Health Care Resources

If you have questions about OPERS health care, browse the materials listed below. They cover everything from eligibility and plan details, to information on providers and federal health care issues.

Documents

Refer to the documents below for more information regarding OPERS health care coverage.

OPERS Health Care Coverage Guide (2018)

The 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.

Medical Mutual Medicare Plan - Medical Plan Description (2018)
Medical Mutual Pre-Medicare Plan - Medical Plan Description (2018)

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

Understanding the Basics: Medicare and OPERS Connector Basics Guide

This guide reviews important steps to take for enrolling in Medicare and a medical/prescription plan supplement, addresses differences between Medigap and Medicare Advantage plans, provides detailed information about the reimbursement process and much more.

HRA Summary Plan Description (2018)

The Summary is designed to help eligible participants understand how the HRA works and describes the benefits available, advantages of a health reimbursement arrangement and key features of the HRA.

HIPAA Authorization

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).

Prescription Drug Coverage Summary Plan Description (2018)

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

Health Care Report

This report explains OPERS health care operations.

Humana Interim Plan description for Medicare A & B participants

This Summary Plan Description explains in detail the OPERS Humana Interim Plan for Medicare A & B participants and those who do not qualify for premium-free Medicare Part A.

Affordable Care Act Glossary of Terms

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


Summary of Benefits and Coverage

In addition to our existing OPERS communications above, we have included the 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 SBC broken down by the following plans:

Medical Mutual (MMO)


Important Links

Below you will find links to important health care resources, including health care providers, RMA fact sheets and other reference materials.

Health Care Providers

Retiree Medical Account (RMA)

Federal Health Care Issues