Eligibility

Join the Health Options Program! It’s retiree health coverage designed especially for retirees of the Pennsylvania Public School Employees’ Retirement System (PSERS).   

What Makes You Eligible

Generally, you first become eligible to enroll in the Health Options Program when you retire as a PSERS annuitant. You must enroll within the three months before or the three months after you turn age 65; otherwise, you will only be able to enroll in the Health Options Program if you experience a qualifying event (see Other Ways to Become Eligible, below).

The Health Options Program is available for annuitants, spouses of annuitants, survivor annuitants and their dependents. 

To be eligible for 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 plan).

You Can Also Cover Family Members

Your eligible dependents include:

• Your spouse. See the special consideration for your spouse.
• Your unmarried children under age 19, including natural children, stepchildren, legally adopted children, and children legally placed for adoption.¹
• 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 are:
  • Incapable of self-sustaining employment,
  • Dependent on you for support, and
  • Live with you.

Other Ways to Become Eligible

If you are not enrolled in the Health Options Program and experience a qualifying event, you may be able to enroll. Qualifying events can apply to you, your spouse and your dependents.

Eligible 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, 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.²
• 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.

Changes to your coverage must be made within a specified time frame, depending on your Qualifying Event. Call the HOP Administration Unit at 1-800-773-7725 for more information. 

Comparable Coverage for Your Spouse

If you and your spouse are both PSERS retirees, you may individually 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 that you enroll in. If your spouse is not eligible for Medicare, he or she must enroll in the same type of plan that you enroll in (the HOP Pre-65 Medical Plan if you enroll in the HOP or Value Medical Plan, or a managed care plan offered by the same insurance company if you enroll in a Medicare Advantage plan).

Therefore, if your spouse will have a qualifying event in the next year and is also considering enrolling, but not at the same time you will enroll, you may want to consider electing an option now that is good for both of you. Otherwise, your next opportunity to change options will be next fall during the Option Selection Period. Call the HOP Administration Unit at 1-800-773-7725 with any questions and for more information about plans for non-Medicare-eligible participants.

1. 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. ↩︎
2. 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. ↩︎

Last Modified: November 17, 2023