State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
Welcome to the Health Care Program Highlights presentation. This presentation will provide
health care open enrollment information for non-Medicare enrollees. The open enrollment period
for the STRS Ohio Health Care Program is November 1 through November 22. Open enrollment
is offered each year for STRS Ohio’s medical plans and once every two years for the dental and
vision plans.
www.strsoh.org
State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
We will begin this presentation with a review of the plan and premium changes for 2017. This
will be followed by a look at key considerations for comparing health care plan options in the
general marketplace.
We will then discuss the features and costs of the dental and vision plans offered by STRS
Ohio, highlight open enrollment details and timelines, and conclude with important information
about the future of the STRS Ohio Health Care Program.
www.strsoh.org
State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
Before we discuss health care program changes for the 2017 plan year, let’s review the medical
plan options available to individuals not yet enrolled in Medicare.
STRS Ohio offers two national plans (Medical Mutual Basic and Aetna Basic) and two regional plans
(AultCare PPO and Paramount Health Care).
If you are a current Medical Mutual Basic Plan enrollee without Medicare who resides outside of
Ohio, you will be moved to the Aetna Basic Plan in 2017. The Aetna Basic provides more network
coverage for non-Ohio residents.
With regard to the two regional plans, the AultCare PPO plan is only available in select northeastern
Ohio area ZIP codes. Paramount Health Care is available in select northwestern Ohio and southern
Michigan area ZIP codes.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
Now, let’s look at the health care program changes for the 2017 plan year that impact
non-Medicare enrollees.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
The urgent care copayment will increase to $40 from $35 for all plans.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
The Alere Disease Management Program is being discontinued. The medical plans — Medical
Mutual Basic, Aetna Basic, AultCare PPO and Paramount Health Care — will now oversee disease
management for their enrollees.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
Express Scripts will continue to be the pharmacy benefit manager for all of the STRS Ohio medical
plans.
The annual deductible will increase to $250 for covered brand-name drugs, including specialty.
Generic drug costs do not apply to the deductible.
The maximum annual expense will increase to $4,950 and includes copayments, coinsurance and
deductible for generic, covered brand-name and specialty drugs. Once you reach that amount, you
pay nothing for those covered drugs for the remainder of the calendar year.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
There will now be two types of network retail pharmacies — preferred and non-preferred. You can
use either type of network pharmacy. If you use a preferred pharmacy you will pay the standard
copayment or coinsurance.
If you use a non-preferred pharmacy you will pay a $10 fee per fill in addition to the application
copayment or coinsurance. This fee does not apply to the annual deductible or maximum annual
expense.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
Coverage for proton pump inhibitors – also known as PPIs – will be discontinued. These drugs,
such as Nexium and Prilosec, are all available over-the-counter.
The one-half copayment program for diabetic prescriptions will be discontinued. Enrollees will pay
the full copayment amount for all diabetic medications and supplies.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
And, lastly, in terms of changes to prescription drug coverage for 2017, there is a change related to
specialty drugs.
The specialty drugs coinsurance percentage will increase to 13% from 10%, and the per
prescription maximum will increase to $550 from $500. That maximum is after the deductible is met,
if applicable.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
With regard to the monthly medical premiums, premiums for dependent children are changing to a
per child rate. This monthly premium will range from $203 to $243 per child, depending on the
medical plan selected.
Coverage for sponsored dependents of unmarried retired teachers will no longer be offered. This
change does not include disabled adult children.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
One of the most significant changes impacting non-Medicare enrollees is the subsidy provided by
STRS Ohio. Health care premiums are subsidized based on years of service multiplied by a subsidy
multiplier. In 2017, the subsidy multiplier will decrease to 1.9% per year of service. This means a
member with 30 years of service would receive a 57% subsidy.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
This table shows the 2017 monthly medical plan premium for a benefit recipient with 30
years of service and the rate for a spouse. A complete table of premiums is available on the
STRS Ohio website.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
As a health care insurance consumer, you may decide you want to evaluate medical plan options
and associated costs outside of the STRS Ohio Health Care Program. As you evaluate your
options, there are a few considerations to keep in mind.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
As a result of the Patient Protection and Affordable Care Act, each state has an exchange — or
Health Insurance Marketplace. It may prove advantageous for some STRS Ohio medical plan
enrollees to consider coverage in the marketplace.
