1 Your 2015 Health Care Selection Guide Survivor Benefit Applicants
2 Section 1: Welcome This mailing includes the following materials designed to assist you in selecting your health care plan: Your STRS Ohio Health Care Plan Options sheet lists the specific plans available to you and the monthly premiums for each plan. You and your eligible dependents must enroll in the same option. If two plans are listed under an option, you and your dependents are eligible for different plans under that option based on Medicare status. A 2015 Plan Overview Chart outlines the major medical and prescription drug features of your plan options. Please note that the Medical Mutual Plus Plan is closed to new enrollments. This booklet, Your 2015 Health Care Selection Guide, provides step-by-step instructions for evaluating and selecting a plan, as well as contact information for all plan administrators. A Notice of Privacy Practices is also included for your reference. When choosing your survivor benefit plan of payment, you should consider how the cost of your monthly health care premium will impact your monthly STRS Ohio benefit payment. Your access to health care coverage and monthly health care premiums may vary depending on the type of survivor benefit you choose. For more information, please see the Survivor Benefits Summary included with your survivor benefit materials. If you re eligible for more than one survivor benefit option (i.e., a retirement-based benefit and a dependent-based or service-based benefit), a copy of Your STRS Ohio Health Care Plan Options sheet is enclosed for each health care plan option available to you. Be sure to choose a plan that corresponds with the survivor benefit option you re selecting. Questions about specific coverage features or health care provider information should be directed to the plan administrators. The plans toll-free numbers and website addresses are listed on Page 7. If you have general enrollment questions, please call STRS Ohio s Member Services Center toll-free at The center s hours are Monday Friday, 8 a.m. to 5 p.m. All STRS Ohio health care plans meet the Affordable Care Act s minimum essential coverage requirement, so you are considered covered and should not be assessed a fee. Section 2: Evaluating Your Options Evaluating Your 2015 Plan Options Step 1 Begin by reading What s Most Important to You? and Plan Features to Consider in this booklet on Page 2. This information will help you focus on key questions and considerations that are critical to choosing the right health care plan for you and your family. Step 2 Review Your STRS Ohio Health Care Plan Options sheet to find out which plan options are available to you and the monthly premium for each plan. Access to health care coverage and monthly premiums may vary depending on the type of survivor benefit you choose. Step 4 If you want information about specific plan features not listed on the 2015 Plan Overview Chart, call the health care plans directly using the toll-free numbers listed on Page 7 of this guide. Step 5 Call the health care plans directly or visit the plans websites to find out if the doctors and hospitals you use participate in their networks. These toll-free numbers and website addresses are also listed on Page 7 of this guide. Step 3 Review the enclosed 2015 Plan Overview Chart for major medical and prescription drug plan features for each plan available to you. Be sure to review the plan features that apply to you and your eligible dependents based on each individual s Medicare status. (Please note that the Medical Mutual Plus Plan is closed to new enrollments.) 1 Your 2015 Health Care Selection Guide
3 Section 3: Selecting a Plan for You and Your Family Selecting the right health care plan is an important decision. STRS Ohio makes the decision-making process easier by offering plans that include hospital, medical and prescription drug coverage. Separate dental and vision insurance is also available. What s Most Important to You? Before selecting your plan, you should decide what is most important to you. Some health care plans have different coverage levels, so you should ask yourself these questions: How much am I willing to spend on monthly premiums and other out-of-pocket expenses? How important are limits on my choice of doctors or hospitals? How convenient does the location of my providers need to be? Do I or any of my eligible family members qualify for Medicare? You should also think about whether the services a plan offers meet your needs: Are you and your eligible family members relatively healthy? Do you or your eligible family members have any chronic health conditions or disabilities? Do you or your eligible family members travel frequently or spend time at two homes? Plan Features to Consider When comparing plans, features to consider include services offered, choice of providers, location and costs. Services Look at the services offered by each plan. Are any services limited or not covered? Is there a good match between what is provided and what you think you will need? Choice Which doctors, hospitals and other medical providers can you use? Do you need approval from the plan before going into the hospital or getting