PSERS Health Options Program
PSERS sponsors the Health Options Program to provide retirees and their dependents access to group health insurance. The benefits provided by Health Options Program are designed to meet the health insurance needs of PSERS retirees. Participation in Health Options Program is voluntary and the benefits are financed by the premiums paid by plan participants.
You may enroll in Health Options Program within 180 days of a Qualifying Event if you are a:
- Annuitant (PSERS retiree)
- Spouse of Annuitant
- Survivor Annuitant
- Dependent child of an Annuitant or Survivor Annuitant
Qualifying Events include:
- You retire or lose health care coverage under your school employer’s health plan.
- You involuntarily lose health care coverage under a non-school employer’s health plan.
- You or your spouse reach age 65 or become eligible for Medicare.
- You experience a change in your family status (including divorce, your death or death of a spouse, addition of a dependent through birth, adoption, or marriage, or a dependent loses eligibility).
- You become eligible for Premium Assistance due to a change in legislation.
- A plan approved for Premium Assistance terminates or you move out of a plan’s service area.
Qualifying Events apply to you, and may apply to your spouse, and your dependents. For example, if your spouse or dependents lose coverage under an employer's health plan, they may enroll in the Health Options Program.
Eligible dependents include:
- Your spouse
- Your unmarried children under age 19, including natural children, stepchildren, legally adopted children, and children legally placed for adoption (Although the Affordable Care Act, or health care reform, extends coverage under employer plans to children under age 26, the law does not apply to retiree plans such as the Health Options Program.)
- Your unmarried children age 19 to 23 who are enrolled as full-time students in an accredited college or university or in a technical or specialized school and who are not regularly employed by one or more employers on a full-time basis.
- Your unmarried children disabled by a mental and/or physical disability before age 17 who meet all of these conditions:
- Incapable of self-sustaining employment
- Dependent on you for support
- Live with you.
For more information about the Health Options Program or for customer service assistance you should contact HOP Administration Unit directly at 1.800.773.7725 or visit the HOP website at www.hopbenefits.com.
Health Options Program Contact
PSERS Health Administration Unit
PO Box 1764
Lancaster, PA 17608-1764
Health Options Program: 1.800.773.7725
Hours: 8 a.m. to 8 p.m. EST, Monday-Friday
www.hopbenefits.com
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Premium Assistance
In order to receive Premium Assistance, you must have an out-of-pocket premium expense for your own basic health insurance coverage. Premium Assistance is not payable for separate dental, vision or prescription drug plans. It is not payable for out-of-pocket premium expenses for the retiree's spouse or dependents, or if your school employer provides coverage to you at no cost. Any premium payments made with pre-tax or non-taxed funds are not eligible for Premium Assistance. As a reimbursement, Premium Assistance cannot exceed the retiree’s actual out-of-pocket premium expense and is not treated as taxable income. You must also meet one of the years of service requirements or retirement type requirements and, have your health insurance coverage through one of the approved plans.
Eligibility
The eligibility requirements for Premium Assistance are:
a. One of the following requirements:
For Classes T-C, T-D, T-E, T-F, T-G, and T-H:
(i) Any membership class with at least 24 ½ eligibility points regardless of age, or
(ii) Class T-C or Class T-D and terminated school employment on or after reaching age 62 with at least 15 eligibility points and who are annuitants with an effective date of retirement after age 62, or
(iii) Class T-E or Class T-F and terminated school employment on or after reaching age 65 with at least 15 eligibility points and who are annuitants with an effective date of retirement after age 65, or
(iv) Class T-G or Class T-H and terminated school employment on or after reaching age 67 with at least 15 eligibility points and who are annuitants with an effective date of retirement after age 67, or
(v) Receiving a disability benefit from PSERS.
For Class DC:
(vi) Class DC participants with at least 24 ½ eligibility points who have terminated school service, are eligible for Medicare, and who received all or part of their distributions, or
(vii) Class DC participants with at least 15 eligibility points who terminate school service on or after reaching age 67 and receive all or part of their distributions.
And, for all membership classes:
b. Out-of-pocket premium expense for basic health insurance coverage from one of the following:
(i) PSERS Health Options Program, or
(ii) A Pennsylvania Public School group health insurance plan providing hospital, medical, and major medical coverage.
For more information regarding Premium Assistance, contact the Premium Assistance Unit at 1.866.483.5509 or visit the HOPbenefits.com website and click on Premium Assistance.
*The amount of the Premium Assistance benefit is determined by the Pennsylvania legislature and is subject to change.
Premium Assistance Contact
PSERS Premium Assistance Unit
1280 North Plum Street Lancaster, PA 17601
Premium Assistance: 1.866.483.5509
Hours: 8:00 a.m. to 8:00 p.m. EST, Monday - Friday
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