Text Size:   A+ A- A   •   Text Only
Find     
Site Image

Frequently Asked Questions (FAQs) - Early Retiree Coverage
Timely Topics

How does the new Health Care Bill affect early retirees on OEBB plans? 
The Early Retiree Reinsurance Program, or ERRP, is available through the U.S. Department of Health and Human Services (HHS). The ERRP was established by the Affordable Care Act to assist employers and plan sponsors in providing health care coverage for early retirees and their dependents. The program provides reimbursement to sponsors of participating employment-based plans for a portion of the cost of health benefits for early retirees, surviving spouses and their dependents. The ERRP became effective on June 1, 2010, and ends no later than January 1, 2014, or when the $5 billion in funds appropriated by Congress are exhausted, whichever comes first.
 
Employers, or employer-sponsored plans like OEBB, that are accepted into the program can receive reimbursement for up to 80 percent of the costs for eligible claims between $15,000 and $90,000 incurred by eligible early retirees, spouses and their dependents.  Reimbursements can only be used to reduce the health benefit premiums or health benefit costs of the participants.  OEBB submitted an application and was accepted into the Program on October 4, 2010.  We are working to create the list of eligible members and will submit that to the HHS in the near future.  The next step will be to submit the claims cost information and request reimbursement. It is important to note that the $5 billion allocated to the Program is not expected to last long.
 
OEBB will use any funds received to buy-down future premium increases during renewal negotiations for future plan years. Premium rates for 2010-11 will not be affected. 
 
As an early retiree, can I add my 24-year-old adult dependent child during Open Enrollment (Aug. 15 – Sept. 15, 2010)?
If your adult dependent child previously met eligibility requirements and you choose to not cover them, they are ineligible for coverage. However, you can enroll your adult dependent if they were ineligible for coverage prior to October 1, 2010, and now they meet the new dependent eligibility requirements. (See question below) You must contact your Educational Entity to add the dependent during Open Enrollment.
 
What are the new dependent eligibility rules that took effect October, 1, 2010?
Effective October 1, 2010, all OEBB health plans will allow children to be covered through age 25 no matter their marital, student, employment, residency or tax status. You can even enroll your adult dependent child if they are eligible to enroll in a group health plan through their employer*. The adult dependent child may have dual coverage through both parents and/or legal guardians.
 
* This detail was clarified late in the Open Enrollment period; therefore, members have an additional opportunity to add dependents who were believed to be ineligible due to having coverage available through their employer. Submit the "Overage Dependent Child QSC Change Form" to your educational entity no later than October 29, 2010. Note: Coverage must be retroactively effective October 1, 2010 and retroactive premiums may apply.
 
 

General Questions
 
What is an early retiree?
An early retiree is someone who retires before the age of 65.
 
What is the cost of plans and where do I send my payment?
You will need to contact your educational entity payroll office to find out the cost and to set up payment arrangements.
 
As an early retiree, if I’m not currently enrolled in one of the available plans, can I enroll later?
Early retirees cannot voluntarily enroll in a plan type they previously chose to waive. For example, if you are enrolled in medical only, you would not be able to enroll in a vision or dental plan at Open Enrollment.  However, if you “opted out” of dental because you had other group coverage and then you lost your other group dental coverage, this would be a valid QSC to add a dental plan under OEBB as long as you notify your educational entity within 31 days of the QSC by providing proof of the loss and requesting the coverage.
 
As an early retiree, can I add dependents to my plan?
Early retirees can only add dependents to their OEBB health plans within 31 days of a Qualified Status Change (QSC) event. For instance, if you adopted a child you could add them to your plan by submitting a change form to your educational entity within 31 days. View the all qualifying events. 
 
As an active employee, I only had dental and vision.  At retirement, can I now enroll in medical? Can I now enroll my spouse?
OEBB requires that an individual be covered under an educational entity or OEBB medical plan(as a dependent or the employee) at the time of retirement. Coverage must be continuous.  Application for a retiree plan will need to be made within 31 days of retirement, or within 31 days of losing coverage under an active employee medical plan sponsored by an educational entity or OEBB. Please note that a retiree cannot return to the OEBB plans if there is any interruption in coverage under an educational entity or OEBB-sponsored medical plan. OEBB will not recognize any other employer-sponsored medical coverage as continuous coverage.
 

