Health Care Program News

Open Enrollment for 2020 Medical Plans Begins Nov. 1

Open enrollment for STRS Ohio’s medical plans is Nov. 1–26, 2019. The open-enrollment period provides benefit recipients the opportunity to change plans or enroll in a new plan for calendar year 2020 without a qualifying event. Board-approved premiums resulted in no premium increase for more than 90% of current enrollees for the upcoming year. While most plan features will remain the same, a few changes will be made for the STRS Ohio Health Care Program for 2020 and are outlined below under “Medical Plan Changes for 2020.”

In late October, current medical plan enrollees who did not request electronic delivery will receive open-enrollment materials by mail in an STRS Ohio envelope marked, “Your health care open-enrollment materials are enclosed.” This mailing includes a list of plans and premiums. The medical plan listed on the front of the letter is the plan you will be enrolled in for 2020 unless you contact STRS Ohio. Additional plan options (if available) are listed on the back of the letter. You and your eligible dependents must enroll in the same option. If two medical plans are listed under an option, you and your dependents are eligible for different plans based on Medicare status.

If you are not currently enrolled in coverage through STRS Ohio and would like a personalized enrollment packet, contact STRS Ohio’s Member Services Center toll-free at 888‑227‑7877 to request these materials.

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New for 2020 — Online Health Care Enrollment

STRS Ohio benefit recipients who want to enroll, cancel or change their medical plan coverage can now do so online during open enrollment through a secure Online Personal Account. You can simply log in anytime during open enrollment to complete changes to medical plan coverage or to add coverage for the 2020 plan year. You can also use your Online Personal Account to update contact information, register for meetings and counseling sessions, view important documents and more. If you do not have an Online Personal Account, register here — just click “Login” at the top of the home page and then click “Register now” under the Login button.

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Health Care Assistance Program Available to Benefit Recipients

STRS Ohio offers a Health Care Assistance Program (HCAP) to qualifying benefit recipients that provides medical and prescription drug coverage for a $0 premium. Eligibility for the program is based in part on an annual family income limit of $23,800 and a household liquid asset limit of $23,800 (a home is not considered a liquid asset). New HCAP applicants must be eligible for a subsidy under the STRS Ohio Health Care Program to qualify for HCAP enrollment. Benefit recipients, survivors and beneficiaries who are currently enrolled in HCAP are not subject to the subsidy requirement as long as they continue to meet all other HCAP requirements and remain continuously enrolled in the program. New and current STRS Ohio Health Care Program enrollees may apply. The application and additional program details are available on the STRS Ohio website or by request from the Member Services Center (toll-free) at 888‑227‑7877.

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2020 Medical Plan Premiums

Medical plan premiums for 2020 provide more than 90% of plan enrollees with a premium less than or equal to their current premium. Open-enrollment packets include 2020 plan options and monthly premiums for current enrollees. A complete list of premiums is available on the STRS Ohio website or by request through the STRS Ohio Member Services Center. A sampling of the medical plan premiums is shown below. Lower than anticipated health care claims during the review period for STRS Ohio’s self-insured plans had a positive impact on the 2020 premiums.

Monthly Enrollee Premiums for 2020 — With Medicare

Benefit Recipient Years of Service* (See requirements below.) Aetna Medicare Plan (Medicare Advantage PPO)
Total Cost: $340
Medical Mutual Basic (Indemnity or PPO)
Total Cost: $320
AultCare PrimeTime Health Plan (Medicare Advantage HMO-POS for Parts A & B) AultCare (PPO for Part B-only) Total Cost $368 Paramount Elite (Medicare Advantage HMO)
Total Cost: $364
30+ $126 $120 $154 $150
25 $161 $153 $189 $185
20 $197 $186 $225 $221
15 $233 $220 $261 $257
<15 $340 $320 $368 $364
Spouse $340 $320 $368 $364
Child $340 $320 $368 $364

Monthly Enrollee Premiums for 2020 — Without Medicare

Benefit Recipient Years of Service* (See requirements below.) Aetna Basic/Medical Mutual Basic (Indemnity or PPO)
Total Cost: $986
AultCare (PPO)
Total Cost $894
Paramount Health Care (HMO)
Total Cost: $936
30+ $399 $362 $379
25 $497 $451 $472
20 $595 $539 $565
15 $693 $628 $657
<15 $986 $894 $936
Spouse $986 $894 $936
Child $266 $267 $279

*Eligibility requirements

Members who retired before Jan. 1, 2004, with less than 15 years of service credit have access to coverage but pay the full cost of their premium.

