About Your HOP Benefit Options

HOP offers a choice of coverage options that provide hospital, medical/surgical, and prescription drug benefits for Medicare-eligible and non-Medicare-eligible individuals.

Medicare-Eligible Participants

This section applies to you if you are a PSERS retiree, survivor annuitant, or the spouse of a PSERS retiree or survivor annuitant, and you are eligible for Medicare. Since some Medicare-eligible individuals want greater or different coverage than what Original Medicare provides, HOP offers you a choice.

The HOP Medical Plan

If you keep Original Medicare, you can supplement it by enrolling in the HOP Medical Plan. This Plan covers many of the deductibles, coinsurance and other expenses that you are required to pay under Original Medicare. Here are some of the advantages of keeping Original Medicare and enrolling in the HOP Medical Plan:

• You have the freedom to use virtually any health care provider (doctor or hospital) you want.
• You pay nothing for covered hospital and medical expenses, except for $10 per physician visit.
• You’re covered anywhere in the United States and abroad when you are traveling.
• You can add prescription drug coverage by enrolling in HOP’s Basic or Enhanced Medicare Rx Option.

The Basic and Enhanced Medicare Rx Options

The Basic and Enhanced Medicare Rx Options are Medicare prescription drug (Part D) plans designed specifically for HOP Medical Plan participants and their eligible dependents. These plans give you prescription drug choices at competitive rates.

• The Basic Medicare Rx Option provides the standard level of prescription drug coverage required by Medicare.
• The Enhanced Medicare Rx Option covers certain medications that are not covered under the Basic Medicare Rx Option or any of the other prescription drug programs offered by commercial carriers. Unlike many other plans (including the Basic Medicare Rx Option), it also provides coverage in the Medicare coverage gap. Premiums for the Enhanced Medicare Rx Option are higher than those for the Basic Medicare Rx Option because the plan provides greater coverage.

Find more information about the options available in your county.

The HOP Managed Care Plan/Highmark FreedomBlue

You also have an option to choose the HOP Managed Care Plan/Highmark FreedomBlue instead of Original Medicare and the HOP Medical Plan. The HOP Managed Care Plan/Highmark FreedomBlue provides Highmark benefits designed especially for HOP and includes both medical and prescription drug coverage. Therefore, if you choose this option, you cannot enroll in any other Medicare prescription drug plan. Doctor visits and certain preventive care such as physicals and ob/gyn exams require a $15 copay—and you must always use hospitals, doctors, and other medical service providers that accept Highmark members. Otherwise, you may pay some or all of the cost of services.

Options for Enrolling in HOP if You Are Eligible for Medicare

• HOP Medical Plan only (no prescription drug coverage)
• HOP Medical Plan with the Basic Medicare Rx Option
• HOP Medical Plan with the Enhanced Medicare Rx Option
• Basic Medicare Rx Option only (no medical coverage)
• Enhanced Medicare Rx Option only (no medical coverage)
• HOP Managed Care Plan/Highmark FreedomBlue

Non-Medicare-Eligible Participants

This section applies to you if you are a PSERS retiree, survivor annuitant, or the spouse or dependent child of a PSERS retiree or survivor annuitant, and you are not eligible for Medicare.

The HOP Pre-65 Medical Plan

The HOP Pre-65 Medical Plan covers hospital, surgical, and medical services and offers an option for prescription drug coverage. Except for a free physical exam each year that requires no deductible, you must meet a $1,500 annual deductible before the Plan pays benefits. Once you meet the deductible, you pay 25% of the cost for network providers and 40% of the cost for out-of-network providers. If your annual out-of-pocket spending reaches $5,000 in a calendar year, the Plan will pay 100% of your covered medical expenses for the rest of the year, up to a $200,000 annual maximum benefit.

You can elect to enroll in the HOP Pre-65 Medical Plan with or without prescription drug coverage, but you cannot enroll for prescription drug coverage only. If you choose prescription drug coverage, you must meet a $350 annual deductible (separate from the medical deductible). Once you meet the deductible, you pay 50% of the cost for most generic and brand-name drugs that you purchase either at a local network pharmacy or by mail.

The HOP Pre-65 Managed Care Plan/Highmark PPOBlue

You have an option to choose the HOP Pre-65 Managed Care Plan/Highmark PPOBlue instead of the HOP Pre-65 Medical Plan. The HOP Pre-65 Managed Care Plan/Highmark PPOBlue provides Highmark benefits designed especially for HOP and includes both medical and prescription drug coverage. If you use Highmark network doctors, you pay $20 for a visit to your primary care physician and $40 for a visit to a specialist. For most other covered services provided in network, you pay 20% after you meet an annual deductible of $100 per person. If you go out of network, you pay 30% of the cost of most covered services after you meet an annual deductible of $500 per person.

Options for Enrolling in HOP if You Are Not Eligible for Medicare

• HOP Pre-65 Medical Plan only (no prescription drug coverage)
• HOP Pre-65 Medical Plan with prescription drug coverage
• HOP Pre-65 Managed Care Plan/Highmark PPOBlue