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OPERS Health Care Program

Frequently Asked Questions

General

What is Via Benefits?

OPERS has partnered with Via Benefits to create the OPERS Connector. Via Benefits Insurance Services, founded in 2004, has helped more than 2 million people evaluate and enroll in individual health insurance. Via Benefits is a resource offering personal service to help retirees understand coverage options through a robust online experience supported by a customer service team. It operates the first and largest Medicare marketplace in the country and, in 2014, expanded to include individual and family plans for Pre-Medicare retirees.

What is a Health Reimbursement Arrangement?

An HRA is an account funded by OPERS that provides tax-free reimbursement for qualified medical expenses such as monthly insurance premiums, deductibles, co-insurance and co-pays incurred by eligible retirees. Via Benefits will administer the HRA.

Benefit recipients can use their HRA to be reimbursed for qualified medical expenses. Only OPERS can contribute funds to the HRA. Benefit recipients cannot add their own funds and they must submit a request for reimbursement including supporting documentation for Via Benefits to approve and release the money from the HRA into the benefit recipient's personal bank account. Expenses are determined eligible for reimbursement based on IRS guidelines.

Will the funds in my HRA expire at the end of each year?

No. Benefit recipients can carry their HRA balance from year to year and continue using the funds to be reimbursed for qualified medical expenses.

Can benefit recipients make contributions to their HRA?

No. Federal regulations are clear that the contributions can only come from the employer (OPERS in this case) and cannot be reduced by "salary reduction" (taking it from the pension).

Will benefit recipients receive HRA deposits for dependent children?

No. Dependent children will not receive HRA deposits. However, retirees can choose to use HRA dollars to be reimbursed for qualified medical expenses incurred by eligible dependents.

Will I be charged to use the OPERS Connector to find and enroll in a medical plan?

No. Services provided by the OPERS Connector are available to you at no cost. However, Via Benefits will charge a fee of $2.60 per month for the administration of the HRA.

Based on my monthly HRA deposit amount, I don't think OPERS is providing me enough money to cover my medical plan premium.

Covering the entire cost of health insurance is not the intention of the OPERS health care program. However, there is flexibility. To the extent that a participant opts for lesser coverage, he or she may be able to cover the full premium, and even have money left over to go toward dependent coverage or to save for future health care expenses.

Can benefit recipients living outside the United States and the District of Columbia receive HRA deposits?

Yes. Provided they meet the eligibility requirements, benefit recipients living outside of the United States of America and the District of Columbia will be able to opt in to the HRA and receive monthly deposits from OPERS. They may seek health care coverage through the foreign country in which they live or enroll in a plan with an insurance carrier that offers international coverage. When seeking reimbursement from the HRA, qualified expenses will need to be translated into English and US currency as of the date the expense was incurred.

Will my HRA earn interest?

Health Reimbursement Arrangements do not earn interest. This is not specific to OPERS, as no HRA earns interest. On the other hand, Health Savings Accounts (HSA) do earn interest, but these are a different type of account not offered by OPERS.

Can contributions be made to both a Health Savings Account (HSA) and an HRA at the same time?

Except in certain situations, the law does not allow an individual to have an HRA and contribute to an HSA at the same time. Please refer to your HSA provider or a tax advisor for more details.

If a benefit recipient is no longer contributing to a Health Savings Account (HSA) but they have an existing balance, can they receive reimbursements from both an HSA and their OPERS HRA?

Yes, but the IRS has specific rules that must be followed for an individual to seek reimbursement from an HSA and an HRA. Typically, an individual cannot be reimbursed for the same expense from both accounts. Please refer to the HSA provider you are seeking reimbursement from or a tax advisor for more details.

Does OPERS offer dental and vision plans?

Yes. OPERS offers optional group dental and vision plans. All OPERS benefit recipients can choose to enroll in these plans even if they're not eligible for the HRA. Eligible dependents also can be enrolled. Participants pay the full premium for these plans.

