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SERS Marketplace Wraparound Plan
SERS offers a Marketplace Wraparound Plan. Participants are able to choose insurance from any insurer offering coverage in the federal Marketplace, and if eligible, receive a federal subsidy to lower the premium and cost-sharing amounts.
 
The SERS Marketplace Wraparound Plan provides additional benefits to help pay for deductibles, co-pays, and other costs.
 
To receive the SERS Marketplace Wraparound benefits, you MUST complete the Health Insurance Marketplace enrollment process through HealthSCOPE.
 
You are eligible for the Marketplace Wraparound Plan when you are eligible for SERS health care coverage. However, this option is NOT available when you:
  • waive SERS coverage
  • are eligible for Medicare
  • are enrolled in Medicaid, or
  • have a family member enrolled in a SERS Medicare Advantage Plan.
How It Works
 
Select a health care plan from the Marketplace with the help of a counselor from our Marketplace Wraparound administrator, HealthSCOPE Benefits.
 
The HealthScope counselor will help you review the Marketplace plans that are best for you, and will assist you in signing up for both the Marketplace plan and the SERS Marketplace Wraparound Plan.
 
The counselor will also tell you whether you are eligible for a federal subsidy for your Marketplace plan to help pay your premium.
 
After you have selected your Marketplace plan, the SERS Marketplace Wraparound Plan will provide additional benefits to help you pay deductibles, co-pays, and other costs. There is no additional premium for the SERS Marketplace Wraparound Plan.
 
Important Facts:
  • When you enroll in a Marketplace plan, you are responsible for paying the monthly premium directly to the Marketplace plan. SERS cannot deduct Marketplace premiums from your monthly benefit payment. 
  • Federal subsidies offered in the Marketplace are based on household size and whole-household income.  
Benefit Maximum Reimbursement
Deductible Up to $2,000*
Covered prescription drugs co-payment/coinsurance
50% of the Marketplace plan’s prescription drug
co-payment/coinsurance (up to $200 per prescription)*
Physician Office Visit co-payment Up to $50 per visit*
Inpatient Hospital Admission co-payment/coinsurance
 
Up to $300 per admission*
Imaging (X-rays, CT/PET Scans,MRI) co-payment or coinsurance Up to $100 per service*
Hearing Aid One hearing aid per year; up to $1,500**
*This is the maximum amount that the Wraparound Plan will reimburse each participant for each benefit category. Reimbursement is limited to cost-sharing after the participant’s Marketplace plan has adjudicated any claim(s). Actual reimbursement may vary according to the participant’s Marketplace plan’s terms, but will in no event exceed the participant’s actual out-of-pocket expenses under the applicable Marketplace plan.
 
**The Wraparound Plan will reimburse each participant on a first dollar basis up to this limit.
 
The 2018 SERS Wraparound Plan benefits noted above only apply to covered services under your Marketplace plan. Claims for non-covered services are not eligible for reimbursement, except for hearing aids.

 

How Do I Sign Up?

Check the box for the “Marketplace Wraparound” plan on SERS’ service retirement or other benefit application.

A HealthSCOPE counselor will contact you.

If you decide not to enroll in a Marketplace plan, you will still have the option to select a different SERS health plan or waive SERS coverage.

To learn more about Marketplace coverage and the SERS Marketplace Wraparound Plan benefits, call HealthSCOPE Benefits toll-free at 888-236-2377. Be sure to tell the representative that you are a member of the School Employees Retirement System of Ohio. 

Health Insurance Marketplace and SERS Marketplace Wraparound Plan Questions and Answers

Q: Can I enroll in a Marketplace plan on my own, and still receive the additional benefits from the SERS Marketplace Wraparound Plan?

No. In order to receive the SERS Marketplace Wraparound Plan benefits, you must sign up for a Marketplace plan through HealthSCOPE.

Q: What plans can I select on the Marketplace?

The Marketplace offers a variety of plans at different prices and benefit levels. You may choose any plan offered through the Marketplace and receive the SERS Wraparound benefits.

Q: How much does Marketplace coverage cost?

The cost can be different for each person depending upon his or her household income, age, location, and which coverage is chosen.

Q: If I receive SERS’ Wraparound benefits, am I still eligible for a federal premium subsidy?

Yes, if you are eligible for a federal premium subsidy, the Wraparound benefits will not affect your subsidy. Combining the federal premium subsidy and the Wraparound benefits make the SERS Marketplace Wraparound Plan an affordable option, particularly for lower-income households.

Q: Can I enroll in a Marketplace plan outside the annual November 1 – December 15 Marketplace Open Enrollment Period?

No, unless you qualify for a Special Enrollment Period. Getting married, getting divorced or legally separated, or losing employer health coverage would qualify you to join a Marketplace plan outside the annual open enrollment period.

Q: What if I decide to cancel my Marketplace plan? Could I enroll in another SERS health care plan?

Yes. If you cancel your Marketplace Plan along with the SERS Marketplace Wraparound Plan, you have 31 days to enroll in another SERS non-Medicare health care plan. Before making any changes, you should contact SERS’ Health Care Services at 800-878-5853 to discuss your premium costs and options.

 

Resources and Links

SERS Marketplace Wraparound Summary of Benefits

SERS Marketplace Wraparound Brochure 

SERS Non-Medicare Plans

Member Health Care Guide