Health Care

The latest information concerning retiree health care benefits is featured below. Additional information from our health care partner, Aon Retiree Health Exchange, can be found at a special website for OP&F members.

In the spring of 2017 the OP&F Board of Trustees made the decision to restructure the retiree health care plan, ending the group-sponsored model that was in place for several years. A new model has been implemented as of Jan. 1, 2019. This model will provide eligible retirees with a fixed stipend earmarked to pay for health care. OP&F, through its partner, Aon, will assist in finding the right plan for each retiree. It is OP&F’s goal that the move to a new health care option will extend available funding for health care to approximately 15 years. Current projections show that without changes, funding for retiree health care will be depleted in less than 10 years.


Important contact information:


Aon Retiree Health Exchange 1-844-290-3674, Monday – Friday,
8 a.m. – 9 p.m. Eastern Time

Aon website for OP&F retirees
myexchangeconnection.com

Eligibility

A retiree is eligible for the OP&F health care stipend unless they have access to any other group coverage including employer and retirement coverage. The eligibility of spouses and dependent children could increase the stipend amount. If the spouse or dependents have access to any other group coverage including employer or retirement coverage they are not eligible for stipend support from OP&F. Even if an OP&F member or their dependents are not eligible for a stipend, they can use the services of the Aon Retiree Health Exchange to select and enroll in a plan.

When you submit a Service Retirement Application or a Disability Benefit Application, members must also complete the Health Care Stipend Eligibility form, which is included in your retirement packet. New retirees must enroll in health care and\or prescription drug coverage through the Aon Retiree Health Exchange within 60 days of losing access to health care from their employer. If more than 60 days elapse, the member must have a Qualifying Life Event (QLE) to again become eligible for the stipend.

For OP&F members, a QLE must occur to enroll and to be eligible for a stipend. Other common QLEs include marriage (pre-Medicare only), divorce, at the time of Medicare eligibility, birth or adoption of a child and death.

Once OP&F receives the Health Care Stipend Eligibility form and confirms your eligibility for the stipend, it will take approximately two weeks for Aon (OP&F’s health care partner) to send out information about enrolling in a health care plan and using your stipend to help pay for the plan. OP&F will notify the member if they are not eligible for a stipend.

2020 OP&F Retiree Health Care Plan Monthly Stipend Levels

  Medicare Status Monthly
Medical/Rx
Stipend
Monthly
Medicare Part B Reimbursement
Total OP&F
Monthly Support
for Health Care
Retiree Spouse
Retiree only: Medicare   $143 $107 $250
Non-Medicare $685 $0 $685
Retiree + Spouse: Medicare Medicare $239 $107 $346
Medicare Non-Medicare $525 $107 $632
Non-Medicare Medicare $788 $0 $788
Non-Medicare Non-Medicare $1,074 $0 $1,074
Retiree + Dependent(s): Medicare   $203 $107 $310
Non-Medicare   $865 $0 $865
Retiree + Spouse + Dependent(s): Medicare Either Medicare or Non-Medicare $525 $107 $632
Non-Medicare Either Medicare or Non-Medicare $1,074 $0 $1,074
Surviving Spouse: Medicare   $143 $107 $250
Non-Medicare   $685 $0 $685
*The OP&F Medicare Part B reimbursement is an ongoing benefit that has been in place for many years, but should be included in the support provided for health care coverage. The Med B reimbursement is added to a member’s monthly pension benefit. (updated 8/8/2018)

Health Reimbursement Accounts

Once enrolled in an eligible plan, the providers you have selected will contact Aon, who will then create an HRA for the member. Members should be aware that once they enroll with a health care provider, a premium may be required. Reimbursement for this premium through your HRA may not be available for several weeks.

A single HRA will be available to the member, regardless of the stipend amount and number of participants enrolled in a plan. The HRA will be in the member’s name, but all participants may submit claims. The stipend will be prorated based on your month of retirement and an annualized amount will be provided for use during the year. At the end of the year, any amounts not used will be forfeited. However, participants will receive a full annual stipend amount each Jan. 1.


image 1
image 2

Qualifying Life Events (QLE)

If you experience life changes outside of the open enrollment period you may qualify for a Special Enrollment Period. However, these qualified life events may be different for Medicare and non-Medicare plan enrollees. Qualifying life events include:

  • At the time of your OP&F retirement and loss of your employer group coverage within 60-days;
  • Marriage (pre-Medicare only) as long as the member or spouse had coverage 60-days prior;
  • Death or divorce resulting in loss of group coverage;
  • Involuntary loss of group coverage
  • Involuntary loss of individual coverage due to plan ended contract with Medicare/Affordable Care Act;
  • At the time you become eligible for Medicare;
  • Loss of premium assistance for member or dependent child under a Medicaid plan or Children’s Health Insurance Program (CHIP);
  • Loss of Medicaid or CHIP coverage for member or dependent child;
  • Moving out of service area;
  • Becoming a dependent as a result of birth, adoption or placement in foster care;
  • Plan renewing outside of enrollment period;
  • Becoming a U.S. Citizen;
  • Income increase that moves out of poverty level;
  • Income changes that make a person newly eligible or ineligible for premium tax credits or cost-sharing subsidies, if already enrolled in the exchange; or
  • Native Americans\Alaskan Natives as defined by the Indian Health Care Improvement Act.

Pre-Medicare Enrollment

Once the information is received from Aon, members who are not yet eligible for Medicare can create an account with Aon and shop for plans on the eHealth website which is customized for OP&F retirees. As a pre-Medicare participant you will not have a scheduled appointment, however, if you need additional assistance Aon and eHealth will be able to assist you.

Members must follow the path for enrollment from the Aon retiree website and not through eHealth directly, otherwise Aon will not be able to track you and you will lose stipend and HRA eligibility.

Non-Medicare participants can shop coverages in their area using the Health Coverage Resources website to see live plan option information. It is critical that members do not follow through with enrollment from this site. If they do, Aon will not be able to track them and members will lose HRA eligibility. This should only be used for modeling.

For Non- Medicare-eligible participants:

  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
    • And for the Special Enrollment Date field, the date entered cannot be more than 30 days out
  5. It will then tell you 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

Medicare Enrollment

Retirees who are 65 years of age or older must be enrolled in Medicare Part A and Part B and provide OP&F with a copy of your Medicare card. This is also necessary for early Medicare recipients. If OP&F determines that you are eligible to receive the stipend, you must enroll in health care plan and/or prescription drug plan through the Aon Retiree Health Exchange within 60 days of losing access to your employer’s group health care plan. Medicare-eligible members will receive information from Aon to have a scheduled phone appointment with an Aon benefits advisor who can assist you in what plans are available to supplement your Medicare coverage. To contact Aon, please call 1-844-290-3674, Monday – Friday, 8 a.m. – 9 p.m. Eastern Time.






COBRA

If you are applying for a disability benefit OP&F encourages you to apply for COBRA coverage through your employer for health care. Once you leave employment there will likely be a gap between when your employer’s health care coverage expires and when you will be eligible to enroll in a plan through OP&F. Obtaining COBRA coverage will prevent a lapse in coverage while your disability application is being considered, and COBRA premiums are also a stipend-eligible expense.

To qualify for a stipend from OP&F you must become eligible for the OP&F health care stipend during the next open enrollment period. If you do not become eligible during the next open enrollment period, you will need to remain on COBRA until the contract period ends.