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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 With Medicare Parts A & B
Premium information for this plan is listed after the plan features.

Medical HMO Plans

Paramount Elite

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

No annual maximum

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 for
primary care physician; $20 for specialists
Hospital Inpatient Services
Enrollee pays 0%
Hospital Charges for Outpatient Surgery and Preadmission Testing
Emergency Room Care
Enrollee pays $50; waived if admitted

Skilled Nursing Facility

Enrollee pays 0%
per benefit period for days 1–20; $75 for days 21–100; after 100 days, enrollee pays 100%

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

Physical Exam

Enrollee pays $15 for primary care physician; $20 for specialists (age/gender coverage guidelines may apply to immunizations/inoculations)
Bone Density Screening
Immunizations/Inoculations
Colorectal Cancer Screening
Prostatic Specific Antigen (PSA)
Pap Smear
Mammogram
Enrollee pays 0%; limit one per calendar year
Outpatient Services
Diagnostic X-ray and Lab Testing
Enrollee pays 0%
Outpatient Mental Health
Enrollee pays $25; no visit limit
Additional Services
Dental Care
No coverage
Vision Care
No coverage
Prescription Drug Coverage
Retail Network Provider
Retail Copayment/
Coinsurance1

Tier 1: $10 ($25 PPI)

Tier 2: $30 ($50 PPI)

Tier 3: $50 ($75 PPI)

Prilosec OTC®/OTC omeprazole: $5 with prescription

If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug.

Once the enrollee has paid a total of $2,000 out of pocket in retail and mail-order copayments, that individual pays nothing for covered drugs for the remainder of the year.

Out-of-network pharmacy: Reimbursed the amount STRS Ohio would have been charged at a network pharmacy, less copayment.

Maximum Day Supply at Retail2
30 (28 Prilosec OTC®/OTC omeprazole)
Mail-Order Provider
Mail-Order Copayment1

Tier 1: $25 ($65 PPI)

Tier 2: $75 ($125 PPI)

Tier 3: $125 ($190 PPI)

Prilosec OTC®/OTC omeprazole: Not covered

If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug.

Once the enrollee has paid a total of $2,000 out of pocket in retail and mail-order copayments, that individual pays nothing for covered drugs for the remainder of the year.

Maximum Day Supply at Mail2
90

1 Different copayments apply to proton pump inhibitor (PPI) medications under Express Scripts. Designated double-strength medications may be available for half the applicable copayment under Express Scripts.

2 Applies to all medication classes unless otherwise specified. Designated double-strength medications are only available for half the maximum day supply under Express Scripts.

 

Paramount Elite
Monthly Premiums — With Medicare Parts A & B

Eligibility Group

TOTAL COST: $264

Benefit Recipient Years of Service STRS OHIO PAYS YOU PAY
30+ 221 43
29 213 51
28 206 58
27 198 66
26 191 73
25 184 80
24 176 88
23 169 95
22 162 102
21 154 110
20 147 117
19 140 124
18 132 132
17 125 139
16 118 146
15 110 154
Less than 15 Years of Service1 0 264
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 0 305
Dependent Children 0 305
Sponsored Dependent, Adult 0 305
Sponsored Dependent, Children 0 305
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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