What should members consider when choosing a medical plan for retirement?

Benefit recipients should carefully consider the details of the plans that are available in their area. Weigh the pros and cons of having more or less coverage. For instance, would they prefer to pay higher premiums up front to pay less out-of-pocket costs for treatment? Or would they be better off with lesser coverage and lower premiums, which could allow them to save a portion of the HRA deposit each month? Via Benefits licensed benefit advisors can help guide retirees through this decision-making process.

Pre-Medicare Benefit Recipients

NEW My wife and I are both retired with an OPERS pension benefit and we both receive a monthly HRA deposit. We are enrolled in a family medical plan. How should we request reimbursement for our medical plan premium?

There are two ways that a married couple with two different OPERS HRAs can receive reimbursement for a family medical plan premium.

  1. One Spouse Requests Reimbursement for the Full Premium

    One spouse submits a request for reimbursement through the Via Benefits mobile app, online, or by mail for the entire monthly premium.

    Example: John and Jane Sample are enrolled in a family plan that has a monthly premium of $500.

    • John submits a reimbursement request and provides supporting documentation for the entire amount each month.
    • Via Benefits processes his request and $500 is deposited into his bank account.
    • The couple can then submit qualified expenses other than their medical plan premium for reimbursement from Jane's HRA.

  2. Both Spouses Request Reimbursement for Half of the Premium

    Both spouses submit a request for reimbursement for half the monthly premium.

    Example: John and Jane Sample are enrolled in a family plan that has a monthly premium of $500.

    • John and Jane each complete their own reimbursement requests (mobile app or online) or complete their own Reimbursement Request forms (by mail), each for $250.
    • If submitting the reimbursement by mail: John and Jane must write on the supporting documentation that they are a couple with their own HRAs and would like Via Benefits to split the premium. They should include their respective forms and supporting documents in one envelope and mail it to Via Benefits.
    • If submitting the reimbursement via online or the mobile app: John and Jane must write on the supporting documentation – before they take a picture of the documentation - that they are a couple with their own HRAs and would like Via Benefits to split the premium.
    • Via Benefits processes each of their requests and $250 is deposited into their respective bank accounts.
NEW I am enrolled in a group medical plan offered by my husband's employer. His employer deducts the premium from his check. I submitted this premium for reimbursement from my HRA, but it was denied because the premium is deducted pre-tax. Is there any way I can receive reimbursement?

No. A Pre-Medicare OPERS retiree can be enrolled in any medical plan they choose including a plan sponsored by their employer or a spouse's employer. However, they can submit employer-sponsored medical plan premiums for reimbursement from their HRA ONLY if those premiums were paid post-tax.

IRS Publication 502 spells out qualified expenses and specifically excludes employer-sponsored health insurance plan premiums unless the premiums are included as income. Most employer-sponsored plans are paid using pre-tax deductions, meaning the premium itself is not reported as taxable income for the employee. Because the employee has already received a tax-free benefit on the premium when it was deducted on a pre-tax basis, they may not receive a second tax-free benefit by receiving a reimbursement from their HRA for that same premium.

Are Pre-Medicare benefit recipients required to enroll in a medical plan through Via Benefits?

No. Pre-Medicare benefit recipients can enroll in any medical plan they choose. Although it's not required, we highly recommend that benefit recipients explore their coverage options through the OPERS Connector (Via Benefits).  Via Benefits is a resource that helps retirees understand and navigate individual and family health plan options.

Via Benefits isn't an insurance carrier. It's a company that provides:

  • Consulting – Via Benefits helps you understand your funding options. If you qualify for a federal subsidy, Via Benefits will walk you through a side-by-side comparison to help you decide between taking advantage of the federal subsidy or opting in to the OPERS HRA if eligible. By law, you can't have both at the same time.
  • Education, support, and assistance – Via Benefits provides these services to benefit recipients and their dependents when selecting and enrolling in individual or family coverage options.
  • HRA administrative services – Via Benefits reviews claims and issues reimbursements for all eligible recipients that opt into the HRA.
  • Ongoing benefit recipient support after medical plan enrollment – Via Benefits is an experienced, informed, and unbiased Connector that will help you understand your medical plan details at any time and help you re-evaluate your needs on an annual basis.
How much money will OPERS deposit into an individual's HRA?

