Psers Health Options Program

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Commonwealth of Pennsylvania - Public School Employees' Retirement System
Mail Center
5 N 5th Street
Harrisburg PA 17101-1905
Toll-free: 1.888.773.7748
PSERS Health Options Program
Fax: 717.772.3860
PSRS-1165 (05/2014)
PSERS HEALTH OPTIONS PROGRAM (HOP)
The Public School Employees' Retirement System (PSERS) sponsors the Health Options Program for PSERS annuitants
(retirees), spouses of annuitants, survivor annuitants and their dependents. Those individuals participating in the Health
Options Program pay the premium cost for coverage. PSERS does provide a Premium Assistance benefit to eligible
retirees (please see the back of this page for additional information regarding the Premium Assistance Program).
TYPES OF COVERAGE AVAILABLE THROUGH THE HEALTH OPTIONS PROGRAM
The Health Options Program provides coverage for individuals eligible for Medicare. For individuals not eligible for
Medicare, coverage is provided through the Pre-65 Program. Both Programs offer various coverage options to best suit
your health care needs and financial resources. The HOP Medical Plan (for retirees eligible for Medicare) and the Pre-65
Medical Plan (for retirees not eligible for Medicare) provide fee-for-service hospital, medical/surgical, Major Medical, and
optional prescription drug coverage and are available regardless of where you live. Medicare Advantage and managed
care plan coverage are available within specified service areas throughout Pennsylvania and other states.
Comprehensive descriptive material is available upon request to explain the details of each option and monthly premium
1.800.773.7725
cost. You can obtain this information by calling
.
ENROLLING IN THE HEALTH OPTIONS PROGRAM
If a PSERS annuitant (retiree), spouse of an annuitant, survivor annuitant or their dependents needs health care
coverage, they may enroll in the Health Options Program within 180 days of a Qualifying Event. The following is a list of
Qualifying Events:
The annuitant’s retirement or loss of health care coverage under a school employer’s health plan.
The involuntary loss of health care coverage under a non-school employer’s health plan.
An annuitant, survivor annuitant, or spouse attains age 65 or becomes eligible for Medicare.
An annuitant experiences a change in family status (including divorce, your death or death of a spouse,
addition of a dependent through birth, adoption, or marriage, or loss of a dependent through loss of
eligibility).
An annuitant becomes newly eligible for Premium Assistance due to a change in legislation.
The loss of coverage due to the termination of a plan approved for Premium Assistance or moving out of
the service area of a plan approved for Premium Assistance.
During annual option selection periods (conducted in the fall), individuals participating in HOP will be able to change
their coverage option for the following calendar year, regardless of their health.
PAYMENT OF PREMIUMS
When a PSERS retiree or survivor annuitant enrolls in the Health Options Program, PSERS deducts the premiums for
coverage from the monthly retirement benefit. If the monthly retirement benefit does not cover the premium cost,
premiums must be paid directly to the PSERS HOP Administration Unit. The premium rates for each Health Options
Program plan or option are set each calendar year. The premium rates for the coming year are provided to Health
Options Program participants during the option selection period, and at which time participates may change plans.
PSERS Health Options Program
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