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OPERS Health Care Resources

This page is designed as a resource for all OPERS health care guides and coverage booklets. Please click on the links below for more information regarding the OPERS health care coverage.

RESOURCES
OPERS Health Care Coverage Guide

The 2014 Health Care Coverage Guide explains health care coverage that applies to individuals in the Traditional Pension and Combined plans who qualify for health care coverage at retirement.

Medicare Guide

OPERS has created this publication to help you understand how we work with Medicare and to help you navigate the Medicare enrollment process with Social Security. This guide will help explain how Medicare works in conjunction with the following OPERS health care coverage options:

  • The Humana Medicare Advantage Plan
  • The Medical Mutual Plan
  • Healthspan (formerly known as Kaiser Permanante) (only available in certain Ohio counties)

RMA Wellness Incentive Guide

This guide will explain the details of our wellness programs offered by OPERS through Humana and Medical Mutual and how the incentives earned through these programs apply toward your Retiree Medical Account (RMA).

OPERS Prescription Coverage – Express Scripts

This guide explains OPERS' prescription coverage for both Medicare and Non-Medicare participants administered by Express Scripts.

OPERS Humana Medicare Advantage Plan

These Evidence of Coverage documents explain in detail the OPERS Medicare Advantage Plan for both Medicare A & B participants and Medicare B only participants.

OPERS Retiree Health Plan – Medical Mutual

This Medical Plan Description explains in detail OPERS' medical coverage for participants enrolled in Medical Mutual.

Uniform Glossary of Terms

This document provides a glossary of health coverage and medical terms required by the Affordable Care Act (ACA).

HIPAA Authorization

Federal law prohibits the release of protected health information to a third party without the written authorization of the participant who is receiving health care coverage from OPERS. If an individual is receiving health care coverage from OPERS and would like to authorize a third party to receive personal health information related to the individual’s health care coverage, they must complete the HIPAA authorization form. The HIPAA authorization form will not authorize the release of confidential pension account information.

For release of confidential pension information, the member/recipient must complete the Authorization for Release of Account Information (LL-2) which can be found here.

Summary of Benefits and Coverage

In addition to our existing OPERS communications above, we are pleased to introduce new 2014 OPERS summary of benefits and coverage booklets (SBC), which are required by the Affordable Care Act (ACA). The following links will provide access to each specific 2014 SBC broken down by the following plans:

Medical Mutual

(This SBC includes medical coverage administered by MMO and pharmacy coverage administered by Express Scripts)

OPERS Health Care Plan for Non-Medicare participants who reside within any Medical Mutual or affiliated provider network areas.  To find network providers by zip code, please access medmutual.com.

(This SBC includes medical coverage administered by MMO and pharmacy coverage administered by Express Scripts)

This is an out-of-area OPERS health care plan for non-Medicare participants who reside outside of any  Medical Mutual or affiliated provider networks.  For more provider information, access medmutual.com.

(This SBC includes medical coverage administered by MMO and pharmacy coverage administered by Express Scripts)

OPERS Health Care Plan for Medicare participants who are also enrolled in the OPERS Medicare D Prescription Drug Plan.  The medical coverage through Medical Mutual is not a Medicare Advantage Plan.  Instead, it is a Medicare supplement plan that pays after Medicare.  This plan is typically only for participants who have other primary coverage medical coverage.

(This SBC includes medical coverage administered by MMO and pharmacy coverage administered by Express Scripts)

OPERS Health Care Plan for Medicare participants who are also enrolled in the OPERS Medicare commercial prescription drug plan.  This is not a Medicare Advantage Plan or a Medicare D prescription plan. Instead, the medical coverage through Medical Mutual is Medicare supplement plan that pays after Medicare. This plan is typically only for participants who have other primary medical and prescription drug coverage.

(This SBC includes medical coverage administered by MMO)

OPERS Health Care Plan for Medicare participants who are not enrolled in OPERS pharmacy coverage. The medical coverage through Medical Mutual is not a Medicare Advantage Plan.  Instead, it is a Medicare supplement plan that pays after Medicare.  This plan is typically only for participants who have other primary medical coverage and have opted out of the OPERS Medicare D prescription drug plan.


Healthspan (formerly Kaiser Permanante)

(This SBC includes medical coverage administered by Healthspan and pharmacy coverage administered by Express Scripts)

This is a plan that provides comprehensive coverage to Medicare retirees and dependents who utilize providers within the Healthspan (formerly Kaiser Permanante) network or non-network providers that accept Medicare.  This plan is only offered to participants who reside in the following counties: Cuyahoga, Geauga, Lake, Lorain, Medina, Portage, Stark, Summit and Wayne.

(This SBC includes medical coverage administered by Healthspan (formerly known as Kaiser Permanante) and pharmacy coverage administered by Express Scripts)

This is an HMO plan that provides comprehensive coverage and requires Non-Medicare participants to use network doctors and hospitals. This plan is only offered to participants who reside in the following counties: Cuyahoga, Geauga, Lake, Lorain, Medina, Portage, Summit.


Humana

(This SBC includes medical coverage administered by Humana)

This is a plan for Medicare participants that typically have incorrect Medicare information according to CMS guidelines.  This plan has very few participants enrolled and they are typically enrolled for a short period of time.  This plan is not a Medicare Advantage Plan.  Instead, it is a Medicare supplement plan that pays after Medicare. 

The Humana Medicare Advantage Plan does not have an SBC because it was not required according to guidelines of the Affordable Care Act (ACA). 

Please Note: OPERS retirees and dependents are automatically enrolled in an OPERS health care plan based upon the following: Medicare status, participant’s other health care coverage, The Center for Medicare & Medicaid (CMS) guidelines and place of residence. 

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