FAQ’s

Q: My spouse will be Medicare eligible before me and will no longer be able to stay on my retiree plan. Can my spouse enroll in PHIP while I stay on my retiree plan?
A: Yes. Your spouse may enroll in PHIP at their initial Medicare eligibility while you stay on your retiree plan. The reverse is also true. If you, as the retiree, are Medicare eligible before your spouse, the spouse may stay on the retiree plan and while you enroll under a Medicare plan under PHIP. When the spouse becomes entitled to Medicare, he/she could enroll in PHIP as a dependent under your PHIP plan.

Q: I am presently covered under PHIP but will be going back to work. Can I take advantage of my new employer insurance and drop my PHIP coverage? Will I be eligible to re-enroll in a PHIP when I quit work?
A: Yes. You can leave PHIP coverage and join an employer group plan, regardless of whether it is a PERS or non- PERS employer. When you decide to stop working and are no longer covered by the employer coverage you will be able to re-enroll in PHIP coverage under the “loss of employer coverage” enrollment opportunity.

Q: I have a pre-existing condition; will I be able to enroll in PHIP?
A: Yes. PHIP has never denied coverage due to a pre-existing health condition. In addition, The Affordable Care Act (ACA) of 2010 forbids any insurance company to deny coverage due to a pre-existing health condition as of January 1, 2014. You must still experience an enrollment opportunity in order to enroll in PHIP coverage.

Q: I am eligible for Veteran’s benefits, but my spouse is not. May my spouse enroll in PHIP at any time, even if I choose not to enroll?
A: No. In order for your spouse to enroll in PHIP, you as the retiree must also enroll in PHIP upon reaching your final enrollment opportunity. The only time the spouse of a PERS retiree is eligible to enroll without the retiree is when the spouse becomes Medicare eligible first. If the retiree does not enroll in PHIP upon their last enrollment opportunity (usually at Medicare eligibility) then the non-PERS spouse will lose PHIP coverage.

Q: Both my spouse and I are PERS retirees, and have 8 or more years of qualifying PERS service time, do we have to enroll separately in order to take advantage of either the RHIA or RHIPA subsidy that PERS contributes toward my monthly health insurance premium?
A: No, you do not have to enroll separately. You can enroll on the same Enrollment Request Form, making sure to mark the box that indicates your spouse is also a PERS retiree. We will automatically review your account to see if you both qualify for a premium subsidy.

Q: Can I use either the RHIA or RHIPA subsidy in a non-PERS Health Insurance Program plan?
A: No. You must be enrolled in PHIP to be eligible to receive either subsidy. For details on the subsidy programs see Subsidies.

Q: How do I know I am Tier 1, Tier 2 or OPSRP to determine if I am eligible for a PHIP subsidy?
A: Tier 1 and Tier 2 retirees are determined by your hire date with a public employer, at which point you began contributing to PERS. Contact the PERS pension office if you are unsure of your tier.

Q: If I am an OPSRP retiree and receiving a disability benefit, am I eligible to enroll in PHIP?
A: No. You must be receiving a PERS retirement pension allowance to be eligible for enrollment in PHIP. A disability benefit under OPSRP does not qualify.

Q: How do I receive a Certificate of Creditable Coverage (COCC) to reflect medical coverage through PHIP?
A: Contact your previous health plan directly for a Certificate of Creditable Coverage.

Q: If I did not enroll in dental when I first enrolled in PHIP, can I add dental when my spouse is added to PHIP coverage upon their enrollment opportunity?
A: Yes. When a spouse is added on to the coverage they will have an opportunity to choose both medical and dental coverage. Unless the spouse is a PERS retiree, their coverage must match the retiree’s coverage, which allows the retiree to pick up dental as well at that time. A 12-month waiting period could apply if you do not have 12 months of continuous dental coverage prior to enrollment into PHIP.

Q: After submitting my enrollment to PHIP I discovered that my employer would be covering me for an additional month. How do I change my effective date?
A: If the effective date has not passed, you may submit a request to PHIP in writing stating that you need to move your PHIP effective date. Once the effective date has passed, PHIP will not be able to notify the health plans to change the original effective date.

Q: As a retiree, if I miss my final enrollment opportunity, would I be able to enroll when my non-PERS spouse experiences an enrollment opportunity?
A: No. A retiree must experience an enrollment opportunity to enroll onto PHIP coverage. If the retiree misses their opportunity neither the retiree, nor the spouse, are eligible to enroll in PHIP.

Q: If I go outside the U.S. due to work and am covered by nationalized health coverage, can I come back to PHIP due to the loss of health coverage?
A: No. Nationalized health coverage is not considered employer-sponsored coverage and loss of that coverage would not be considered an enrollment opportunity.

Q: How do I request information for taxes?
A: Contact PHIP Customer Service via phone or email to request a record of premiums for your tax records.