Retiree Health Care FAQ
How can I contact Alight Retire Health Solutions or eHealth representatives familiar with OP&F?
For all OP&F retirees eligible for a health care stipend, start by contacting Alight at 1-844-290-3674. To contact eHealth by phone, call Alight and request to be transferred to an eHealth representative familiar with OP&F.
Retirees are also encouraged to register online with Alight, where Medicare-eligible members can review plans available to them and pre-Medicare retirees can shop for health care plans.
How much are the stipends?
A chart showing the stipend levels can be found on the OP&F website on the health care page here.
Is the OP&F health care stipend taxable income?
No, the stipend is not considered taxable income since the money is in a Health Reimbursement Arrangement managed by our partners, Alight and YSA.
Will the stipend be included in my monthly OP&F benefit?
No, the stipend amount will not be added to a member’s monthly OP&F benefit. Instead, the stipend amount is deposited to a member’s health reimbursement arrangement (HRA) as a way for you to be reimbursed for certain health care costs that you and your eligible dependents pay out of pocket such as premiums for coverage and other eligible health-related expenses.
If there is stipend money remaining in my HRA at the end of the year, can I use it the following year?
No, you may not rollover any amount remaining in the HRA to the following year. The stipend must be used for eligible health-related expenses that occur during that calendar year. There will be a window where reimbursements can be made for bills processed after Jan. 1 for expenses incurred before the start of the new calendar year.
How will I pay for the plans I enroll in?
Once enrolled, materials will be sent from Alight and include instructions how to pay for your health care and be reimbursed through your stipend-funded HRA. Depending on the plan you select, you may pay by electronic fund transfer or by coupon. This is up to the health care provider you select. Since you could select both medical and prescription drug (and potentially dental and vision also), there may be several transactions per month.
Who is Alight, and how are they involved in my health care plan?
The Alight Retiree Health Exchange is OP&F’s health care partner. They can directly assist OP&F members in selecting a health care plan. Alight will work with their partner, Your Spending Account, to manage the HRA, which will be set up specifically for eligible members and will be funded with the stipends from OP&F.
What if I am not eligible for a stipend?
For OP&F retirees who do not qualify for a stipend, the Alight Retiree Health Exchange will still be available to help you select a health care plan if you wish to use their services. There will be no charge for this service.
Who is eligible for the health care stipend?
OP&F retirees are eligible to participate in the health care stipend program unless they have access to another group health care plan. The retiree must become enrolled in a new plan within 60 days of involuntarily losing access to the employer’s plan or group healthcare and submit the required paperwork to OP&F. Otherwise, a Qualifying Life Event, or QLE, must occur to establish eligibility.
What plan choices are available to me?
For MEDICARE-eligible retirees, a wide variety of Medicare-Advantage or Medigap plans are available through the Alight Retiree Health Solutions Exchange. You must enroll in a medical and\or prescription drug plan through Alight to be eligible for the OP&F stipend. You can review these plans by logging on to your account with Alight or by contacting Alight to review your choices.
For PRE-MEDICARE retirees, OP&F allows you to receive the stipend by enrolling in an Individual or Family major medical qualified health plan that is compliant with the rules of the ACA and contains the ten essential benefits and prescription drug coverage.
- Qualified health plans found on the open market, healthcare.gov, or through any independent broker as long as the plan is ACA compliant and contains the ten essential benefits and prescription drug coverage;
- The eligible plans available to you through the Alight Retiree Health Exchange’s enrollment partner eHealth;
- A COBRA plan with the member’s former employer (does not have to be an OP&F employer).
Employer or group sponsored plans, short term plans, Christian Ministry and group share plans and non-accredited ACA plans are examples of plans that do not meet eligibility for a member to receive the stipend.
A plan offered by a retiree’s employer and plans through a spouse’s employer, spouse’s retirement system or spouse’s COBRA do not meet eligibility for a member to receive a stipend.
What are the opportunities to enroll?
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); continuation of previous bullet
- Loss of Medicaid or CHIP coverage for member or dependent child;
- Moving out of a 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 the member out of poverty level;
- Income changes that make 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.
What will happen to the Medicare Part B reimbursement that OP&F has provided?
The Medicare Part B reimbursement program is not changing. Eligible members will continue to receive the reimbursement as a part of their monthly benefit payment once they complete and return the Medicare Part B Reimbursement Statement along with a copy of their Medicare card or billing statement.
What about dental and vision coverage?
Alight will assist you in finding a plan that you desire, which can include dental and vision coverage if you choose. The stipend can be used toward premiums for medical, dental or vision coverage too. Having only dental or vision coverages DO NOT MEET eligibility for a member to receive a stipend.
I’m retired from OP&F, but have a job and health care coverage through my employer. Do I need to quit that job to get the stipend?
