OP&F News

Eligibility for the OP&F health care stipend: What to do when you have a QLE

To become eligible for the OP&F health care stipend, a Qualifying Life Event, or QLE, must first occur. A common QLE is the involuntary loss of group health care coverage, which can happen when a member or spouse becomes unemployed and their employer’s plan is no longer available.

There is a 60-day window to apply for the OP&F health care stipend after the loss of group coverage. The first step to applying is to complete OP&F’s Health Care Stipend Eligibility Form, found here on the OP&F website. The completed form can be faxed to OP&F at 614-628-1777, emailed to questions@op-f.org, sent via U.S. mail, or dropped off in OP&F’s lobby mailbox. This will start the process for OP&F to establish eligibility to receive the health care stipend.

OP&F will acknowledge receipt of the form and request additional documentation, such as proof of loss of coverage and proof of enrollment in an eligible plan. We will also send the member’s information to our retiree health care partner, Aon, who will mail a welcome kit and other materials. Additional information is on the health care section of the OP&F website, and Aon’s OP&F-specific websites. Links to these websites are also under the retiree section of the OP&F homepage.

For Non-Medicare-eligible participants, Members can shop for coverage prior to receiving the Aon welcome packet. The instructions below should be used for information and pricing information only. Do not follow through with the enrollment process from the website below.

  1. Go to healthcoverageresources.com/Aon/home
  2. Selected Early Retiree Plans
  3. Click on the federal subsidy Coverage Calculator
  4. Answer the questions but
    • Say No to the COBRA coverage question
    • Under qualifying event select Loss of Coverage
    • For the Special Enrollment Date field, the date entered cannot be more than 30 days out
  5. It will tell you if you’re not eligible for a federal subsidy and then click on See Plan Options
  6. It transfers you to eHealth
  7. You will now see plans

Members may also enroll in COBRA, or shop for major medical qualified health plans on their own, either online or at healthcare.gov or from a broker of their choice. It is important to get enrolled in an eligible plan within 60 days of losing access to the employer’s plan. Otherwise, a member may have to wait until the next open enrollment period, which is typically in the fall of each year. Please be aware that while COBRA is an eligible stipend expense for members, if the COBRA coverage is through a spouse or dependent's previous employer, those expenses are not eligible for reimbursement with the OP&F health care stipend.

For Medicare-eligible participants, the member must contact the Aon Retiree Health Exchange at 844-290-3674 to enroll in either a major medical or prescription drug plan through Aon to receive the stipend. Short-term plans, Christian and other cost sharing and group plans are not eligible for the stipend. Finally, members who get enrolled by the 15th of the month will have coverage effective the 1st of the following month, which will be important to avoid having a gap in coverage.

Posted 4/08/2020, updated 7/2/2020

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