Monthly HRA deposits will vary depending on the age when the benefit recipient first became eligible for the HRA and their qualifying years of health care service credit at retirement. The allowances will range from 51 percent to 90 percent of the base allowance amount. The Pre-Medicare base allowance amount is $1,200 from 2022 through 2024. It will be re-evaluated based on market conditions and funding. Benefit recipients can find their monthly HRA deposit amount within their OPERS online account. Members preparing for retirement can find their estimated monthly HRA deposit within the online estimator at opers.org.

Can Pre-Medicare benefit recipients cover dependents on their medical plan?

Yes. Retirees can choose between individual and family medical plans.

What if I choose not to enroll in a medical plan, will I still receive HRA deposits?

Yes. Enrolling in a medical plan is not a requirement for Pre-Medicare benefit recipients to receive HRA deposits. Pre-Medicare benefit recipients only need to meet eligibility guidelines and opt-in when eligible to receive HRA deposits.

If a Pre-Medicare benefit recipient is covered as a dependent on their spouse's medical plan or enrolled in an employer's plan, are they still eligible to receive HRA deposits?

Yes, if eligible for the OPERS health care program, they can receive HRA deposits. This is how an open HRA works. Benefit recipients can use the funds within their HRA to be reimbursed for qualified medical expenses such as post-tax premiums, deductibles, co-insurance, and other out-of-pocket expenses regardless of their medical plan.

Will a Pre-Medicare member with a pre-existing condition be refused coverage under a new medical plan for retirement?

No. Under the Affordable Care Act, health insurance companies can't refuse to cover individuals or charge them more just because they have a pre-existing condition — that is, a health problem you had before the date that new health coverage starts. This protection applies to all plans.

Are the medical plans offered through the OPERS Connector compliant with the Affordable Care Act?

Yes. All individual and family medical plans offered by healthcare.gov and the OPERS Connector's private market are compliant with the Affordable Care Act (ACA).

However, there are some differences between plans. The ACA designation of qualified health plan (QHP) is given to health insurance plans that are sold within the government-run marketplace (healthcare.gov). Basic rules apply to plans sold via healthcare.gov: they must be guaranteed issue (not impose pre-existing condition restrictions), follow the ACA's cost-sharing guidelines, and cover "essential health benefits" with no lifetime or annual maximums for coverage. A QHP is also eligible to be purchased using a premium tax credit.

Medical plans offered through the private market are considered non-qualified plans because they are not certified by healthcare.gov but they are ACA-compliant medical plans and follow the same basic rules as qualified health plans. Non-qualified plans are not eligible to be purchased with a premium tax credit.

Medicare Benefit Recipients

Are Medicare-eligible benefit recipients required to enroll in a medical plan through the OPERS Connector to receive HRA deposits?

Yes. Medicare-eligible benefit recipients participate in a closed HRA. This means they must be enrolled in a medical plan through Via Benefits to receive monthly HRA deposits.

Why doesn't OPERS also offer an open HRA to Medicare-eligible benefit recipients?

A "closed HRA" means that Medicare-eligible benefit recipients must be enrolled in a Medicare medical plan through the OPERS Connector to receive monthly HRA deposits from OPERS. Each year thousands of seniors are misled into purchasing fraudulent Medicare plans or Medicare plans that don't live up to what was promised. Using Via Benefits ensures that you will receive unbiased support in selecting a Medicare plan that best suits your individual needs.

How much money will OPERS deposit into an individual's HRA?

