Eligibility & Enrollment

Medicare Coverage

STRS Ohio requires all medical plan participants to enroll in Medicare Parts A & B at age 65 or when eligible. Medicare Part B is required for all enrollees. Medicare Part A is also required if it is available to you at no cost (premium free). If you decline Medicare Part B or premium-free Part A, you will no longer be eligible for STRS Ohio medical coverage.

Residency Requirement

To be eligible for coverage, the individual must actively reside in the United States with a permanent residence in one of the U.S. 50 states or U.S. territories.

Benefit Recipients

If you have questions about eligibility, please call STRS Ohio’s Member Services Center toll-free at 888‑227‑7877. Note: Members retiring Aug. 1, 2023, or later, must have 20 or more years of total service credit to be eligible for coverage.

Service Retirement

A Defined Benefit Plan or Combined Plan member is eligible for coverage based on years of total service credit. To access coverage:

• A member who retires on or after Aug. 1, 2023, must have 20 or more years of total service credit.
• A member who retires Jan. 1, 2004, through July 1, 2023, must have 15 or more years of total service credit.
• A member who retired before Jan. 1, 2004, does not have a minimum service credit requirement. However, the member pays 100% of the health care premium if the member has less than 15 years of total service credit.

Disability

A disability recipient is eligible for coverage. If a disability recipient later applies for service retirement, the following applies:

• If the disability effective date is on or after Aug. 1, 2023, the recipient must have 20 or more years of total service credit to have access to health care coverage if the recipient later applies for service retirement.
• If the disability effective date is Jan. 1, 2004, through July 1, 2023, the recipient must have 15 or more years of total service credit to have access to health care coverage if the recipient later applies for service retirement.
• If the disability effective date was before Jan. 1, 2004, the recipient qualifies for access to health care coverage under the service retirement account as long as there was no break in benefits between the disability benefit and the service retirement benefit. However, if the recipient has less than 15 years of total service credit, the recipient pays the full cost of the coverage.

Employed Non-Medicare Enrollees

Coverage under the STRS Ohio Health Care Program is limited for retirees not eligible for Medicare who are employed in public or private positions. Employed enrollees are eligible only for secondary health care coverage through STRS Ohio’s Basic Plan if they: (1) are eligible for medical and prescription drug coverage through their employer, or (2) hold a position for which other similarly situated employees are eligible for medical and prescription drug coverage at the same cost as full-time employees. The rule applies to all employed enrollees who are not eligible for Medicare, regardless of hire date or type of employment.

STRS Ohio requires enrollees not eligible for Medicare to verify their employment status and access to employer health care coverage. If you are employed and not eligible for Medicare, it is your responsibility to provide verification through your Online Personal Account. If you prefer to opt out of secondary coverage by canceling your STRS Ohio medical plan enrollment, contact STRS Ohio.

Eligible Dependents

Once the benefit recipient enrolls, a spouse, child and/or disabled adult child may be eligible for coverage. You must notify STRS Ohio in writing when a dependent no longer meets eligibility requirements and indicate the day, month and year your dependent is no longer eligible. Premium deductions from your monthly STRS Ohio benefit payment do not guarantee coverage if your dependent no longer meets eligibility requirements.

Spouse

A person who is married to a service retirement benefit recipient or disability benefit recipient; or a person who was married to a member, service retirement benefit recipient or disability benefit recipient at the time of the member’s or benefit recipient’s death.

Child

A person who is a child of a living or deceased service retirement benefit recipient, disability benefit recipient or member. To qualify as a child, the person must be under age 26 and be a:

• Biological child; or
• Legally adopted child or stepchild; or
• Child for whom the benefit recipient or member has been legally appointed as guardian.

Disabled Adult Child

Eligibility must be verified before enrollment. Contact STRS Ohio to begin the eligibility determination process.

A disabled adult child is a person age 26 or older who meets the following requirements:

• Has never been married; and
• Is a biological child, legally adopted child prior to age 18 or a stepchild of a living or deceased primary benefit recipient or member; or a child for whom a primary benefit recipient has been legally appointed as guardian prior to the child attaining age 18; and
• Continuously meets the requirements for physical or mental incompetency as set forth in Administrative Code Rule 3307:1-8-01; and
• Either was adjudged physically or mentally incompetent by a court prior to age 22; or was continuously physically or mentally incompetent and continuously unable to earn a living where both conditions occurred prior to age 22.

Beneficiaries and Survivors

Beneficiaries of Service Retirement Benefit Recipients

A spouse, child or disabled adult child receiving benefits under a Joint and Survivor Annuity or Annuity Certain plan of payment who was an eligible dependent of the service retirement benefit recipient at the time of the benefit recipient’s death. The service retirement benefit recipient must have been eligible for coverage at the time of death for a beneficiary to qualify for coverage. (See “Benefit Recipients” for eligibility criteria.)