For example, if you are not yet Medicare eligible and have less than 20 years of service, you may
find more affordable health insurance options in the marketplace. The pool of enrollees is younger
than the STRS Ohio pool of enrollees; a feature that can help contain costs. Furthermore, the
Affordable Care Act limits the difference insurance companies are allowed to charge between the
youngest and the oldest enrollees. Also, plans are limited to a $6,850 out-of-pocket maximum,
which may or may not include the deductible and all copayments.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
It is important to understand the differences in medical plan costs and features.
For instance, the monthly premium the plan charges may be low, but the deductible and out-ofpocket maximum may be high.
What does the out-of-pocket maximum amount include? Some plans may include the
deductible in that maximum while other plans may not.
Are your favorite doctors and medical facilities within the provider network?
What is the prescription drug coverage offered by the plan?
And, what are your anticipated health care needs for the coming year and the projected costs
for those services?
Knowing this information puts you in a better position to make an apples to apples comparison
of health care plans and hopefully prevents any surprises when medical bills arrive.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
This is also an open enrollment year for dental and vision coverage. You can enroll in either the
dental or vision plan, or both plans. Enrollment in an STRS Ohio medical plan is not required to
obtain dental and vision coverage.
www.strsoh.org
State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
STRS Ohio offers dental coverage through Delta Dental and vision coverage through Vision Service
Plan (VSP). Coverage is effective for two years. Coverage will begin January 1, 2017, and ends
December 31, 2018. Premium payments will continue through December 31, 2018, even if you no
longer need or use services under the plan.
After this fall’s open enrollment, the next opportunity to enroll will be fall 2018 for 2019–2020, unless
you or your eligible dependents have a qualifying event.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
Delta Dental includes two network options: Delta Dental PPO and Delta Dental Premier. This table
demonstrates the percentage you pay for preventive and diagnostic services, basic services and
major services based on your selection of a PPO dentist versus a Premier dentist.
Although you can seek services from any licensed dentist, you will increase your level of coverage
and lower your out-of-pocket costs by going to a PPO dentist. If you choose a Premier provider;
however, you may still save money.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
The maximum benefit allowance for all covered services is $1,500 per person. After the plan has
paid $1,500 per person, the enrollee is responsible for 100% of the cost for the remainder of the
calendar year.
There is a $50 deductible per person for basic and major services. This is limited to a maximum of
$100 per family. These coverage amounts are per calendar year.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
The monthly premium for Delta Dental coverage is $30.35 per month for a benefit recipient. Adding
another adult would cost an additional $39.87 per month. Adding children would increase the cost
by a flat rate of $22.75 per month.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
The monthly premium for VSP coverage is $6.85 for a benefit recipient, $13.56 for a benefit
recipient and one other adult, $14.58 for a benefit recipient and children, and $21.28 for a benefit
recipient and all other combinations of enrollees.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
VSP enrollees are eligible to receive an eye exam every 12 months for a $10 copayment. Lenses
are covered once every 24 months after a $10 copayment. Frames are covered in full once every
24 months up to a $130 retail allowance, after a $10 copayment. Anything above the $130
allowance is covered at 20%.
VSP offers the greatest cost savings when an enrollee obtains services from a VSP doctor or
affiliate provider.
Out-of-network, an eye exam is reimbursed up to $50 and lenses are reimbursed from $50 up to
$125 depending on the type of lenses. Frames are reimbursed up to $70.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
Now that we have reviewed medical plan changes for 2017 as well as dental and vision plan
coverage information, let’s review enrollment details. If you are enrolling in coverage, changing
plans or canceling coverage, the deadline is November 22.
www.strsoh.org
State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
If you are currently enrolled in Delta Dental or VSP and wish to continue your coverage, you do not
need to do anything. Your coverage will automatically be extended through December 31, 2018.
To enroll yourself and any eligible dependents in one or both plans, submit an enrollment application
to STRS Ohio.
If you wish to cancel dental and/or vision coverage for 2017-2018 contact STRS Ohio. Your
coverage will end December 31, 2016.
www.strsoh.org
State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
With regard to medical plan enrollment, no action is required by you if you want to remain in the plan
listed as your 2017 plan enrollment. That plan will be specified in the personalized letter sent with
your health care open-enrollment materials.
