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Who's Eligible

You may enroll in the Health Options Program within a limited time after a Qualifying Event if you are a(n):

  • Annuitant (PSERS retiree)
  • Spouse
  • Survivor Annuitant
  • Dependent child of an Annuitant or Survivor Annuitant.

The enrollment, change or addition must be made within a specified time frame, depending on your Qualifying Event. If such an event occurs, call the HOP Administration Unit at 1-800-773-7725.

  • 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

As a rule, retirees and their dependents must be covered under the same type of plan. For example, if a retiree elects the HOP Medical Plan, the spouse must elect the HOP Medical Plan if he or she is eligible for Medicare or the HOP Pre-65 Medical Plan if he or she is not eligible for Medicare. However, if both are PSERS annuitants, they may elect different options.

If you are married and your spouse is not currently enrolled, consider when they might retire. The type of plan a retiree and dependent must be enrolled in is determined by who enrolls first. Therefore, if your spouse will become eligible within the next year, but after you make your decision during an Option Selection Period, you may want to consider what options will work for both of you. Otherwise, you won’t have the opportunity to change coverage (for both of you) until the following Option Selection Period.

Last modified: August 27, 2020