Coverage Considerations

Changes in Eligibility

Eligible dependents — Notify STRS Ohio by phone or in writing before the end of the month when an enrolled dependent no longer meets eligibility requirements. Please indicate the date your dependent is no longer eligible. Note: If your dependent is enrolled in the Aetna Medicare Plan or Paramount Elite and you notify us at the end of the month, your cancellation request may not be fulfilled until the end of the following month due to insufficient time to relay the request to your plan administrator and Medicare under their termination requirements. STRS Ohio must receive all termination requests by the 15th of the month to stop the next month’s premium deduction from your STRS Ohio benefit payment. Premium deductions from your monthly benefit payment do not guarantee coverage if your dependent no longer meets eligibility requirements.

Employed non-Medicare enrollees — You must notify STRS Ohio if you are employed in a public or private position. Coverage under the STRS Ohio Health Care Program may be limited for employed enrollees who are not eligible for Medicare. See Employed Non-Medicare Enrollees for additional information.

Moving to a new residence — If you are moving, call STRS Ohio as soon as you know your new address. STRS Ohio will inform you over the phone if your medical plan options will change as a result of your new address.

Foreign Travel

Before traveling to a foreign country, check with your medical and prescription drug plan administrators to learn how your coverage will be affected while you are abroad.

Coverage Under More Than One STRS Ohio Account

If you are eligible for health care coverage under more than one STRS Ohio account, you are limited to coverage under only one account. For example, you cannot be covered as both a benefit recipient and a survivor of a benefit recipient. Your monthly premium cost may be significantly different under each account. Be sure to compare premium rates for each type of account, taking into consideration such factors as years of service and Medicare eligibility. It is your responsibility to contact STRS Ohio each year to indicate from which account your monthly premium should be deducted.

Coverage Under More Than One Ohio Public Retirement System

If you are eligible for health care coverage through more than one Ohio public retirement system, guidelines determine which system is responsible for your health care coverage. Contact STRS Ohio for details.

Also, if you are eligible for partial Medicare Part B premium reimbursement through more than one Ohio public retirement system, specific guidelines apply. It is your responsibility to contact STRS Ohio to determine which system is responsible for providing your reimbursement. Please note, STRS Ohio Medicare Part B premium reimbursements will be discontinued effective Jan 1, 2019.

Changing Plans After Enrollment

Once you enroll in an STRS Ohio medical plan, you will remain in the plan you select for the calendar year, unless you experience a qualifying event.

The qualifying events listed below allow enrollees to change plans during the calendar year. This means enrollees can switch to any STRS Ohio medical plan for which they are eligible. Plan changes may apply to both the benefit recipient and any covered dependents.

  • Enrollee experiences one of the following events and requests to change plans within 31 days of the event: (1) marriage, divorce, dissolution or legal separation; (2) birth, adoption or legal guardianship of a child; (3) death; or (4) full loss of premium subsidy.
  • Enrollee becomes eligible for and enrolls in Medicare Parts A & B or Part B-only. Enrollee must request to change plans within three months following the effective date of Medicare. Note: If you are enrolled in the Basic Plan, you will be enrolled in the Aetna Medicare Plan, if eligible, unless you specify a different plan when you submit proof of Medicare enrollment to STRS Ohio.
  • Enrollee is a new retiree. The new enrollee must request to change plans within 31 days of receiving the first monthly benefit payment.
  • A PPO or an HMO enrollee experiences the loss of a key provider from the network.
  • An enrollee permanently moves to another service area, which results in different plan options being available.
  • An Aetna Medicare Plan or Paramount Elite enrollee may cancel coverage at the end of any month and select another available plan. The request must be received by the 15th of the month to take effect the first of the following month.

Note: If you experience a qualifying event during the calendar year and choose to change plan administrators, your medical deductible and out-of-pocket maximums will transfer to the new plan administrator only if you move between an Aetna plan and a Medical Mutual plan.

Canceling Coverage

Canceling Coverage at Any Time

You may cancel your or your dependent’s STRS Ohio medical coverage at any time by calling STRS Ohio. All cancellation requests must be received by the 15th of the month to stop the next month’s premium deduction from your STRS Ohio benefit payment. Please note, there are limited opportunities to reenroll in an STRS Ohio plan after you cancel coverage. See Enrollment Guidelines for details.

Canceling Your Dependent’s Coverage Due to Loss of Eligibility

  • Spouse — In the event of a divorce, your spouse’s coverage ends the first of the month following finalization of the divorce. The cancellation request must be received by the 15th of the month to stop the next month’s premium deduction from your STRS Ohio benefit payment. Your spouse may be eligible for COBRA continuation coverage. Call STRS Ohio for more information. Please note that some plans do not allow retroactive cancellations. It is the benefit recipient’s responsibility to notify STRS Ohio when a divorce is finalized.
  • Child — In the event a covered child loses access to STRS Ohio coverage because a parent dies, parents become divorced or the child stops being eligible for coverage, the child may be eligible for COBRA continuation coverage. Call STRS Ohio for more information.
  • After death of benefit recipient (Single Life Annuity) — If you selected a Single Life Annuity at the time of retirement and have dependents enrolled in an STRS Ohio plan at the time of your death, dependent coverage will be discontinued at the end of the month in which your death occurred. Your dependents may be eligible for COBRA continuation coverage. Contact STRS Ohio for more information.