To enroll yourself and any eligible dependents in a plan, you must submit an enrollment application
to STRS Ohio by November 22.
If you want to select a different plan or cancel your coverage for 2017, contact STRS Ohio.
www.strsoh.org
State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
If you are currently enrolled in the Paramount plan and want to remain in Paramount, no action is
required.
To enroll in the Paramount HMO plan, you will need to contact Paramount to request an HMO
enrollment application. You will then need to submit two enrollment applications. You will submit the
enrollment application to STRS Ohio that you receive in the mail with open enrollment materials and
you will submit the HMO enrollment application to Paramount. Both of these applications will need
to be completed and submitted by November 22.
www.strsoh.org
State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
If you are currently enrolled in a Paramount HMO plan and you want to select a different plan, you
will need to send a written request to STRS Ohio to cancel coverage under the HMO after you
contact STRS Ohio to select your new plan. The letter must be signed by the benefit recipient and
any covered Medicare enrollees on the account.
To cancel coverage, you must send a written request to STRS Ohio. Again, this letter must be
signed by the benefit recipient and any covered Medicare enrollees on the account.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
If you are turning age 65 in 2017, do not forget about Medicare enrollment. STRS Ohio requires you
to enroll in Medicare Part B and pay the monthly premium to Medicare. You are also required to
enroll Medicare Part A if it is available to you at no cost from Medicare.
STRS Ohio will send you Medicare enrollment information three months before you turn age 65.
Enrollment in Medicare determines your eligibility for STRS Ohio medical plans offered to Medicare
enrollees and the lower premium that is associated with those plans.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
STRS Ohio offers a Medicare enrollment meeting and webinar. These presentations provide
details about the parts of Medicare, Medicare enrollment and STRS Ohio medical plan options
once enrolled.
The in-person group meetings are offered January thru May at various locations in the state. The
live webinar is offered January thru September and you can view the presentation anytime during
the year in the Videos section of the STRS Ohio website.
www.strsoh.org
State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
Looking down the road at the future of the STRS Ohio Health Care Program, there are many
factors to consider. The Health Care Fund is responsible for covering nearly 130,000 individuals.
During the 2015 fiscal year, the fund paid $1.9 million dollars in benefits per day, and as of January
1, 2016, its balance was $3.26 billion.
The Health Care Fund is comprised of premiums paid by enrollees, investment gains and
government reimbursements.
The 1% of the 14% employer contribution that was previously allocated to the Health Care Fund
has been allocated to the pension fund since July 2014. Based on current assumptions, the return
of this allocation to the Health Care Fund is unlikely for about 20 years. With the continued rise in
health care costs and a decrease in funding resources, STRS Ohio faces significant challenges.
The State Teachers Retirement Board and staff are exploring ways to extend the solvency of the
fund while maintaining a meaningful health care program for enrollees. Working with membership
and stakeholder groups on approaches to increase funding continues to be a key objective.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
All benefit recipients eligible for the STRS Ohio Health Care Program will be mailed a packet of
open enrollment materials. Those who previously indicated a preference to view the materials online
will be able to do so in their Online Personal Account.
Information is also available in the Open-Enrollment Resource Center on the STRS Ohio website.
To talk to an STRS Ohio associate, call toll-free 888-227-7877, Monday through Friday between 8
a.m. and 5 p.m.
All members with an email address on file with STRS Ohio receive our email news service
eUPDATE. If you do not currently receive this email and would like to register, you can do so by
clicking on “Subscribe” at the bottom of the home page on the STRS Ohio website.
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State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
If you would like additional information about obtaining coverage through the Health
Insurance Marketplace, visit www.healthcare.gov.
For Medicare information, go to www.medicare.gov or call toll-free 800-633-4227.
www.strsoh.org
State Teachers Retirement System of Ohio
Health Care Program Highlights for 2017
This concludes our presentation highlighting STRS Ohio Health Care Program information for
the 2017 plan year. We hope this information will prove helpful to you during the health care
open-enrollment process. Remember, you have until November 22 to notify STRS Ohio if you
are enrolling in, changing or canceling coverage.
www.strsoh.org