Health Care Program News

Open Enrollment for 2019 STRS Ohio Medical Plans Begins Nov. 1

Open enrollment for STRS Ohio’s medical plans is Nov. 1–20, 2018. This is the period for benefit recipients to decide if they want to continue coverage or enroll in a new plan for 2019. The medical plans will remain largely the same in 2019, and more than 90% of current enrollees will see no premium increase for 2019.

In late October, current medical plan enrollees who did not request electronic delivery received open-enrollment materials by mail in an STRS Ohio Health Care Program envelope marked “Your open-enrollment materials are enclosed.” This mailing included a personalized list of plans and premiums. The medical plan listed on the front of the letter is the plan you will be enrolled in for 2019 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 the Member Services Center toll-free at 888‑227‑7877 to request these materials.

Limited Plan Design Changes for 2019

For the 2019 plan year, the only plan design change is a $100 increase in the out-of-pocket limit for prescriptions, to $5,100 from $5,000. As in past years, Express Scripts’ preferred medication lists may also change. Express Scripts will send letters to impacted enrollees. If you have questions after reviewing your open-enrollment materials, please visit STRS Ohio’s Open-Enrollment Resource Center or contact STRS Ohio’s Member Services Center toll-free at 888‑227‑7877.

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Dental, Vision Open Enrollment Runs Nov. 1–20; Premiums Essentially Unchanged

All eligible benefit recipients recently received information for dental and vision coverage in their open-enrollment packet. Open enrollment for these plans is Nov. 1–20. You can enroll yourself or your dependents for the upcoming two-year contract period (Jan. 1, 2019–Dec. 31, 2020) by using your Online Personal Account or submitting an enrollment application to STRS Ohio by Nov. 20. Enrollment in an STRS Ohio medical plan is not required to enroll in dental or vision coverage.

STRS Ohio offers dental coverage through Delta Dental and vision coverage through Vision Service Plan (VSP). If you enroll in either or both of these plans, you will pay premiums from January 2019 through December 2020, even if you no longer need or use services under the plan. Premiums and coverage features for these plans are included in the open-enrollment packet and are available on the STRS Ohio website. If you are currently enrolled and wish to remain enrolled, you do not need to contact STRS Ohio — your coverage will be extended through Dec. 31, 2020. However, if you would like to cancel coverage in either or both plans, you must submit your cancellation request through your Online Personal Account or call or email STRS Ohio by Nov. 20.

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2019 Medical Plan Premiums

Board-approved medical plan premiums for 2019 result in more than 90% of plan enrollees seeing no premium increase for plan year 2019. Open-enrollment packets include 2019 plan options and monthly premiums for current enrollees. A complete list of premiums is also available through the STRS Ohio Member Services Center and on the STRS Ohio website. 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 2019 premiums.

Monthly Enrollee Premiums for 2019 — With Medicare

Benefit Recipient Years of Service Aetna Medicare Plan (Medicare Advantage PPO)
Total Cost: $342
Medical Mutual Basic (Indemnity or PPO)
Total Cost: $300
AultCare PPO
Total Cost $473
Paramount Elite HMO (Medicare Advantage)
Total Cost: $359
30+ $127 $111 $258 $144
25 $162 $142 $293 $179
20 $198 $174 $329 $215
15 $234 $205 $365 $251
<15* $342 $300 $473 $359
Spouse $342 $300 $473 $359
Per Child $342 $300 $473 $359

Monthly Enrollee Premiums for 2019 — Without Medicare

Benefit Recipient Years of Service Aetna Basic/Medical Mutual Basic (Indemnity or PPO)
Total Cost: $957
AultCare PPO
Total Cost $890
Paramount Health Care (HMO)
Total Cost: $946
30+ $399 $371 $394
25 $492 $457 $486
20 $585 $544 $578
15 $678 $630 $670
<15* $957 $890 $946
Spouse $957 $890 $946
Per Child $282 $246 $260

*Members who retired before Jan. 1, 2004, with less than 15 years of service credit have access to the STRS Ohio Health Care Program but pay the full cost of the 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 have access to coverage. Members who retire on or after Aug. 1, 2023, must have at least 20 years of qualifying service credit to have access to coverage.

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Visit STRS Ohio’s Online Open-Enrollment Resource Center for Plan Details

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

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STRS Ohio Offers Health Care Assistance Program

STRS Ohio’s Health Care Assistance Program (HCAP) provides qualifying benefit recipients with 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 at 888‑227‑7877 (toll-free).

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Health Care Items of Note

  • Aetna and Medical Mutual networks have expanded to include most AultCare providers.
  • Effective Jan. 1, 2019, your permanent residence must be in one of the U.S. 50 states or U.S. territories to be eligible for coverage under the STRS Ohio Health Care Program.
  • STRS Ohio requires all medical plan participants to enroll in Medicare Parts A & B at age 65 or whenever eligible. If Medicare Part A is not premium-free, you do not need to enroll in Part A. However, Medicare Part B is required. If you decline Medicare Part B coverage or premium-free Medicare Part A, you will not be eligible for STRS Ohio medical and prescription drug coverage.
  • All non-Medicare enrollees must verify employment and access to employer health coverage annually. STRS Ohio will notify you when it’s time to complete the verification process.

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Health Care Fund Continues to Strengthen; Board Aims to Preserve Fund Stability

In preparation for its October meeting, the Retirement Board is expecting a report from its actuary, Cheiron, to show the Health Care Fund gained further strength since the last actuarial valuation of the fund in January. Good claims experience had a positive impact on the fund. The fund balance increased to $3.72 billion as of July 1, 2018, up from $3.69 billion on Jan. 1, 2018. It is estimated that if the fund earns 7.45% in all future years — which could be challenging in the next decade — and all other plan experience matches assumptions, the fund is projected to remain solvent for all current members.

The board has expressed its interest in developing a plan management policy for the Health Care Fund to provide the guidance necessary to make the health care program more stable, reliable and secure. With no employer contributions currently going into the Health Care Fund, STRS Ohio staff said the retirement system should position itself to be able to withstand investment market volatility. The Health Care Fund in now funded by premiums paid by enrollees, government reimbursements and investment earnings on these funds.

In the months that follow the valuation report in October, the board hopes to finalize its work on the plan management policy. The board would like the policy to address two key principles:

  1. The desire to offer a meaningful premium subsidy to plan enrollees, and
  2. Sustainability of the fund for current and future plan enrollees.

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