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STRS Ohio Optional Health Care

Plan Information
All information displayed in the STRS Ohio Optional Health Care section applies only to benefit recipients in the Defined Benefit and Combined Plans.

Selecting Your Plan

How to Enroll in a Plan

Enrolling as a Benefit Recipient

When Monthly Benefits Begin
Before you begin receiving service retirement, disability or survivor benefits, you must complete a benefit application. A section of this form asks whether you want to enroll in an STRS Ohio health care plan. If you elect to enroll, information about your plan options and monthly premiums will be mailed to you after your benefit application has been processed. If you fail to enroll in an STRS Ohio health care plan within 31 days after your first partial benefit payment begins, you could be subject to a six-month waiting period.

For service retirement or survivor benefit recipients, coverage is effective the first of the month following the date your benefit application is received and approved by STRS Ohio or on the benefit effective date, whichever is later. For disability benefit recipients, coverage is effective the first of the month following the date your application is received by STRS Ohio or the first of the month after the State Teachers Retirement Board approves your benefits, whichever is later.

New service retirement or disability benefit recipients should verify the last date of health care coverage with their employer before selecting a health care effective date with STRS Ohio. This will ensure that coverage dates do not overlap. After you have selected your STRS Ohio health care effective date and premium deductions have begun, you cannot change your STRS Ohio effective date regardless of the termination date of your employer plan. Any amounts you have accumulated toward an annual deductible or out-of-pocket maximum do not carry over from your employer plan when you retire and enroll in the STRS Ohio Health Care Program.

After carefully studying your health care plan options and the monthly premiums charged for coverage, select your health care plan by calling STRS Ohio. For more information, refer to “What to Expect During the Enrollment Process.”

After Monthly Benefits Begin

  • No waiting period — After your first monthly benefit payment, you may enroll yourself, a spouse, dependent children or sponsored dependents with no waiting period if hospital/medical and prescription drug coverage is terminating and you contact STRS Ohio within 31 days of the termination of your other coverage. A “Certificate of Creditable Coverage” from your group health care plan, or a letter signed by your current or former employer or plan sponsor on company letterhead verifying the date your health care coverage terminated, must be submitted along with a completed enrollment application. STRS Ohio coverage is effective the first of the month following termination of other coverage if we receive and approve your request to enroll within the 31-day period.

  • Six-month waiting period — There will be a six-month waiting period before coverage is effective if you are currently not covered under another health care plan or are currently covered under another hospital/medical and prescription drug plan that will not be terminating. There will also be a six-month waiting period if you do not provide a “Certificate of Creditable Coverage” from your group health care plan, or a letter signed by your current or former employer or plan sponsor on company letterhead verifying the date your health care coverage terminated, within 31 days of the termination of your other coverage. A shorter waiting period may apply if you enroll during the open-enrollment period.

A six-month waiting period will also apply if you request enrollment for yourself and/or your dependents as a result of marriage, birth, legal guardianship, adoption or placement for adoption later than 31 days following the event.

During Open Enrollment
STRS Ohio currently offers an open-enrollment period each fall. During this time, you can change your health care plan or enroll for the first time. You may enroll yourself, a spouse, dependent children or sponsored dependents during the fall open-enrollment period, provided the eligibility guidelines are met. Coverage becomes effective Jan. 1 following open enrollment.

Medicare HMOs
If you choose to enroll in a Medicare HMO, you will still need to apply for Medicare benefits in the three-month period before turning age 65, or earlier if you are eligible for Social Security disability benefits.

Once enrolled in Medicare Part A and/or Part B, you must send STRS Ohio proof of Medicare enrollment and submit a completed Medicare HMO application directly to the plan administrator. To obtain an application for enrollment, please contact the plan administrator directly.

If you or your covered dependent are currently enrolled in a Kaiser Permanente plan and are eligible for Medicare, you must enroll in Kaiser Permanente Medicare Plus. You will not be enrolled in this Medicare HMO until Kaiser Permanente receives and approves your completed application. Failure to submit a completed enrollment application to Kaiser Permanente or failure to provide a copy of your or your dependent’s Medicare card to STRS Ohio will result in a much higher health care premium until the necessary information is submitted.

Enrolling Dependents
An enrollment application is required for dependents. Please call STRS Ohio toll-free at 1-888-227-7877 to request an enrollment application, or visit the online forms section in the “Benefit Recipients” section to print the form.

Spouse
Service retirement or disability benefit recipients can enroll a spouse by submitting an enrollment application. A waiting period may apply depending on whether other coverage is terminating (see above for more information). Coverage for a new spouse may be effective the first of the month following the marriage, if a request to enroll is received within 31 days of the marriage date. (A survivor benefit recipient can enroll a spouse only as a sponsored dependent if guidelines are met.)

Child
You can enroll a newborn, adopted child or child for whom you are the legal guardian by submitting an enrollment application. If STRS Ohio receives the enrollment application within 31 days of the birth, adoption, placement for adoption or legal guardianship, coverage for the new dependent child may be effective the first of the month following the event.

If STRS Ohio does not receive the enrollment application within 31 days of the event, the effective date of coverage depends on whether you currently have a dependent child covered under your account. If you currently have a dependent child covered under your account, coverage for the new dependent child becomes effective the first of the month after STRS Ohio receives the application. If you do not currently have a dependent child covered under your account, a six-month waiting period applies.

Sponsored Dependent
If you are enrolled in an Aetna, Medical Mutual or Paramount health care plan, you can enroll a sponsored dependent by submitting a sponsored dependent enrollment application. A child sponsored dependent and an adult sponsored dependent must meet the definition of a sponsored dependent. In addition, a child sponsored dependent must be under age 18 and unable to qualify as a dependent child. An adult sponsored dependent must be age 18 or older and unable to qualify as a dependent child or spouse. Sponsored dependent eligibility must be verified annually. A copy of your federal income tax return may be required to verify dependent status.