Survivors of Active Members or Disability Benefit Recipients

A spouse, child or disabled adult child who is granted survivor benefits under division (C)(2) of section 3307.66, Revised Code, and who was an eligible dependent at the time of the active member’s or disability benefit recipient’s death. For survivors of active members, if the effective date of survivor benefits is Jan. 1, 2004, through July 1, 2023, 15 or more years of service at the time of the member’s death may be required depending on the type of survivor benefit selected. If the effective date of survivor benefits is on or after Aug. 1, 2023, 20 or more years of service at the time of the member’s death may be required.

Enrolling as a New Benefit Recipient

Before you begin receiving service retirement or disability benefits, you must complete a pension benefit application. A section of this application asks whether you want to enroll in an STRS Ohio health care plan. If you indicate you want to enroll but do not select a plan, health care information will be mailed to you after your benefit application has been processed.

Review the coverage available to you and the monthly premiums charged for coverage. If you did not previously select a plan in writing or in your online application, you must call STRS Ohio to select your plan. If you do not specify a plan or submit required Medicare information, you will be enrolled in the Basic Plan.

The date health care coverage begins for you and your eligible dependents will be determined as follows:

Service retirement recipients — For recipients who elect coverage within 31 days of their benefit effective date, coverage begins on their benefit effective date. For recipients with a retroactive benefit effective date who elect coverage within 31 days of the first of the month following receipt of the retirement application, coverage begins the first of the month following the date the retirement application is received.

Disability recipients — For recipients who elect coverage within 31 days from the end of the month when disability benefits are granted, coverage is effective the first of the month following the date the Retirement Board grants disability benefits.

Survivor and service retirement beneficiary recipients — For recipients who elect coverage when benefits are granted or within three months from the end of the month of the member’s date of death, coverage begins the first of the month following the member’s date of death. For a service retirement beneficiary recipient who was enrolled as a dependent of a member at the time of the member’s death, coverage will continue at the same level on the first of the month following the member's date of death.

Determining Your Effective Date of Coverage

Be sure to verify the date your employer-sponsored coverage will end. Knowing this information will help you determine an accurate start date of STRS Ohio coverage. Keep in mind:

• The effective date of STRS Ohio coverage cannot be changed after premium deductions and coverage have begun.
• The health care coverage you had through your employer is separate from your STRS Ohio coverage. Any amounts you have accumulated toward an annual deductible or out-of-pocket maximum do not transfer to your STRS Ohio plan from your employer plan.

Paying Your Monthly Premium

Your monthly premium for coverage will be deducted from your STRS Ohio benefit payment. If your monthly premium exceeds your benefit payment, the remainder of your premium must be paid in full through a direct debit account with your financial institution and STRS Ohio. (A direct debit account allows premium payments to be automatically withdrawn from your checking or savings account.) If payment is not received by the first business day of the month the premium is due, your coverage may be canceled.

Enrolling After Monthly Benefits Begin

Opportunities to join an STRS Ohio plan are limited after monthly benefits begin. Eligible benefit recipients who do not enroll in a plan when monthly benefits begin may later request enrollment under the following circumstances. An eligible dependent may also request enrollment under the following circumstances but only if the benefit recipient is enrolled in the plan.

Qualifying Events — The following qualifying events apply to each individual requesting enrollment. Family enrollments will not be accepted after monthly benefits begin unless each individual experiences a qualifying event. An enrollment application is required and must be received within 31 days of the qualifying event, unless otherwise specified. You can submit the enrollment application through your Online Personal Account. Other documentation may also be required.

• Loss of other coverage: An eligible individual may enroll upon loss of other coverage. This includes an individual moving to a permanent U.S. residence from a foreign country. Coverage becomes effective the first of the month in which other coverage is lost. Required documentation may include a “Certificate of Creditable Coverage” from your group health care plan; or a letter signed by your current or former employer or plan sponsor on company letterhead verifying the date coverage terminated. The certificate or letter must also include the names of any covered dependents, types of coverage and the dates of termination.
• Medicare enrollment: An eligible individual may enroll upon initial eligibility for and enrollment in Medicare Parts A & B or Part B-only (when you are not eligible for premium-free Part A). Coverage will be effective the first of the month Medicare coverage begins. See Medicare Enrollment for information.
• Marriage: Service retirement or disability recipients may enroll a spouse upon marriage. Coverage will be effective the first of the month following the date of marriage. If the marriage occurs on the first of the month, coverage is effective on that date.
• Birth, legal adoption or legal guardianship: Benefit recipients may enroll an eligible child for coverage beginning the first of the month of the date of birth, legal adoption or legal guardianship.

Open Enrollment — An eligible individual may enroll during open enrollment without a qualifying event. Open enrollment is offered in November each year for medical plans and once every two years for dental and vision plans. Online enrollment applications are accepted Nov. 1 through the Tuesday before Thanksgiving. Coverage will be effective Jan. 1 following open enrollment.