2010 STRS Ohio Health Care Program Special Edition Newsletter & Premiums

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During its June meeting, the State Teachers Retirement Board approved several changes to the STRS Ohio Health Care Program, as well as approved premiums for all health care plans, for calendar year 2010.

Beginning Jan. 1, 2010, Medical Mutual will be the only administrator for STRS Ohio’s Plus and Basic plans; Aetna will no longer be used for the non-Medicare plans. Results of an extensive review process conducted in conjunction with the Ohio Public Employees Retirement System (OPERS), School Employees Retirement System (SERS) and Highway Patrol Retirement System (HPRS) showed that Medical Mutual’s significantly lower administrative fees and better provider discounts could save $8.7 million each year for the STRS Ohio Health Care Program. In addition, Aetna’s continually higher premiums for non-Medicare enrollees compared to Medical Mutual was resulting in fewer STRS Ohio members choosing an Aetna-administered plan before reaching age 65. Individuals residing in the Cleveland, Canton and Toledo areas will continue to have the option of enrolling in the plans offered in their respective areas (AultCare — Canton area, Kaiser Permanente — Cleveland area and Paramount — Toledo area), as well as the Medical Mutual Plus and Basic plans. STRS Ohio’s initial contract with Medical Mutual will extend through Dec. 31, 2014. Express Scripts will continue to provide prescription drug coverage.

Health Care Plan Enrollment Options for 2010

Non-Medicare enrollees can use the Medical Mutual Web site to learn if their providers are in the network. Enrollees living in Ohio should click on “Find a Doctor in Ohio” on the home page, and then access the Medical Mutual SuperMed Plus network. Non-Ohio residents can click on “Find a Doctor Other States.”

For 2010 Medicare enrollees, STRS Ohio will provide the Aetna Medicare Plan (PPO) that has enhanced coverage at lower premiums than the 2009 Plus plans. STRS Ohio benefit recipients who have both Medicare Parts A & B and are currently enrolled in the Aetna or Medical Mutual Plus or Basic plans will be automatically enrolled in the Aetna Medicare Plan (PPO). All benefit recipients will also have the option of selecting the Medical Mutual Basic Plan.

Aetna-administered Medicare Advantage plans have been used successfully the last two years by both OPERS and SERS members.

The Aetna Medicare Plan (PPO) that STRS Ohio is offering provides a number of benefits to its enrollees, including:

• Lower premiums and a $1,500 maximum in out-of-pocket costs (includes all copayments, the $500 deductible and coinsurance)

• Low office copayments of $15

• Ability to see virtually any physician who accepts Medicare

• Unlimited lifetime maximum coverage

• Administrative simplicity (no claims coordination required)

• Preventive services covered at 100%

• Value-based prescription program for diabetic medications

• Gym memberships at participating fitness centers

• Care management resources (including help for dementia and depression, as well as social service issues)

• Discounts for eyewear and hearing aids

• Vision and hearing screenings

Express Scripts will continue to provide prescription drug coverage.

One way enrollees will experience a savings is through lower premiums. For example, the monthly premiums for a 30-year retiree in the Aetna Medicare Plan (PPO) in 2010 will be $58, compared to the 2009 Medical Mutual Plus Plan monthly premium of $73. The spouse premium under the Aetna Medicare Plan (PPO) will be $231 in 2010 versus $336 per month in 2009 in the Medical Mutual Plus Plan. Overall, this change to a Medicare Advantage plan could result in premium savings of $24.6 million for STRS Ohio benefit recipients and their family members, as well as $25.9 million less from the Health Care Stabilization Fund, if all Medicare Parts A & B enrollees remain in the Aetna Medicare Plan (PPO).

Individuals who prefer the Basic Plan can “opt out” of the Aetna Medicare Plan (PPO) and choose the Medical Mutual Basic Plan or one of the regional options if applicable (AultCare, Kaiser Permanente or Paramount) during this fall’s open enrollment.

The Medical Mutual Medicare Plus Plan option will only be available for Medicare Part A-only and Medicare Part B-only enrollees; enrollees living outside the United States; and family accounts where the health care plan participants include both Medicare and non-Medicare enrollees.

Additional information about the 2010 STRS Ohio Health Care Program will be provided in upcoming newsletters and on this Web site, as well as through personalized mailings sent to all STRS Ohio Health Care Program enrollees in October. This year’s health care plan open-enrollment period will run from Nov. 1–24, 2009.

Plan Comparisons

*Annual deductible must be met before benefits are payable.

2010 Premiums

Premiums for the 2010 health care plans are available below. You can also obtain the premiums by calling STRS Ohio’s Member Services Center toll-free at 1-888-227-7877. In late October, all current enrollees will also receive personalized information that outlines their 2010 plan options and monthly premiums in preparation for the fall open-enrollment period, which extends from Nov. 1–24, 2009.