Monthly HRA deposits will vary depending on the age when the benefit recipient first became eligible for the HRA and their qualifying years of health care service credit at retirement. The allowances will range from 51 percent to 90 percent of the base allowance amount. The Medicare base allowance amount is $350 in 2022. It is re-evaluated periodically based on market conditions and funding. Benefit recipients can find their monthly HRA deposit amount within their OPERS online account. Members preparing for retirement can find their estimated monthly HRA deposit within the online estimator at opers.org.

Does OPERS offer reimbursement for Medicare Part A premiums?

Yes. OPERS reimburses benefit recipients who don't qualify for premium-free Medicare Part A for their premium and any penalty at 100 percent. Eligible spouses receive a 50 percent reimbursement.

Re-employed Retirees

How does the OPERS HRA work for re-employed OPERS benefit recipients?

During a re-employment period, monthly HRA deposits accumulate in a separate Re-employed Accumulated HRA, provided the re-employed benefit recipient opts into the HRA when eligible (Pre-Medicare benefit recipient) or enrolls and remains enrolled in a Medicare medical plan through Via Benefits (Medicare-eligible benefit recipient).

However, re-employed retirees cannot access the funds within the Re-employed Accumulated HRA while they're re-employed. It will become available once they terminate their re-employment and can be used to seek reimbursement for any expenses incurred outside of re-employment.

Re-employed retirees can have access to their HRA balance during re-employment to seek reimbursement for expenses incurred outside of re-employment.

If I become re-employed with an OPERS-covered employer only during a few months out of the year, will I have access to my HRA deposits during the months that I am not re-employed?

Yes, you will have access to your HRA funds, but can only be reimbursed for expenses outside of your re-employment period.

If I don't have access to the funds in my Re-employed Accumulated HRA during re-employment, will I still pay an administrative fee on the account?

Yes. Upon the termination of re-employment, an administrative fee of $2.60 will be deducted for every month in which the Re-employed Accumulated HRA received a deposit. The fee covers processing HRA deposits, reimbursements from your existing account and general maintenance.

What happens to my HRA if I return to work in a part-time position?

Re-employment in an OPERS-covered position, regardless of full-time, part-time, or seasonal status, means that your monthly HRA will be deposited in the Re-Employed Accumulated HRA.

How can I track the balance within my Re-Employed Accumulated HRA?

You can see and print the balance from your OPERS online account or by calling OPERS at 800-222-7377.

OPERS Vision and Dental Plans

Does OPERS offer dental and vision plans?

Yes. OPERS offers optional group dental and vision plans. All OPERS benefit recipients can choose to enroll in these plans even if they're not eligible for the HRA. Eligible dependents also can be enrolled. Participants pay the full premium for these plans.

I prefer to keep my current provider. There is not an in-network provider in my area. What are my options?

The OPERS Vision Plan offers the MetLife Superior Vision network which is the largest provider network in the country with a balanced network with both independent and retail providers. The MetLife Superior Vision network has expanded network access to include full benefits at 50 of the nation's top 50 retailers including Costco, Walmart, and Sam's Club, with over 118,000 nationwide access points.

To maximum the benefits you receive through your vision plan, visit an in-network provider. However, your vision plan does not require you to seek services from an in-network provider. We have designed the program to reimburse you for many of the services if you receive care from an out-of-network professional.

If you would prefer to maintain your current out-of-network vision provider, you have the following options:

  • Ask your provider to join the MetLife Superior Vision network. They can sign up for the network at https://superiorvision.com/eye-care-professionals/join/apply/.
  • Continue to see your current provider, pay for your exam or materials up front, then submit a claim to MetLife to be reimbursed from your out-of-network allowance. Claim forms can be found by visiting metlife.com/opers. Click on Resources under Additional Resources, then click on the Vision Expense Claim form under the Vision Product Overview.
Will becoming eligible for Medicare cancel my OPERS vision and/or dental coverage?

No. Becoming Medicare-eligible does not impact your OPERS vision and/or dental coverage.

