About HOP
The Health Options Program (HOP) is sponsored by PSERS and operates for the sole benefit of participating retirees, their dependents and survivors. When you enroll in Medicare, you have two options for medical coverage under HOP. You can enroll in the HOP Medical Plan, which is a supplement to Original Medicare and provides coverage anywhere in the United States and abroad when you are traveling. If you enroll in the HOP Medical Plan, and you have a spouse or dependent who is not yet Medicare-eligible, he or she can enroll in the HOP Pre-65 Medical Plan. As an alternative to Original Medicare and the HOP Medical Plan, you can enroll in the HOP Managed Care Plan/Highmark FreedomBlue. With this plan, you can use any providers that accept Highmark members. If you enroll in this plan, and you have a spouse or dependent who is not yet Medicare-eligible, he or she can enroll in the HOP Pre-65 Managed Care Plan/Highmark PPOBlue.
Prescription drug coverage is also available through HOP. If you are eligible for Medicare, you can choose to enroll in one of two Medicare Part D prescription drug options (the Basic Medicare Rx Option or the Enhanced Medicare Rx Option) either with the HOP Medical Plan or by itself. A spouse or dependent who is not eligible for Medicare can add prescription drug coverage to the HOP Pre-65 Medical Plan. If you enroll in the HOP Managed Care Plan/Highmark FreedomBlue (or a spouse or dependent enrolls in the HOP Pre-65 Managed Care Plan/Highmark PPOBlue), prescription drug coverage will be provided by that plan.
HOP is a voluntary health benefits program funded by participant contributions. Each retiree and survivor annuitant and the spouse and dependent of the retiree or survivor annuitant must decide whether or not to participate. Private health care organizations, third party administrators, and insurance carriers provide the health care coverage and services available through HOP. PSERS is an agency of the Commonwealth of Pennsylvania with primary responsibility to administer the retirement system for all public school employees in the Commonwealth. Neither PSERS nor the Commonwealth of Pennsylvania is an insurer.
In no event will PSERS or the Commonwealth of Pennsylvania be responsible for any act or omission of any insurance company, third party administrator, health care organization, or provider that has a role in this Program. If there is a discrepancy between the information presented on this Web site and the actual Program provisions, the legal Plan documents will govern.
Frequently Asked Questions About HOP
- What is the PSERS Health Options Program (HOP)?
- Does HOP offer Medicare Prescription Drug Coverage?
- Is HOP medical and prescription drug coverage available if I move out of Pennsylvania?
- How do I decide which HOP coverage Option is best for me?
- How is my HOP coverage affected if I live in different parts of the country during the year?
- Will HOP offer the same prescription drug plans (Basic and Enhanced Medicare Rx Options) next year?
- How do I pay my HOP premium?
- How do I find out about the HOP Options available to me?
What is the PSERS Health Options Program (HOP)?
The Pennsylvania Public School Employees' Retirement System (PSERS) sponsors the Health Options Program (HOP) for the sole benefit of PSERS retirees, their spouses or surviving spouses, and their dependents. HOP is a voluntary program, and each retiree must decide whether or not to participate. HOP is funded exclusively by the premiums paid by its participants for the benefit coverage they elect. Private health care insurers and providers provide the medical coverage and services available through HOP.
Does HOP offer Medicare Prescription Drug Coverage?
Yes. The HOP prescription drug coverage options offered to Medicare-eligible individuals are Medicare Prescription Drug Coverage.
Is HOP medical and prescription drug coverage available if I move out of Pennsylvania?
Yes. HOP Medical Plan, the Medicare Rx Options, the HOP Managed Care Plan/Highmark Freedom Blue, the HOP Pre-65 Medical Plan, and the HOP Pre-65 Managed Care Plan/Highmark PPOBlue provide coverage and benefits in all 50 states.
How do I decide which HOP coverage Option is best for me?
Choosing health care coverage is a personal decision. When weighing your Options, consider the monthly premium amount, what you will have to pay out of pocket (deductibles, copays, and coinsurance amounts), level of prescription drug coverage provided, and flexibility to choose your provider.
How is my HOP coverage affected if I live in different parts of the country during the year?
If you have coverage in one of the HOP fee-for-service plans, i.e., the HOP Pre-65 Medical Plan, HOP Medical Plan, Basic or Enhanced Medicare Rx Options, there is no effect. You have the freedom of choice to see any provider you want. The pharmacy network is nationwide. If you are enrolled in a Medicare Advantage/managed care plan, you will have to consult their specific rules as there may be some limitations.
Will HOP offer the same prescription drug plans (Basic and Enhanced Medicare Rx Options) next year?
HOP anticipates offering these same Options next year, but cannot guarantee that these same Options will be available next year.
How do I pay my HOP premium?
Premiums are normally deducted from your PSERS pension check. New enrollees, however, usually start out paying by check on a monthly basis until the PSERS benefit system deducts your premium. If your monthly pension check is less than the amount of your monthly HOP premium, you will have to pay the full amount of the premium by check. Please note: if you elect standalone drug coverage under the Basic or Enhanced Medicare Rx Options, PSERS is not able to deduct the premium from your pension check. In any event, if your premium is not being deducted from your monthly retirement benefit you will receive a payment (coupon) book giving you the information you need to make payments by check.
There are two ways that monthly plan premiums are paid.
If you can pay for the entire HOP Medical Plan and Medicare Rx Option coverage premium with your PSERS retirement benefit, your monthly plan premium is deducted from your monthly PSERS retirement benefit. This option is only available to annuitants choosing both Medicare prescription drug coverage and medical coverage.
If you cannot pay for the entire HOP Medical Plan and Medicare Rx Option premium with your PSERS retirement benefit, or if you have HOP Medicare prescription drug coverage without HOP Medical Plan coverage, you must pay your monthly plan premium directly to our plan. If you make direct payment, you will receive a coupon book prior to your coverage effective date. The monthly coupon and check must be mailed to HOP, PO Box 64979, Baltimore, MD, 21264- 4979, the 25th of the prior month. If you run out of coupons or lose your coupon book, call the HOP Administration Unit for a new one.
Contact the HOP Administration Unit for more information or if you have any questions about your plan premiums.
How do I find out about the HOP Options available to me?
Available Options differ depending on where you live. Click here for more information.