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STRS Ohio Optional Health Care

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

Plans & Premiums for Enrollees Without Medicare
Premium information for this plan is listed after the plan features.

Commercial HMO Plans

Kaiser Permanente

Plan Features
Annual Deductible Per Enrollee1
No deductible
Out-of-Pocket Maximum1 (Annual amount enrollees pay excluding the annual deductible and prescription drug copayments)

$2,000 per single enrollee

$6,000 per family

Lifetime Benefits Maximum per Enrollee
No benefit maximum
Health Provider Access
Use HMO provider
Physician, Hospital, Skilled Nursing & Home Health Care
Physician Office Visit
Enrollee pays $15
Hospital Inpatient Services
Enrollee pays 0%
Hospital Charges for Outpatient Surgery and Preadmission Testing
Enrollee pays $15
Emergency Room Care
Enrollee pays $50; waived if admitted

Skilled Nursing Facility

Enrollee pays 0% for up to 100 days per benefit period; after 100 days, enrollee pays 100%

Inpatient Mental Health
Enrollee pays 0%; no limit on days
Home Health Care
Enrollee pays 0%; no visit limit
Preventive Services

Physical Exam

Enrollee pays $15
Colorectal Cancer Screening
Enrollee pays $15 for physician
Prostatic Specific Antigen (PSA)
Pap Smear
Mammogram
Outpatient Services
Diagnostic X-ray and Lab Testing
Enrollee pays 0%
Outpatient Mental Health
Enrollee pays $15; no visit limit
Additional Services
Dental Care
No coverage
Vision Care
Enrollee pays $15 for annual eye exam at United Optical
Prescription Drug Coverage
Retail Network Provider
Kaiser Medical Facilities and other participating pharmacies
Retail Copayment/
Coinsurance

Formulary generic: $15

Formulary brand-name: $30

Services must be received by pharmacies participating in the HMO.

Maximum Day Supply at Retail
31
Mail-Order Provider
Kaiser Mail-Service
Mail-Order Copayment

Formulary generic: $15

Formulary brand-name: $30

Maximum Day Supply at Mail Service
90

1 Payments are based on usual, customary and reasonable fees for medically necessary services as established by the health care plan administrator.

2 Annual deductible must be met before benefits are payable, unless otherwise noted. In-network and out-of-network accumulations are separate.

 

Kaiser Permanente
Monthly Premiums — Without Medicare

Eligibility Group

TOTAL COST: $646

Benefit Recipient Years of Service STRS OHIO PAYS YOU PAY
30+ 543 103
29 525 121
28 507 139
27 489 157
26 471 175
25 453 193
24 434 212
23 416 230
22 398 248
21 380 266
20 362 284
19 344 302
18 326 320
17 308 338
16 290 356
15 272 374
Less than 15 Years of Service1 0 646
NOTE: The “Total Cost” listed above is the amount a benefit recipient would pay if he or she paid 100% of the premium cost for coverage under each plan.
Spouse 0 536
Dependent Children 0 187
Sponsored Dependent, Adult N/A N/A
Sponsored Dependent, Children N/A N/A
NOTE: The “Total Cost” for eligible dependent coverage varies by plan and is listed in the “You Pay” columns.

1 Benefit recipients with a benefit effective date of Jan. 1, 2004, or later need 15 years of qualifying service credit to purchase health care coverage through STRS Ohio. Benefit recipients with a benefit effective date before Jan. 1, 2004, who have less than 15 years of service credit have access to coverage, but will pay 100% of their health care premium.

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