a medical plan through the Connector.


How much is deposited into my HRA?

The monthly amount deposited into your HRA depends on your years of service and age when enrollment in the OPERS health care plan first takes place.

Individual allowance amounts range between $229 and $405 with more than 90 percent of current retirees receiving $337 or more per month.

You can check the amount in your HRA at anytime by logging into your OneExchange Online account.


Submitting Claims for Reimbursement from your HRA

The HRA will reimburse you up to the extent that there is a balance available in your account.

There are two different ways to receive reimbursements from your HRA: automatic and manual.

For some medical and prescription drug premiums, retirees have the option of either Automatic Premium Reimbursement or Recurring Reimbursement. Refer to the OneExchange Getting Started Guide for detailed descriptions that describe the benefits of each type of reimbursement method.

Reimbursement Forms

Reimbursement forms are available through the retiree's OneExchange online account and by phone at 1-844-287-9945. Each form includes a personalized barcode specific to the retiree's HRA as well as a check list detailing the required documentation needed with each claim type. Personalized barcodes eliminate the use of social security numbers to identify accounts and increases accuracy and efficiency when OneExchange processes reimbursement requests.


Claim Forms

There are three types of reimbursement claim forms:

OPERS Recurring Medicare Part B Premium Reimbursement Form

The OPERS Recurring Medicare Part B Premium Reimbursement Form is used specifically for the Medicare Part B monthly premium.

How is this form to be used?

The form is specific to Medicare Part B premium reimbursements which are reimbursable every month throughout the year.

How often must I submit this form?

Must be submitted once per calendar year.

How quickly will I receive my reimbursement?

Initial monthly reimbursement should be received the month following submission of the form and documentation.

Do I need supporting documents with this form?

Yes, please submit your Social Security Award letter or Medicare coupon (monthly or quarterly) containing:

  • Proof of premium
  • Monthly Amount
  • Date of service
  • Premium type
  • Participant name

Examples of supporting documents

  • Award letter from Social Security
  • Monthly or quarterly Medicare coupon (billing, invoice)

Manual Reimbursement Claim Form

The Manual Reimbursement Claim Form is used to manually submit general expenses.

How is this form to be used?

Reimbursement of any qualified out-of-pocket expense, such as: Copays, deductibles, and prescriptions.

How often must I submit this form?

As needed.

How quickly will I receive my reimbursement?

Reimbursement should be received approximately 14 days following submission of the form and documentation.

Do I need supporting documents with this form?

Yes, please submit documents that contain the following:

  • Covered participant name
  • Provider name
  • Date of service
  • Description of coverage
  • Proof of premium

Examples of supporting documents

  • Explanation of Benefits (EOB)from insurance carrier
  • Itemized bill from provider
  • Receipt from pharmacy

Recurring Premium Reimbursement Claim Form

The Recurring Premium Reimbursement Claim Form is used to submit recurring expenses such as medical, prescription, dental and vision premiums

How is this form to be used?

Reimbursement of monthly premiums, including: Medical, Prescription, Dental (OneExchange or OPERS) and Vision (OneExchange or OPERS)

How often must I submit this form?

Must be submitted once per calendar year.

How quickly will I receive my reimbursement?

Initial monthly reimbursement should be received the month following submission of the form and documentation.

Do I need supporting documents with this form?

Yes, please submit documents that contain the following:

  • Covered participant name
  • Provider name
  • Date of service
  • Description of coverage
  • Proof of premium

Examples of supporting documents

  • OPERS Health Care Premium Receipt
  • Carrier proof of coverage (Proof of Coverage/Evidence of Coverage letter)
Proof of payment

Recurring claim forms require supporting documentation that contains a proof of payment. Documents that can be used as Proof of Payment include, but aren’t limited to:

  • Cancelled check
  • Checking/savings account statement*
  • Credit card statement*
  • Provider or facility receipt
  • Notice of Medicare Premium Payment Due (for Medicare Part B premium reimbursement only)
  • Benefit Award letter, if Medicare Part B premiums deducted from SSA check (for Medicare B premium reimbursement only)
  • Policy statement (for Medicare Part D premium reimbursement only)

* Personal information not applicable to the reimbursement should be deleted or blacked out.

Submit claims online

Claims may also be submitted through your online OneExchange account. For step-by-step instructions, refer to the OneExchange Getting Reimbursed Guide.

For Caregivers and Families

A trusted resource (such as a caretaker, family member or friend) can be given as little or as much access to your HRA account as you'd prefer.

To provide someone with these privileges, you will need to contact OneExchange and provide them the appropriate authorization form: Authorized Representative Full, Authorized Representative Limited, and/or Power of Attorney.

To discuss the Health Reimbursement Arrangement

To grant someone permission to discuss your OneExchange account, they must call OneExchange with you (the account holder) on the line.

Under this designation, they cannot sign forms, enroll or change your selected plan.

After the initial call, a person with these privileges will not have to call OneExchange with the account holder on the line.

To speak on the retiree's behalf

In order to speak on your behalf, you (the account holder) must fill out and submit the Authorization to Release Personal Information form.

This form is available through your OneExchange online account, under the Funding section, or by calling OneExchange directly.

To be granted full control of the Health Reimbursement Arrangement

To manage full activity of the account when you are no longer able to do so, a Power of Attorney or Guardianship of the Estate document must be on file with OneExchange.

This document can be obtained with the assistance of an attorney and should be mailed or faxed to OneExchange.

Assisting someone who has recently passed

If you are assisting someone who recently passed away, you will need to notify OPERS (1-800-222-7377) and OneExchange (1-844-287-9945) that the OPERS benefit recipient is deceased.

You will also need to inform medical and pharmacy carriers to stop charging monthly premiums.

More Information

More information for caregivers can be found within A Guide for Caregivers and Families.

Did you know?

Medical expenses after a retiree passes away

Any outstanding, qualified medical expenses in the retiree’s name can be submitted to the retiree’s Health Reimbursement Arrangement for reimbursement up to 24 months following the retiree’s death.

Eligible spouses and dependents can also submit qualified medical expenses to the HRA for reimbursement until the funds in the HRA are exhausted. The balance of the HRA will be forfeited into the OPERS health care fund after 24 months of inactivity on the account.