PERACare is the voluntary health, dental, and vision benefits program for PERA retirees and their eligible dependents. Understanding how insurance works can be overwhelming but we’re here to help by explaining who does what in relation to PERACare, and to highlight what you can do to be an informed PERACare enrollee.

The PERACare staff at PERA is responsible for:

• Selecting carriers via competitive proposal processes
• Determining the plans offered and the level of benefits for each plan (copays, deductible, etc.)
• Reviewing premium renewals with the carrier to ensure accuracy and to negotiate when possible
• Ensuring that carriers meet PERA’s contractual performance standards
• Maintaining retiree eligibility records and sending eligibility information to carriers
• Collecting monthly premiums from enrollees
• Working with carriers to resolve elevated retiree issues
• Monitoring health insurance regulations to ensure PERA’s compliance

PERACare carriers are responsible for:

• Calculating the premium required to cover the expected claims for each plan year
• Determining the services covered under the plan and which services need prior authorization
• Maintaining a network of providers and facilities
• Processing prior authorization requests received from providers
• Setting the list of covered medications (formulary)
• Paying claims accurately and timely
• Providing Customer Service and Care Management services to enrollees
• Helping you determine the cost of medical services prior to getting services

Doctors/providers (dentists, hospitals, etc.) are responsible for:

• Answering questions about the care you might need
• Determining when a prior authorization is required and submitting that request to the carrier
• Identifying alternatives if a particular service or medication is not covered
• Filing claims to your insurance carrier on a timely basis
• For dental, submitting a pre-treatment estimate so you know your cost in advance

You are responsible for:

• Reading all PERACare information mailed or emailed to you
• Providing requested documents to PERA for eligibility determination
• Reviewing information mailed or emailed to you from your carriers
• Contacting your carrier for help with a claim or needing a new ID card (If you are unable to resolve the issue on your own, you can contact PERA for assistance)
• Updating PERA if your address or phone number changes
• Paying your Medicare Part B premium (if enrolled in a Medicare plan)

Turning 65 in 2024?

If you will be celebrating your 65th birthday this year, congratulations! You’ll be eligible to enroll in Medicare. This also means that you can enroll in a PERACare Medicare plan.

To prepare for the transition, attend our PERACare for Medicare Plans Webinar. In just 45 minutes, we’ll walk you through important Medicare basics and your PERACare health options.

Visit the Turning 65: Planning for Medicare webpage for more information and other resources.