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 Account managed by our partner, Alight.

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 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 approved medical 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.

Also, if you are Medicare eligible, your Medicare Part B reimbursement will continue to be added to your monthly pension benefit.

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, Alight Solutions, 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?

For Medicare-eligible retirees, if you used the Alight Retiree Health Exchange to enroll in a medical or prescription drug plan for 2019, you remain stipend eligible for 2020. This group will remain eligible as long as they continue to enroll in medical or prescription drug plans through The Aon Retiree Health Exchange. If you did not enroll using the Aon Retiree Health Exchange, a qualifying event must occur to again become eligible.

For pre-Medicare retirees, OP&F has provided an exception to become eligible for the stipend for 2020. If you are not yet eligible for Medicare, you are eligible for the stipend in 2020 if:

  • You enrolled through the Alight Retiree Health Exchange in a medical or prescription drug plan for 2019; or
  • If you were enrolled in the OP&F-sponsored group health care plan in 2018 (even if you did not enroll through Alight for 2019). This exception is being granted since OP&F is using an open HRA in 2020 and allowing pre-Medicare retirees to enroll either through Aon or by purchasing a qualified plan on the open market.

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 Exchange. You can review these plans by logging on to your account with Aon or by contacting Aon to review your choices.

For pre-Medicare retirees, in 2020 OP&F will allow you to receive the stipend by enrolling in the following plans:

  • The plans available to you through the Alight Retiree Health Exchange;
  • Qualified plans on the open market (must include the minimum coverage requirements outline by the Affordable Care Act);
  • A COBRA plan with the member’s former employer (does not have to be an OP&F employer).

An employer’s plan, a spouse’s employer/retirement/COBRA plan are not eligible plans 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 benefit payments.

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 and vision coverage too.

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?

For the 2020 plan year, eligible pre-Medicare retirees can purchase a health care plan either through Alight or on the open market as long as the plan meets the minimum requirements set forth in the Affordable Care Act. A plan offered by a retiree’s employer and plans through a spouse’s employer, spouse’s retirement system or spouse’s COBRA are not eligible plans to receive a stipend.

Medicare-eligible retirees must go through Alight and purchase either a medical or prescription plan to be eligible for the stipend.

What happens if a member retires and goes on COBRA?

A COBRA plan through the member’s former employer (even if it is not an OP&F employer) is eligible and these premiums are eligible for reimbursement. This change was made in the spring of 2019, so any eligible COBRA health care premiums after April 1, 2019 are eligible for reimbursement as long as the enrollment began after Jan. 1, 2019.

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 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?

If a member and their spouse are eligible (meaning they don’t have access to group coverage elsewhere) and enroll in either a qualified medical or prescription drug plan the total stipend amount received by the member will increase. However, there will be only one Health Reimbursement Arrangement, 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.

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 each year from OP&F to those who began receiving the increase from September of the previous year thru Aug. 31 of the current year. This is because anyone who began receiving the discount in the fourth quarter of a year is automatically eligible for the discount the subsequent year. The Low-Income Stipend Increase Program increases the stipend 30 percent for those who qualify.

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 participant 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.

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.

What is the catastrophic HRA that I see in Alight materials?

This additional feature to our health care program applies only to Medicare Part D (prescription) participants and provides up to $500,000 per year to help cover the expense of drugs that are used to treat certain illnesses and are extremely expensive (cancer drugs, for example).

  • Catastrophic HRA eligibility is gained by meeting the threshold for the annual out of pocket maximum in Medicare Part D. The catastrophic HRA will reimburse retirees for prescription expenses purchased through their Part D plan once they have reached the catastrophic phase of the plan.
  • The Medicare RX plan will cover 95 percent of the prescription drug and the retiree is responsible for the remaining five percent.
  • The member’s stipend must be depleted before the catastrophic HRA is activated.
  • Both a member and their spouse have the ability to file claims with the catastrophic HRA.
  • The non-Medicare population have out of pocket maximums required by CMS so the additional coverage isn’t needed.

Is there additional stipend money available for a survivor and their dependent children?

No. A surviving spouse will receive a stipend of $685.00 per month (non-Medicare) for health care. There is not an additional stipend for dependent children of a surviving spouse. However, a surviving spouse may still select 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 or your dependents are eligible for any other group coverage including employer or retirement coverage, they are not eligible for a stipend. However, if they 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 they can then become eligible for the OP&F stipend program, provided they enroll within 60 days of the event. Please contact OP&F and Aon in order to become eligible for the stipend.

Updated 8/14/2019