If I enroll in a vision and/or dental plan through Via Benefits, will my OPERS vision and/or dental plans be terminated automatically?

No. Your enrollment in the OPERS plan(s) will not automatically terminate. If you do not want to be enrolled in the OPERS vision and/or dental plans, you must cancel the coverage by contacting OPERS during open enrollment (October 15 – December 15). You may cancel coverage by calling OPERS at 1-800-222- 7377 or by submitting the Vision/Dental Open Enrollment Change Form provided annually within your open enrollment packet.

Can I cancel or change coverage levels for my OPERS vision and/or dental coverage outside of open enrollment?

No. Enrollment in the OPERS vision and/or dental plans is for the entire calendar year. Changes can only be made during open enrollment. If you are currently enrolled in more than one vision and/or dental plan, you should evaluate your needs and make any necessary changes during open enrollment.

Both my spouse and I are OPERS benefit recipients enrolled in the OPERS vision and dental plans. I receive automatic reimbursement for my monthly premiums from my Health Reimbursement Arrangement (HRA), but my spouse isn’t eligible for an HRA. How can I receive reimbursement for my spouse’s monthly premiums?

Your spouse isn't eligible for automatic reimbursement since they aren't eligible for an HRA. However, you can set up recurring reimbursements for your spouse's vision and/or dental premiums from your HRA. You may use the OPERS Health Care Premium Receipt as the supporting documentation to receive reimbursement. The premium receipt can be accessed through your OPERS online account at member.opers.org or by calling OPERS at 1-800-222-7377.

Can I opt out of the OPERS dental automatic premium reimbursement, but keep the OPERS vision automatic premium reimbursement or vice versa?

Yes. If you are enrolled in both the OPERS vision and dental plans, you can opt out of automatic premium reimbursement for one plan while maintaining automatic reimbursement for the other.

Can I opt my spouse or children out of the OPERS vision and/or dental automatic premium reimbursement but not myself?

No. If you are opted in to automatic premium reimbursement for the OPERS vision and/or dental plans, it applies to all those enrolled in the plan. If you opt out of automatic premium reimbursement, the opt out applies to all those enrolled in the plan.

How do I opt out of automatic premium reimbursement for the OPERS vision and/or dental plans?

You may opt out of receiving automatic premium reimbursement; however, you need to wait until after you receive your first reimbursement. To opt out, you can either call Via Benefits at 1-844-287-9945 or sign into your online profile marketplace.viabenefits.com/opers. Select View Accounts under Funds & Reimbursement and scroll to Automatic Premium Reimbursement.

I am currently opted out of automatic premium reimbursement for the OPERS vision and/or dental plans. How do I opt back in?

To opt back in to receiving automatic premium reimbursement for your vision and/or dental premiums from your HRA, you can either call Via Benefits at 1-844-287-9945 or sign into your online profile marketplace.viabenefits.com/opers. Select View Accounts under Funds & Reimbursement and scroll to Automatic Premium Reimbursement.

Can I be reimbursed for my OPERS vision and dental premiums for a period during which I was opted out of automatic reimbursement?

For premiums for months prior to Oct. 1, 2022, you can submit the OPERS Health Care Premium Receipt as the supporting documentation to receive reimbursement for any months in which you were opted out of automatic reimbursement. You can access your premium receipt through your OPERS online account at member.opers.org or by calling OPERS at 1-800-222-7377.

For premiums starting the month of Oct. 1, 2022 and after, sign into your online profile at marketplace.viabenefits.com/opers.

  • Select View Accounts under Funds & Reimbursement and scroll to Automatic Premium Reimbursement.
  • Once you turn on your premium reimbursement, if any eligible transactions are available, an alert stating "Additional Premiums May Be Considered for Reimbursement" will display.
  • Select Show Me from the alert.
  • In the "Past Premiums Eligible for Reimbursement" window, select the months you wish to be reimbursed by checking the "Submit for Review" box.
  • Once finished, select "Save".

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