OPERS Medicare Connector Health Reimbursement Arrangement
A Health Reimbursement Arrangement, or HRA, is the account in which OPERS deposits a monthly allowance and is administered by OneExchange.
This tax-free account can accumulate from month to month and, unlike most flexible spending accounts, the balance will roll over from year to year.
What can I use my HRA funds for?
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.
To be eligible to receive the HRA, you must be:
- Currently eligible for OPERS health care coverage as a primary benefit recipient
- Enrolled in both Medicare Parts A and B
- 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 are funds, or allowances, available in your account.
There are two different ways to receive reimbursements from your HRA: automatic and manual.
Automatic reimbursement applies to monthly Medicare medical and prescription plan premiums only and allows you to be reimbursed for premiums without submitting a monthly reimbursement request form.
To arrange for automatic reimbursement, contact OneExchange. Please note that not all insurance carriers offer automatic reimbursement through OneExchange.
Manual reimbursement applies to monthly premiums (medical, prescription, Medicare Part B, vision and dental) and out-of-pocket costs.
You are responsible for submitting monthly premiums to your insurance carrier and paying for any out-of-pocket expenses incurred at your provider. Then, you can submit a claim form coupled with supporting documentation to seek reimbursement for costs from your HRA.
Recurring Premium Reimbursement Claim Form
The Recurring Premium Reimbursement Claim Form form is used to submit recurring expenses such as medical, prescription, dental and vision premiums
What can I use this form for?
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 payment
Examples of supporting documents
- Vision/dental premium receipt from OPERS
- Enrollment acknowledgement received from OneExchange
- Other docs from insurance carrier
All 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. Simply log in to your personal account and select the Funds & Reimbursements tab from the drop down menu. Once there, click the Reimbursement Center button and then select File a Spending Account Claim from the Quick Links menu.
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 Onexchange and/or provide them with certain documents, as detailed below:
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 the HRA administrator (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 for caregivers can be found within A Guide for Caregivers and Families.
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.