Open Enrollment Options
 
As an early retiree, if I’m not currently enrolled in one of the available plans, can I enroll later?
Early retirees cannot voluntarily enroll in a plan type they previously chose to waive. For example, if you are enrolled in medical only, you would not be able to enroll in a vision or dental plan at Open Enrollment.  However, if you “opted out” of dental because you had other group coverage and then you lost your other group dental coverage, this would be a valid QSC to add a dental plan under OEBB as long as you notify your educational entity within 31 days of the QSC by providing proof of the loss and requesting the coverage.
 
As an early retiree, can I add dependents to my plan?
Early retirees can only add dependents to their OEBB health plans within 31 days of a Qualified Status Change (QSC) event. For instance, if you adopted a child you could add them to your plan by submitting a change form to your educational entity within 31 days. View the all qualifying events. 
 
As an early retiree, can I add my 24-year-old adult dependent child during Open Enrollment (Aug. 15 – Sept. 15, 2010)?
If your adult dependent child previously met eligibility requirements and you choose to not cover them, they are ineligible for coverage. However, you can enroll your adult dependent if they were ineligible for coverage prior to October 1, 2010, and now they meet the new dependent eligibility requirements. (See question below) You must contact your Educational Entity to add the dependent during Open Enrollment.
 
What are the new dependent eligibility rules that took effect October, 1, 2010?
Effective October 1, 2010, all OEBB health plans will allow children to be covered through age 25 no matter their marital, student, employment, residency or tax status. You can even enroll your adult dependent child if they are eligible to enroll in a group health plan through their employer*. The adult dependent child may have dual coverage through both parents and/or legal guardians.
 
* This detail was clarified late in the Open Enrollment period; therefore, members have an additional opportunity to add dependents who were believed to be ineligible due to having coverage available through their employer. Submit the "Overage Dependent Child QSC Change Form" to your educational entity no later than October 29, 2010. Note: Coverage must be retroactively effective October 1, 2010 and retoractive premiums may apply.
 
As an active employee, I only had dental and vision.  At retirement, can I now enroll in medical? Can I now enroll my spouse?
OEBB requires that an individual be covered under an educational entity or OEBB medical plan(as a dependent or the employee) at the time of retirement. Coverage must be continuous.  Application for a retiree plan will need to be made within 31 days of retirement, or within 31 days of losing coverage under an active employee medical plan sponsored by an educational entity or OEBB. Please note that a retiree cannot return to the OEBB plans if there is any interruption in coverage under an educational entity or OEBB-sponsored medical plan. OEBB will not recognize any other employer-sponsored medical coverage as continuous coverage.

Turning 65 - Medicare Eligibility
 
What happens when a retiree turns 65 and/or is eligible for Medicare?
The current rules state that retirees can continue coverage under OEBB medical, vision and dental coverage until the first of the month in which they reach age 65 and/or become eligible for Medicare, whichever occurs first. (There is an exception to this for individuals who qualify for Medicare due to end stage renal disease). If the educational entity allows, retirees may elect to continue dental coverage only, but they are not eligible to continue medical, pharmacy or vision.
For more information about Medicare, click here .
 
What happens to my spouse and/or children when I turn 65?
If a retiree becomes eligible for Medicare coverage, but his or her currently-enrolled eligible dependents are not, these eligible individuals may continue OEBB medical, dental and vision insurance coverage until such time as they no longer meet OEBB eligibility requirements or become eligible for Medicare coverage for reasons other than end-stage renal disease, whichever occurs first. The eligible individuals must confirm intent to continue coverage with the retiree plan administrator within 60 days of the retiree’s eligibility for Medicare.
For more information about Medicare, click here .
 
Can my spouse remain on my plans if they turn 65 or become Medicare eligible?
Eligible dependents who were covered on a plan at the time of retirement who are eligible for Medicare, or who become eligible for Medicare, may not continue coverage on an OEBB medical or vision plan unless it is stated in a collective bargaining agreement (union contract) or documented district policy in effect on or before February 1, 2010. Eligible dependents whoare permitted to continue on OEBB medical plans until the retiree becomes eligible for Medicare can do so with the following exception: OEBB coverage must end for Medicare-eligible dependents of a retiree enrolled on a Kaiser Permanente medical plan. There will be a coordination of benefits (for the spouse) and Medicare will be primary and OEBB insurance will be secondary.  Please check with your educational entity for specific coverage options allowed by your entity.
 

Need more information? Review more Frequently Asked Questions.