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Eligibility

Am I Eligible for HOP?

You may enroll in HOP within 180 days of a Qualifying Event if you are a:

  • PSERS retiree
  • Survivor annuitant
  • Spouse or surviving spouse of a PSERS retiree or survivor annuitant
  • Dependent child of a PSERS retiree or survivor annuitant

Eligible dependents include:

  • Your spouse
  • Your unmarried children under age 19, including natural children, stepchildren, legally adopted children, and children legally placed for adoption
  • 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.

Qualifying Events include:

  • You retire or lose health care coverage under your school employer’s health plan. Coverage under your school employer’s health plan includes any COBRA continuation coverage you may elect under that school employer’s plan.
  • You involuntarily lose health care coverage under a non-school employer’s health plan (which includes any COBRA continuation coverage you may elect under that non-school employer’s health plan).
  • You or your spouse reach age 65 or become eligible for Medicare.
  • There is 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, your spouse, and/or your dependents. If one member of your family has a Qualifying Event, all members may enroll in HOP or change their option if already enrolled .For example, if your spouse turns age 65 and becomes eligible for Medicare, that’s a Qualifying Event for all eligible family members.

If I will be turning 65 in a few months, how will this affect my HOP coverage and what will happen?

If you are not currently covered under HOP, turning age 65 is considered a Qualifying Event and gives you the right to enroll in HOP. If you are currently enrolled in HOP, you will have some additional prescription drug coverage options available to you. In either case, you will receive an invitation to a meeting before your 65th birthday where HOP representatives will explain the options available to you and provide you with a personalized statement showing you information about what you need to do if you want to enroll or change your option.

If I (the PSERS retiree) die, can my spouse continue coverage through HOP?

Yes. Your surviving spouse is eligible to continue coverage through HOP provided timely premium payments are received.

Can my Medicare-eligible spouse have coverage under HOP if I am not covered under HOP and I am the PSERS retiree?

Yes.

Are medical and prescription drug coverage available if I travel overseas?

Medicare does not cover medical expenses incurred outside the United States. If you are eligible for Medicare and enrolled in the HOP Medical Plan you can submit medical expenses incurred out of the United States for reimbursement (you would submit claims and they would be treated like a major medical expense). If you are not eligible for Medicare and enrolled in the HOP Pre-65 Medical Plan, you can also receive reimbursement for out-of-country medical expenses. If you are enrolled in a managed care plan, you will have to consult their specific rules.

When can I and/or my dependents enroll in HOP?

If you or your dependent(s) are not currently enrolled in HOP, your next opportunity to enroll would be if you experience a Qualifying Event, which include:

  • You retire or lose health care coverage under your school employer’s health plan. Coverage under your school employer’s health plan includes any COBRA continuation coverage you may elect under that school employer’s plan.
  • You involuntarily lose health care coverage under a non-school employer’s health plan (which includes any COBRA continuation coverage you may elect under that non-school employer’s health plan).
  • You or your spouse reach age 65 or become eligible for Medicare.
  • There is 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.

Prefer to talk to a representative?

Call 1-800-773-7725 for assistance. Our friendly staff is ready to help you. Give us a call.