Members who retire on or after Jan. 1, 2004, and before Aug. 1, 2023, must have at least 15 years of qualifying service credit to access coverage.

IMPORTANT: Members who retire on or after Aug. 1, 2023, must have at least 20 years of qualifying service credit to access coverage.

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Health Care Items of Note

  • Annual deductibles and out-of-pocket maximums reset every Jan. 1. Accumulated amounts do not carry over to the next calendar year.
  • This open-enrollment period is for medical and prescription coverage only. Dental and vision enrollment and plan changes are not permitted at this time.
  • Current medical plan enrollees will receive open-enrollment materials (personalized letter with plans and premiums, overview of plan features and instructions). Enrollees who selected the paperless option can view their materials in their Online Personal Account.
  • If you are not currently enrolled in a plan and are interested in coverage, contact STRS Ohio to request your personalized open-enrollment information.
  • Current enrollees can use their Online Personal Account to change plans, add coverage or cancel enrollment; new enrollees can use their personal account to enroll in a plan.

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Medical Plan Changes for 2020

Prescription drug plan changes for 2020 include:

  • Increasing the maximum annual expense for Medicare enrollees to $6,350 to align with the 2020 standard Medicare prescription plan.
  • Changing the specialty drug coinsurance for all enrollees to the lesser of 13% of the cost or $450 for a supply of 1‑31 days, $900 for a supply of 32–60 days and $1,350 for a supply of 61–90 days.

Medical plan changes for 2020 include:

  • Moving AultCare enrollees with Medicare Parts A & B to AultCare PrimeTime Health Plan. This new plan is a Medicare Advantage HMO with a point-of-service (POS) option, which allows enrollees to seek care outside of the traditional HMO network if needed. Contact AultCare to check the network status of your providers.
  • Adding a 24-hour nurse line for non-Medicare Medical Mutual Basic Plan enrollees.
  • Requiring transplants to be performed at Organ Transplant Centers of Excellence for non-Medicare Medical Mutual Basic Plan enrollees.

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Free In-Home Health Evaluations Help Aetna Medicare Plan Enrollees

Taking care of your health is more than just visiting the doctor when you are sick. This is why Aetna Medicare Plan enrollees are encouraged to participate in Aetna’s in-home assessment program. This free, convenient service allows you to meet with a licensed health care professional in the privacy of your home to talk about your individual needs.

During the visit, you will talk one-on-one with a licensed health care professional, ask questions regarding your health and discuss how to set up a safe, healthy home. The health care professional may suggest a personalized list of topics for you to discuss with your primary care physician. You may also be referred to other programs to manage your health. Feel free to have a family member or caregiver present at the time of the visit, which lasts about an hour.

As an Aetna Medicare Plan enrollee, you will receive a letter in the mail inviting you to participate in the program. You will also receive a follow-up call on behalf of Aetna to schedule your visit. Each year, Aetna is required by Medicare to contact enrollees about the program. If you do not want to receive an in-home visit, simply answer the call and advise that you are not interested versus disregarding the outreach attempts.

These assessments have helped many retirees better manage their health, which can lead to staying in your own home longer. Your participation can also help keep premiums lower for STRS Ohio Aetna Medicare Plan enrollees. For all of these reasons, we encourage you to schedule your free in-home assessment. If you have any questions or would like to schedule your appointment, please call toll-free 877-503-5802. Hours of operation are Monday–Friday, 9 a.m. to 9 p.m. You can also view a brief video about the program.

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STRS Ohio’s Open-Enrollment Resource Center — Your 24/7 Detail Destination

Visit STRS Ohio’s Open-Enrollment Resource Center for the information and materials you need to enroll in a medical plan. This section of the website includes instructions, plan coverage features, premiums and more.

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