Originally posted August 31, 2007

STRS Ohio Health Care Program News — Special Edition

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Retirement Board Approves Premiums for 2008 in Preparation for Health Care Open-Enrollment Period
At its August 2007 meeting, the State Teachers Retirement Board approved the premiums for calendar year 2008 for each of the health care plans offered through the STRS Ohio Health Care Program. The new premiums take into account claims experience for each of the health care plans’ risk pools, as well as the plan design changes for 2008 approved earlier in the year by the board. They also reflect the board’s continuation of its contribution strategy of providing a premium subsidy of 2.5% per year of service, up to a 75% maximum, for benefit recipients, and providing access to spouses and dependents at 100% of projected rates.

The amount of increase in monthly premiums varies among plans. The minimum monthly premium is $40, except for benefit recipients enrolled in the Health Care Assistance Plan. A representative sampling of the premiums for 2008 are shown in the charts below.

Monthly Premiums for 2008 — Without Medicare

Indemnity and Preferred Provider Organization (PPO)
Benefit Recipient Years of Service	Aetna Basic Plan	Medical Mutual Basic Plan	Aetna Plus Plan	Medical Mutual Plus Plan
30+ Years of Service	$145	$111	$235	$181
20 Years of Service	$256	$222	$416	$362
15 Years of Service	$311	$277	$506	$452
<15 Years of Service	$478	$444	$778	$724
Spouse	$388	$362	$717	$669

 

	Preferred Provider Organization (PPO)	Commercial HMO
Benefit Recipient Years of Service	AultCare PPO	Kaiser Permanete	Paramount Health Care
30+ Years of Service	$47	$103	$113
20 Years of Service	$228	$284	$294
15 Years of Service	$318	$374	$384
<15 Years of Service	$590	$646	$656
Spouse	$490	$536	$580

 

 

Monthly Premiums for 2008 — With Medicare Parts A & B

	Indemnity		Preferred Provider Organization (PPO)
Benefit Recipient Years of Service	Aetna Basic Plan & Medical Mutual Basic Plan	Aetna Plus Plan & Medical Mutual Plus Plan	AultCare PPO
30+ Years of Service	$40	$69	$40
20 Years of Service	$73	$138	$107
15 Years of Service	$91	$173	$142
<15 Years of Service	$146	$277	$246
Spouse	$146	$302	$276

 

	Commercial HMO	Medicare HMO
Benefit Recipient Years of Service	Paramount Health Care	Kaiser Permanete Medicare Plus	Paramount Elite
30+ Years of Service	$108	$43	$48
20 Years of Service	$177	$112	$117
15 Years of Service	$212	$147	$152
<15 Years of Service	$316	$251	$256
Spouse	$350	$251	$257

In late October, all current enrollees in the STRS Ohio Health Care Program will receive personalized information that outlines their 2008 plan options, monthly premiums and coverage features. Open enrollment will run from Nov. 1 through Nov. 30, 2007. A complete list of premiums for all plans and each year of service will also be posted on the STRS Ohio Web site at www.strsoh.org on Sept. 4, 2007. At that time, premium information is also available by calling STRS Ohio’s Member Services Center toll-free at 1-888-227-7877.

Express Scripts Chosen as PBM for 2008 Through 2010
Enrollees in the Aetna, Medical Mutual and Paramount health care plans will have a new pharmacy benefits manager (PBM) for their prescription drug coverage beginning on Jan. 1, 2008. STRS Ohio, along with the Ohio Public Employees Retirement System, the School Employees Retirement System and The Ohio State University, have collectively agreed to use Express Scripts for their health care programs. By joining together, the four groups have been able to leverage their collective purchasing power representing 400,000 covered lives to stretch their respective health care dollars as much as possible.

The network of retail pharmacies for Express Scripts is very similar to the network currently offered by the current PBM, Caremark, and includes all the major chains (CVS, Walgreens, etc.). Most existing mail-service prescriptions with refills remaining will be automatically transferred to Express Scripts from Caremark to facilitate a smooth transition with the start of the new calendar year.

STRS Ohio benefit recipients will receive more information about Express Scripts in the October STRS Ohio newsletter as well as in materials they receive this fall as part of open enrollment.

Health Care Plan Changes for 2008 Offer Savings Opportunities
The following two prescription drug changes for 2008 apply to enrollees in the Aetna and Medical Mutual Plus and Basic Plans and the Paramount health care plans:

1) Add coverage for over-the-counter (OTC) Prilosec® (20 mg.) at retail for a 28-day supply for a $5 copayment. A doctor’s prescription will be needed. Copayments for all other tiers (generic and brand-name) of proton pump inhibitors will be increased to $25/$50/$75 at retail and $65/$125/$190 through mail-service. This change applies only to the proton pump inhibitor class of medications. The affected drugs, which are prescribed primarily to treat Gastroesophageal Reflux Disease (GERD), include omeprazole (generic), Nexium®, Protonix®, Prevacid®, Aciphex® and Prilosec®. Last year, about 83,000 prescriptions for drugs in this class were filled through the STRS Ohio Health Care Program. No other prescription drug copayments are changed for 2008.

2) Offer a voluntary pill-splitting program for specified generic drugs. Program enrollees are prescribed half the number of pills for double-strength medications that they then split in half to get the lower strength. In return, they pay only half the copayment amount. Participating enrollees will need to obtain a physician prescription specifying the double-strength dosage and pill splitting.

During calendar year 2007, STRS Ohio saw a significant increase in the number of individuals enrolling in either the Aetna or Medical Mutual Basic Plan. The Basic Plan offers lower monthly premiums for benefit recipients and their family members in exchange for a higher annual deductible and out-of-pocket maximum for each enrollee. In addition, a number of preventive services, such as annual physicals, mammograms and colorectal cancer screenings, are covered at 100% — no deductibles or coinsurance costs apply, although there are some frequency limitations. (For specific information, call Aetna toll-free at 1-800-645-5677 or Medical Mutual toll-free at 1-800-854-8139.)

For calendar year 2008, the Retirement Board added an additional enhancement to the Basic Plan offered by Aetna and Medical Mutual: the prescription drug maximum annual benefit was increased to $10,000 from $5,000. This means a plan enrollee will pay 100% of the full cost of Tier 2 and Tier 3 drugs only after STRS Ohio has paid $10,000 in retail and mail-service prescription drug costs. By reducing each enrollee’s risk of exceeding maximum coverage, more STRS Ohio benefit recipients and their family members may find this a viable option for their health care needs.

Additional information about these changes will be included in the October STRS Ohio newsletter as well as the health care open-enrollment packets.

There are no changes in medical or prescription drug coverage for the Kaiser and AultCare plans offered through STRS Ohio, and no changes to the Paramount plans except those noted above.

Also, as in the past, individuals enrolled in Medicare and an STRS Ohio-sponsored health care plan do not need to enroll in a Medicare Part D prescription drug plan for 2008. STRS Ohio will continue to offer prescription drug coverage that is as good as or better than the standard Medicare Part D coverage.

Current Reimbursement Dollar Level for Medicare Part B Unchanged for 2008
The dollar amount of reimbursement STRS Ohio benefit recipients receive for their Medicare Part B premium will not change in 2008. The maximum amount of reimbursement remains $52.83 per month for the 30-year retiree; the minimum amount of reimbursement is $29.90 per month. By maintaining these reimbursement levels, the annual required contribution for health care funding remains at or below 5%. This annual required contribution amount, which moves the Health Care Stabilization Fund toward a 30-year funding period, is the basis of the Retirement Board’s legislative initiative to create an ongoing, dedicated revenue stream for the health care program.