Health Care Publications & Forms
Brochures
Forms
Plan Coverage Documents
2021 documents will be posted in January. Please contact the plan directly for specific coverage questions.
Aetna Medicare Plan
- Aetna Medicare Plan PPO Evidence of Coverage (Medicare Parts A & B)
- Aetna Medicare Plan PPO Evidence of Coverage (Medicare Part B-Only)
- Aetna Medicare Plan PPO Access2Care Transportation Benefit
Aetna Basic Plan
- Aetna Basic Plan Benefit Description (Non-Medicare)
- Aetna Basic Plan PPO Schedule of Benefits (Non-Medicare)
- Aetna Basic Plan Indemnity Schedule of Benefits (Non-Medicare)
Medical Mutual Basic Plan
- Medical Mutual Basic Medical Plan Description
- Required Notice for the Women’s Health and Cancer Rights Act of 1998
AultCare
- AultCare PPO Summary of Coverage (Non-Medicare)
- AultCare PPO Summary of Coverage (Medicare Part B-Only)
- AultCare PrimeTime Health Plan Summary of Benefits (Medicare Parts A & B)
- AultCare PrimeTime Evidence of Coverage (Medicare Parts A & B)
Paramount
Health Care Assistance Program (HCAP)
Express Scripts Prescription Drug Program
All Enrollees
- STRS Ohio Prescription Drug Program Overview
- Express Scripts Low-Cost Generic Drug List for Home Delivery
Non-Medicare Enrollees
- Express Scripts Prescription Drug Plan Description (Non-Medicare)
- Express Scripts Preferred List of Medications (Non-Medicare)
Medicare Enrollees
- Express Scripts Medicare Benefits Overview (Medicare)
- Express Scripts Medicare Evidence of Coverage (Medicare)
- Express Scripts Medicare Formulary (List of Covered Drugs)
- Notice of Medicare Part D Creditable Coverage