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2009 OPERS Health Care

Jason DavisDevon HooperOPERS

Ohio University March 18, 2009

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History of OPERS Heath Care

• 1962 - OPERS first offered health care coverage to its retirees (retiree paid the entire premium)

• 1974 - OPERS first began paying the premium for recipients

• 1975 - OPERS expanded its health care services to include Kaiser, thereby offering its first HMO

• 1986 - Health care eligibility increased from needing 5 years of service credit at retirement, to 10 years of service credit

• 2007 - Restructured OPERS Health Care Plan

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Service Retirement Qualifications

Pension:

• 5 years service credit at 60 years of age

• 25 years service credit at 55 years of age

• 30 years service credit at any age

Health Care:

• You must meet qualifications above and have 10 years of qualifying service credit to be eligible for OPERS health care

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Eligibility Highlights

• Retiree only eligible for health care from one Ohio retirement system (ORS)

• Spouse of OPERS retiree cannot terminate other ORS coverage to be covered under OPERS

• Spouses under 55 of age & service retirees will pay full health care premium in 2011

• Health Care costs determined by length of service credit & date eligible for retirement

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Three Groups

Group 1 Retirees

• Hired on or before January 1, 2003 and eligible to retire with health care before January 1, 2007

Group 2 Retirees

• Hired before January 1, 2003 and eligible to retire with health care after January 1, 2007

Group 3 Retirees

• Hired after January 1, 2003 and eligible to retire with health care after January 1, 2007

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Eligible Dependents

• Your Legal Spouse

• Your Children:

- Biological and/or legally adopted

- Under age 18, never married and financially dependent upon you

- Under age 22, never married, financially dependent upon you, and attending an accredited school full-time for at least 5 months of the calendar year

• Grandchildren, only if legally adopted or with a court order pursuant to the Ohio Revised Code

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Dependent Coverage

• You may add coverage for a dependent during Open Enrollment or within 60 days of a qualifying event such as:

- Involuntary loss of health insurance

- Marriage

- Birth of a child

• You may drop coverage for a dependent at any time

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OPERS Health Care Plan

The Enhanced Plan Highest premium cost to retirees, lowest out of pocket costs (deductibles, coinsurance, etc.)

The Intermediate Plan Middle ground between Enhanced Plan and Basic

The Basic Plan Lowest premium cost to retirees, highest out of pocket costs (deductibles, coinsurance, etc.)

• Medical Mutual & Aetna administer the OPERS Health Care Plan

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OPERS Medical Coverage

Non-Medicare retirees:

• Lower out of pocket costs by using network providers

• Aetna and Medical Mutual have different provider networks

Traditional Medicare retirees:

• Have no defined provider network

• Medical Mutual/Aetna pay after Medicare

• Member must meet annual deductible before most services are paid

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Medicare & Your Health Coverage

• Medicare A is your hospitalization coverage

• Medicare B is medical coverage

- Everyone is eligible, usually at age 65

- Enrollment is required when first eligible

- Proof of Enrollment must be submitted to OPERS

• OPERS will reimburse retiree for the basic cost of his/her Medicare B premium ($96.40 in 2009)

• Once retired OPERS will send Medicare letter to member & spouse prior to age 65

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Aetna Medicare Open Plan

• All retirees and covered spouses with Medicare A & B and Medicare B who live in the U.S. and not covering children are eligible

• Claims are sent to Aetna only using one ID card

• Pays doctors and facilities using the same pay schedule as Medicare

• The plan offers physicians fast payment and less paperwork

• Providers must agree to accept terms and conditions of the Aetna Medicare Open Plan

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Alternate Plans

• AultCare PPO Plan

- Lower out of pocket costs by using network providers

• Kaiser Permanente HMO Plan

- Medical, vision & dental coverage- Must use Kaiser network providers

• Contact Kaiser or Aultcare for enrollment materials

• Both plans only available in select Ohio counties

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Prescription Coverage

• Administered by Express Scripts

• 30-day supply at retail pharmacy

• 90-day supply through mail order

• No cost savings through mail

• Lower co-payment for generic & formulary drugs

• Call Express Scripts or access Web site to ensure that a medication is on the formulary list

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Optional Coverage

• Aetna Vision and Dental

– High Option– Low Option

• Long Term Care

– Available at retirement– Medical underwriting will apply

• Separate premiums from your medical coverage

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Preventive Coverage

• A few examples are:

- Routine physical exam up to $100 - Preventive services such as PAP, PSA, EKG, Colonoscopy, Mammogram, Bone Density Test

• Most preventive services covered once per calendar year

• Deductibles & copays do not apply

• Educate your physician’s office about your preventive coverage

• Routine vs Medical

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OPERS Wellness Programs

Gordian Healthy Living/Healthy Retirement

• Health Coaching Program for Non-Medicare recipients

• $100 incentive

Aetna Medicare Open Wellness Program

• Free fitness center memberships

• Health Coaching program

• $100 incentive

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Retiree Medical Account

• The incentive earned will be placed into the retiree’s RMA– An RMA will automatically be created by

OPERS

• The RMA can be used for additional/future health care expenditures– It is not taxable– Can be rolled over from year to year– Currently earns a 4% rate of interest– Administered by Aetna

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Important Cost Information

• Online Health Care estimate via MBS

• Request estimate by phone

• Health Care Open Enrollment cost statement

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OPERS Health Care Calculator

SAMPLE

Group 2 retiree

10 years service credit

First eligible to retire in 2008

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OPERS Health Care Calculator

SAMPLE

Group 2 retiree

30 years service credit

First eligible to retire in 2008

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OPERS Health Care Plans and RMA

Enhanced OPERS Pays Plan Cost RMA

Intermediate OPERS Pays Plan Cost RMA

Basic OPERS Pays Plan Cost RMA

$0

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Health Care Plan Selection

• Contact OPERS to receive retirement packet

• Send back health care application before your pension effective date

• Retiree locked into plan level selection (Enhanced, Intermediate or Basic) for two years with the following exception: – Retiree may change plan levels upon aging

into Medicare at age 65

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Remember These Points

• Pre-existing conditions accepted

• Employer Plan vs. OPERS Retiree Plan

• If re-employed in an OPERS position retiree must take health care insurance if offered

• Enroll in Medicare as soon as possible

• Under pension plan of payments A, C, D or F your beneficiary may be eligible for health care if you were eligible

• Health care coverage is subject to change

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Important Phone Numbers

• Aetna - 1-800-645-5677

• Aetna Medicare Open Plan - 1-866-282-0631

• Medical Mutual Kaiser - 1-800-854-8139 - 1-800-686-7100

• Aetna Dental Aetna Vision - 1-800-879-4337 - 1-800-645-5677

• Express Scripts AultCare -1-866-727-5873 - 1-800-344-8858

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Questions?