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Who's Eligible

You may enroll in the Health Options Program within 180 days of a Qualifying Event if you are a(n):

  • Annuitant (PSERS retiree)
  • Spouse
  • Survivor Annuitant
  • Dependent child of an Annuitant or Survivor Annuitant.
  • Please note the following To be eligible for either a Medicare Supplement or Medicare Advantage plan, you must be enrolled in Medicare Part A and Part B—and pay the Part B premium (in addition to the premium paid for the Medicare Advantage plan).

You experience a Qualifying Event when:

  • 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, including 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, the death of a spouse, addition of a dependent through birth, adoption, or marriage, or a dependent loses eligibility. (The death of a retiree is not a Qualifying Event unless the spouse or dependent will receive a pension from PSERS following the retiree's death.)
  • 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.
  • Please note the following Qualifying Events apply to you, and may apply to your spouse, and your dependents. For example, if your spouse turns age 65 and becomes eligible for Medicare, he or she may enroll in the Health Options Program.

Your 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.

Comparable Coverage for You, Your Spouse and Your Dependents

If you and your spouse are both PSERS retirees, you may each enroll in any option.

If your spouse is not a PSERS retiree and is Medicare-eligible, he or she must enroll in the same plan as you.

If your spouse is not eligible for Medicare, he or she must enroll in the same type of plan as you—for example, the HOP Pre-65 Medical Plan if you enroll in either the HOP Medical Plan or the Value Medical Plan.

If your spouse or dependent is not eligible for Medicare and you elect the Enhanced, Basic or Value Medicare Rx Option on a standalone basis, your spouse or dependent will not be eligible for coverage through the Health Options Program until he or she becomes eligible for Medicare.