Use the charts above, titled “Health Care Plan Enrollment Options for 2010,” to determine which plans are available to you.

	Premiums for Enrollees Without Medicare
	Premiums for Enrollees With Medicare Parts A & B — Eligible for Aetna Medicare Plan (PPO) (Applies to enrollees with Medicare Parts A & B living in the United States, and family accounts with each individual enrolled in Medicare Parts A & B)
	Premiums for Enrollees With Medicare — Not Eligible for Aetna Medicare Plan (PPO) (Applies to family accounts that include both Medicare and non-Medicare enrollees; Medicare Part A-only enrollees (except Kaiser and Paramount) and Medicare Part B-only enrollees. Enrollees living outside the United States are eligible only for the Medical Mutual plans.

Low-Cost Generics Now Available for $9 Through Express Scripts Home Delivery
Enrollees in the Medical Mutual, Aetna or Paramount health care plans can now receive a 90-day supply of more than 200 generic medications for just a $9 copayment through Express Scripts Home Delivery Program. Generic medications that can be ordered through this program include commonly prescribed medications for high blood pressure, diabetes, ulcers, osteoporosis, arthritis, asthma and hormone replacement.

STRS Ohio is one of the first large plan sponsors in the country to launch a discount generics program through home delivery.
STRS Ohio Health Care Program participants are expected to save more than $500,000 per year in prescription drug costs. Additional information, including the list of eligible generic medications, will be mailed to all Express Scripts enrollees during July. Click here for the complete list, including the strength and form of each drug available.

Express Scripts can assist you in getting a prescription from your doctor for delivery to your home. Just visit www.StartHomeDelivery.com or call Express Scripts toll-free at 1-877-502-0965 from 9 a.m.–6 p.m., Monday through Friday.

One Prescription Drug Plan for Aetna, Medical Mutual and Paramount Health Care Plans Approved
The Retirement Board recently approved a single prescription drug plan through Express Scripts for the Aetna, Medical Mutual and Paramount health care plans for 2010. This plan includes:

• A $150 individual deductible (generic copayments do not apply toward the deductible); a $3,000 individual out-of-pocket maximum; and changes Tier 3 drugs (non-formulary brand-name drugs) to 50% coinsurance, with a maximum of $100 for retail and $200 for mail order. The retail and mail-order copayments for Tier 1 and Tier 2 drugs will remain the same except for the lower $9 mail-order copayment for the medications included on the Low-Cost Generic Drug List (see previous article).

• Step therapies to new users of applicable drugs in five drug classes (ARB, bisphosphonates, hypnotics generic [Ambien], Lyrica and PPI enhanced).

• A Tier 4 level of coverage, where program enrollees pay the full cost of the drugs, but at the lower, negotiated discount rates generated by the contract between Express Scripts and STRS Ohio. Drugs in this category will include non-sedating antihistamines (e.g., Allegra and Clarinex); erectile dysfunction drugs; and drugs that are for cosmetic purposes, promote hair growth or treat male pattern baldness and depigment skin.

These changes provide better financial protection to Basic Plan members, who had to pay the full cost for Tier 2 and Tier 3 drugs once the $10,000 maximum annual payment from STRS Ohio was reached.

Help With Open Enrollment Available Through Fall Meetings
STRS Ohio will again be offering its popular Health Care Program Highlights Meeting on multiple dates throughout Ohio this fall. This 90-minute session is designed to help guide STRS Ohio members through the annual health care open-enrollment process. STRS Ohio representatives will review the 2010 health care premium information and cost-saving measures for all STRS Ohio health care plans available in the area. Meetings are held three times each day. The 10 a.m. and 2 p.m. meetings are for Medicare Parts A & B enrollees. The 5 p.m. meeting is for enrollees who are under age 65 without Medicare; Medicare Part A-only enrollees; Medicare Part B-only enrollees; and families that include both Medicare and non-Medicare enrollees. Advance registration is required. You may register one month before the date of the program by calling STRS Ohio toll-free at 1-888-227-7877, or going online (where directions are also available).

Meeting dates and locations are as follows:

Oct. 19	Strongsville
Oct. 20	Cambridge
Oct. 21	North Canton
Oct. 22	Boardman
Oct. 23	Mansfield
Oct. 26	Mentor
Oct. 27	Hudson
Oct. 28	Lima
Oct. 29	Perrysburg
Nov. 2	Athens
Nov. 3	Cincinnati
Nov. 4	Dayton/Miamisburg
Nov. 5	Columbus
Nov. 6	Chillicothe
Nov. 13	Columbus

 

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