If you have health care coverage available from your employer, you are not eligible for the OP&F stipend. However, you can become eligible for the OP&F plan, and therefore the stipend, when you decide to leave your post-retirement job and therefore lose that coverage. This becomes a qualifying life event (involuntary loss of group coverage) that triggers eligibility for OP&F’s plan. You would have 60 days from the loss of group coverage to enroll in the OP&F plan.
Do members have to purchase health care through the Alight exchange in order to receive a stipend?
Eligible pre-Medicare retirees can choose an Individual or Family major medical qualified health care plan through Alight/eHealth, COBRA, healthcare.gov or any independent broker. If you opt for a plan outside of eHealth it must be a major medical plan that includes the 10 essential benefits and prescription drug coverage. Retirees who enroll through Alight/eHealth are also provided with access to one-on-one phone and on-line support. A plan offered by a retiree’s employer and plans through a spouse’s employer, spouse’s retirement system or spouse’s COBRA do not meet eligibility for a member to receive a stipend.
Medicare-eligible retirees must go through Alight and purchase either a medical or prescription drug plan to be eligible for the stipend.
What happens if a member retires and goes on COBRA?
If you enroll in your employer’s COBRA (even if it is not an OP&F employer) you will be eligible to receive the OP&F stipend while maintaining your COBRA plan until the next ACA enrollment period or until the expiration of your COBRA plan, whichever you prefer. You must submit the Health Care Stipend Eligibility form along with proof of COBRA enrollment that includes the name of the plan, the names of the participants enrolled, and the effective dates of coverage. If you choose to change your plan from COBRA outside of the open enrollment period or before the expiration date, you must provide OP&F with proof of the new coverage.
Will members be able to have dual coverage (i.e. through Alight and on spouse’s coverage)?
They can have dual coverage, however, if a member is covered through other insurance they will not receive a stipend from OP&F.
Can a member receive a stipend from OP&F if they are Medicare-eligible but not enrolled in Medicare Parts A or B?
No. To receive a stipend, members who are Medicare-eligible must be enrolled in both Medicare Part A and Part B. There are no Medicare plans available unless the member has enrolled in A and B.
Can a member receive a stipend from OP&F if they use Alight to enroll only in a prescription drug plan?
Yes, a Medicare member can receive a stipend if they are eligible and enroll in either medical or prescription drug coverage available through the Alight marketplace.
Will the member and their spouse each receive a stipend?
No - The HRA will be in the member’s name, but all eligible participants may submit claims.
Will pre-existing conditions apply?
The Affordable Care Act provides for guaranteed coverage and participants cannot be refused for pre-existing conditions.
Will the stipend increase program continue to be available to those needing financial assistance?
Yes. OP&F will continue to offer additional support to families who can prove their household income meets the guidelines established by the OP&F Board of Trustees. A mailing will be sent in the fall each year from OP&F.
If a member or spouse is eligible for any type of coverage through an employer or retirement plan, can they enroll on the OP&F plan? For instance, member or spouse is offered medical through an employer, but not prescription drug coverage. Can he / she enroll for prescription coverage only?
If a participant is employed and has access to any other group coverage, including employer or retirement coverage, they are not eligible for the OP&F stipend. Alight can still assist participants in selecting coverage options, however, the member will not be eligible for stipend support from OP&F.
If a member is not employed, but is eligible for coverage through spouse, can they still enroll on OP&F’s plan?
Yes. Members are not required to enroll in coverage provided through a spouse and can enroll in the OP&F plan and receive a stipend. However, a spouse’s employer, spouse’s retirement or spouse’s COBRA plans do not meet eligibility for a member to receive a stipend.
What is the impact if a member has coverage through VA?
Alight benefit advisors will educate retirees on the plan benefits that are offered in their area and direct them to speak with their Tricare contact to assist in making a determination on which benefit or combination of benefits best fits their needs. Retirees may continue to participate in both Tricare and remain eligible for the OP&F stipend as long as the retiree enrolls in a qualified health care plan that is ACA compliant and contains the ten essential benefits and prescription drug coverage..
Is there additional stipend money available for a survivor and their dependent children?
No. A surviving spouse who does not have access to other health coverage may be eligible for the stipend, however, there is not an additional stipend for dependent children of a surviving spouse. A surviving spouse may still opt to enroll in family coverage for a dependent child.
If a retiree has access to health care coverage through an employer, but then leaves that employment, can they get a stipend?
If you are eligible for any other group coverage including employer or retirement coverage, you are not eligible for a stipend. However, if you leave that employer for any reason and do not have access to health care, this becomes a Qualifying Life Event (involuntary loss of group coverage) and you can then become eligible for the OP&F stipend program, provided you enroll in an eligible plan within 60 days of the event and submit the necessary documentation to OP&F. Please contact OP&F to become eligible for the stipend.