STRS Ohio Health Care Program Logo
 
Address & Phone Number
STRS Ohio Optional Health Care Image
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 Enrollee1
No deductible
Out-of-Pocket Maximum1 (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
Colorectal Cancer Screening
Prostatic Specific Antigen (PSA)
Pap Smear
Mammogram
Enrollee pays 0%; limit one per 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
$100 annual rebate for covered out-of-pocket expenses (excludes new dentures and dental
X-rays)
Vision Care
Enrollee pays $20 for annual eye exam at participating providers; $100 benefit allowance every 24 months for eyeglasses or contact lenses
Prescription Drug Coverage
Retail Network Provider
Retail Copayment/
Coinsurance2

Tier 1: $10 ($25 PPI)

Tier 2: $30 ($50 PPI)

Tier 3: $50 ($75 PPI)

Prilosec OTC®: $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.

Nonparticipating pharmacy: Reimbursed the amount STRS Ohio would have been charged at a participating Express Scripts pharmacy, less copayment.

Maximum Day Supply at Retail3
30 (28 Prilosec OTC®)
Mail-Order Provider
Mail-Order Copayment2

Tier 1: $25 ($65 PPI)

Tier 2: $75 ($125 PPI)

Tier 3: $125 ($190 PPI)

Prilosec OTC®: 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 Mail3
90

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

2 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.

3 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: $256

Benefit Recipient Years of Service STRS OHIO PAYS YOU PAY
30+ 208 48
29 201 55
28 194 62
27 187 69
26 180 76
25 173 83
24 166 90
23 159 97
22 152 104
21 145 111
20 139 117
19 132 124
18 125 131
17 118 138
16 111 145
15 104 152
Less than 15 Years of Service1 0 256
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 0 257
Dependent Children 0 209
Sponsored Dependent, Adult 0 257
Sponsored Dependent, Children 0 209
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.

Personal Account Information
SSN 
Password 
  Login

Forgot Your Password?

Problems Logging In?

Related Links