Medical Mutual PPO Plan OPERS Retiree Health Plan
The OPERS Retiree Health Plan for participants not yet eligible for Medicare is administered by Medical Mutual.
The OPERS Retiree Health Plan is a network/PPO plan. In Ohio, and several other states, Medical Mutual has a network of doctors and hospitals. This network gives retirees access to an extensive list of doctors, hospitals and other health care professionals. Call Medical Mutual customer service at 1-877-520-6728 to find network providers in your area.
As the administrator of the Retiree Health Plan, Medical Mutual provides plan participants with the following support:
- Claims processing, payment and appeals based on plan coverage
- Dedicated Customer Care Specialists
- Programs to help live healthier and manage serious or ongoing medical conditions
- Online access to view claims and coverage information on My Health Plan, the secure member website
- A mobile app to check claims and deductibles, look up providers and access your identification card
If you are a Medical Mutual plan participant you have access to a variety of wellness programs that cater towards differing lifestyles to help reach personal goals. You also have access to cost savings resources such as coverage maximums and the My Care Compare tool.
For more detailed program information, refer to the Staying Healthy section of the Medical Mutual OPERS Participant Coverage Guide.
As prices on goods and services steadily climb, protecting your pocketbook may prove to be challenging.
If you are a Medical Mutual plan participant, check out the suite of tools designed to offer savvy saving solutions that may do just that-help protect personal funds and further stretch the dollar.
Did you know?
Preventive tests and services are covered at 100 percent...
...and are not subject to the plan deductible under Medical Mutual (the provider must bill these services as either routine or preventive). OPERS follows preventive services guidelines as recommended by the U.S. Preventive Services Task Force, Centers for Disease Control and Prevention and Advisory Committee on Immunization Practices.
Medical Homes cost you less
A Medical Home is not a physical destination; rather, it is a team of health care professionals led by a primary care physician (PCP) who work together to give you comprehensive and coordinated care. Because OPERS believes that this care model is so important in helping retirees manage health, we offer a lower copay for care received from a SuperMed Network provider recognized as a Medical Home. Talk to your doctor or access the online provider search tool to find out if your current PCP is a part of a Medical Home.
Where you go for care can make or break the bank
Providers can charge different amounts for the exact same service. Medical Mutual’s My Care Compare tool provides you the ability to look up information on estimated cost, patient satisfaction, service locations and more.
You can choose any network lab provider; however, be aware of providers' rates as some may be above the coverage maximum (the most the plan will pay for certain lab services). Costs above the coverage maximum are the responsibility of the plan participant. When receiving lab services, keep the coverage maximum in mind. You can go to any network lab provider, but to save money, go to one whose rates match or are below the coverage maximums. Log into your secure My Health Plan account or call Medical Mutual Customer Care at (877) 520-6728 to learn more.
Income-Based Assistance Program
If the premium to cover a pre-Medicare spouse 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.
Additionally, depending on income level, you could qualify for substantial help from the federal government to help pay for a plan.
Ways to save on prescription medications
Know your options
Prescription drugs are commonly categorized into tiers that range from generic to specialty medications. Be sure to ask your doctor if a generic version of your prescribed medication is available and right for you. Refer to the Express Scripts prescription drug plan page for specific plan information.
Switch to lower cost options
If you are taking a specialty medication, talk with your doctor about switching to lower cost oral or self-injectable traditional, specialty or biosimilar drugs.
Find the best price
Retirees Like Me Examples of other Pre-Medicare Retirees
The following scenarios show a 2020 snapshot of what it will cost to insure Jim, Linda and Charles who have all retired at different stages during public employment and are not yet eligible for Medicare.
83 percent of pre-Medicare retirees will receive at least 75 percent allowance from OPERS toward the cost of coverage in 2020.
Jim loves reading books and spent his entire career working in the library system.
After working 35 years in an OPERS-covered position, Jim retired in 2017 at the age of 64. He now spends his time gardening and catching up on the latest New York Times Best Seller novels.
|90% Allowance example|
As an avid lover of numbers, Linda spent her entire career as an accountant for her hometown city office.
After 29 years serving the public, she retired to spend more time with her extended family.
|75% Allowance example|
Charles spent half of his career in the private sector before moving into an OPERS-covered position at a local university.
He retired at age 60 in 2015 and currently spends his time fishing and exploring the outdoors.
|51% Allowance example|