State Teachers Retirement System of Ohio Health Care Program Highlights for 2017

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1 Welcome to the Health Care Program Highlights presentation. This presentation will provide health care open enrollment information for 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.

2 We will begin this presentation with a review of the four parts of Medicare -- A,B,C and D. Next, we will look at medical plan and premium changes for This will be followed by a look at key considerations for comparing health care plan options in the general marketplace. We will then review the features and costs of the dental and vision plans offered by STRS Ohio, highlight open enrollment details and conclude with important information about the future of the STRS Ohio Health Care Program.

3 Our review begins with Medicare Part A, which is hospital insurance. STRS Ohio requires all plan participants to enroll in Part A, but only if it does not require that you pay a premium. You will be eligible for Part A at no cost if you: Are receiving or are eligible to receive a Social Security or Railroad Retirement benefit, Paid the Medicare tax for 10 years while working, or Have a spouse who paid the Medicare tax or is eligible for Social Security their eligibility may be as early as age 62. If you do not qualify for Part A at no cost, you do not need to enroll and pay for it. STRS Ohio will cover your hospitalization.

4 Medicare Part B is medical insurance. It is mandatory to enroll in Part B when you are eligible which is at age 65. Unlike Part A, everyone pays a premium for Part B. In 2016, the standard premium is $ per month. For information about the 2017 standard rate, please visit Medicare Part C commonly referred to as a Medicare Advantage Plan is a type of health insurance plan approved by Medicare but administered by private companies. STRS Ohio offers two Medicare Advantage Plans, the Aetna Medicare Plan and the Paramount Elite HMO.

5 Medicare Part D is the prescription drug plan. As a Medicare enrollee, the prescription drug coverage included in your STRS Ohio plan is provided under a Part D prescription drug plan. Medicare does not allow enrollment in more than one Part D plan and if you enroll in more than one of these plans, your STRS Ohio medical and prescription drug coverage will be canceled.

6 Before we discuss health care program changes for the 2017 plan year, let s review the medical plan options available to individuals enrolled in Medicare. For Medicare enrollees, STRS Ohio offers two national plans (Aetna Medicare Plan and Medical Mutual Basic) and two regional plans (AultCare PPO and Paramount Elite HMO). The AultCare PPO plan is only available in select northeastern Ohio area ZIP codes. Paramount Elite is available in select northwestern Ohio and southern Michigan area ZIP codes.

7 Now, let s look at the health care program changes for the 2017 plan year that impact Medicare enrollees.

8 The emergency room copayment will increase to $75 from $65 for the Aetna Medicare Plan, AultCare PPO and Paramount Elite plans and remains at $150 for the Medical Mutual Basic. The urgent care copayment will increase to $40 from $35 for all plans.

9 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.

10 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 applicable copayment or coinsurance. This fee does not apply to the annual deductible or maximum annual expense.

11 And, lastly, in terms of changes to prescription drug coverage for 2017, there are a couple changes related to diabetic prescriptions and specialty drugs. The one-half copayment program for diabetic prescriptions will be discontinued. Enrollees will pay the full copayment amount for all diabetic medications and supplies. 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.

12 With regard to the monthly medical premiums, premiums for dependent children are changing to a per child rate. This monthly premium will range from $300 to $440 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.

13 One of the most significant changes to the STRS Ohio Health Care Program in 2017 is to the Medicare Part B partial premium reimbursement. The current reimbursement will be phased out over a three-year period beginning next year. In 2017, the monthly reimbursement will range from $29.90 to $35.22 based on years of service. In 2018, the reimbursement will be $29.90 regardless of years of service and in 2019 the reimbursement will be discontinued. The reimbursement will be discontinued in 2017 for survivors and beneficiaries who were age 65 by 2008 and receiving a benefit as of January 1, 2008.

14 This table provides a complete breakdown of the Medicare Part B partial premium reimbursement amounts for The maximum monthly reimbursement of $35.22 is based on an enrollee with 30 or more years of service. The minimum monthly reimbursement of $29.90 is based on enrollees who have 25 years or less of service.

15 This table shows the 2017 monthly medical plan premium for a benefit recipient with 30 years of service and the rate for a spouse. Benefit recipients with Medicare will continue to receive a 2.1% subsidy per year of service. For an enrollee with 30 years of service this equates to a 63% subsidy. Remember, to remain eligible for a medical plan available to Medicare enrollees, you must maintain and pay your Medicare Part B premiums as well as enroll in Part A if it is at no cost to you. A complete table of premiums is available on the STRS Ohio website.

16 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.

17 As a result of the Patient Protection and Affordable Care Act, each state has an exchange or Health Insurance Marketplace. However, this is not designed for Medicare recipients. Instead, there are a number of individual Medicare Advantage plan options offered in Ohio in the general marketplace. These plans may be more advantageous and cost efficient for the spouse of an STRS Ohio benefit recipient than the group STRS Ohio Medicare Advantage plans. Medicare Advantage plans in the general marketplace require that you be enrolled in Medicare Parts A & B. They may offer better options if you are agreeable to a limited network. Many offer extra benefits such as dental care and eyeglasses, but not all of them include prescription drug coverage. Medicare requires all eligible recipients to enroll in a Part D prescription drug plan.

18 There are also Medicare Supplement Insurance policies also referred to as Medigap. These require that you be enrolled in Medicare Parts A & B and the plan pays for health care costs remaining after Original Medicare pays. All of these types of policies offer the same basic benefits. Enrollment may be limited or could be more costly if you enroll after age 65.

19 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.

20 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.

21 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, 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 , unless you or your eligible dependents have a qualifying event.

22 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.

23 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.

24 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.

25 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.

26 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.

27 There is also vision coverage offered under the Aetna Medicare Plan. This plan covers one routine eye exam every year paid at 100%, as long as you are using a network provider. The Aetna plan also offers eyewear discounts through providers in the Aetna network on lenses, frames, contact lenses and LASIK surgery. Lenses are $40 to $120 per pair with additional cost for lens options such as scratch resistance and UV coating. Frames are 35% off of retail cost and there is a 15% discount on contact lenses and LASIK surgery. Keep in mind, this coverage is included for members enrolled in the Aetna Medicare Plan.

28 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.

29 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, 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 , contact STRS Ohio. Your coverage will end December 31, 2016.

30 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.

31 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.

32 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.

33 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 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.

34 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 , Monday through Friday between 8 a.m. and 5 p.m. All members with an address on file with STRS Ohio receive our news service eupdate. If you do not currently receive this 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.

35 For Medicare information, go to or call toll-free Another resource for Medicare-related information is the Ohio Senior Health Insurance Information Program. Further information is available on the Ohio Department of Insurance website at or by calling

36 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.

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