specialty care? Location Where will you go for care? Are these places conveniently located? How does the plan cover services when you re away from home? Costs How much will you pay for your monthly health care premiums, including Medicare Part B (if applicable) and other out-of-pocket expenses? If a plan does not cover certain services, how much will you have to pay? Although you may not know in advance what your health care needs will be for the coming year, you can think about the services you or your family might need. This will help you estimate what your total costs might be for services under each plan. SIGN UP TODAY Stay up to date on health care program news throughout the year by signing up for eupdate, STRS Ohio s news service. To register, simply send an to Your 2015 Health Care Selection Guide 2
4 3 Section 4: Key Factors to Keep in Mind Plan Eligibility Access to health care coverage may vary depending on the type of survivor benefit you choose. The plans you re eligible for are determined by the ZIP code of your permanent residence and your Medicare status on file with STRS Ohio. Only those plans listed on Your STRS Ohio Health Care Plan Options sheet are available to you. Proof of Medicare Enrollment If you re eligible for Medicare, STRS Ohio requires you to enroll in Medicare Parts A & B or Part B-only. If Part A is not available to you without a monthly premium from Medicare, you are not required to enroll. However, you must enroll in Part B and continue to pay a monthly premium to Medicare. You must send STRS Ohio a copy of your Medicare card showing the effective dates of Parts A & B or Part B-only coverage. Your plan options and monthly premiums change after Medicare enrollment is confirmed. Failure to provide proof of Medicare enrollment will affect your STRS Ohio health care coverage. See Section 6 for more information. Eligibility Under More Than One Account or Retirement System If you re eligible for health care coverage under more than one STRS Ohio account (e.g., as both a benefit recipient and a survivor of a benefit recipient), it s your responsibility to contact STRS Ohio to determine from which account your monthly premium should be deducted. You may not be enrolled under two STRS Ohio health care accounts. Additionally, if you re eligible for health care coverage through more than one Ohio public retirement system, you re limited to coverage under only one system. Specific guidelines determine which system is responsible for your coverage. Contact STRS Ohio for details. Employed Enrollees Not Eligible for Medicare STRS Ohio provides only secondary health care coverage through STRS Ohio s Medical Mutual Plans to any enrollee not eligible for Medicare who is employed in a public or private position. The rule applies to employed enrollees who: (1) are eligible for health care coverage through their employer, or (2) hold a position for which other comparable employees are eligible for health care coverage at the same cost as full-time employees. The employer plan must provide medical and prescription drug coverage. If you think you might be affected, contact STRS Ohio. Failure to report employment can result in retroactive cancellation of your coverage and liability for any claims paid. Monthly Premiums Please review the monthly premium for each plan available to you. Monthly premiums may vary depending on the type of survivor benefit you choose. If you enroll in a plan, your monthly premium will be deducted from your STRS Ohio benefit payment. If your monthly premium exceeds your benefit payment, STRS Ohio requires the remainder of your Your 2015 Health Care Selection Guide premium to be paid in full through the establishment of a direct debit account through your financial institution. Prescription Drug Coverage Prescription drug coverage is included in all STRS Ohio health care plans. Express Scripts administers this coverage. Enrollees with Medicare Parts A & B or Part B-only are automatically covered by a Medicare Part D plan provided by Express Scripts. Foreign Travel Before traveling to a foreign country, check with your medical and prescription drug plan administrators to learn about coverage while you re abroad. Health Care Assistance Program (HCAP) The STRS Ohio Health Care Assistance Program (HCAP) is designed to help qualified benefit recipients who need financial assistance paying for their STRS Ohio health care plan. The assistance program currently includes a $0 monthly premium for the benefit recipient and often lower out-ofpocket costs for all enrollees in the plan. Although covered family members may receive the same plan of coverage as the qualifying benefit recipient, they are not eligible for the $0 premium and must pay the full cost of their coverage. For the remainder of 2015, the program is available to: (1) service retirement benefit recipients with 25 or more years of Ohio-valued service; (2) disability benefit recipients receiving STRS Ohio benefits; (3) beneficiaries of retired teachers with at least 25 years of Ohio-valued service at retirement; (4) survivor benefit recipients of active teachers or disabled teachers eligible to retire with at least 25 years of Ohio-valued service at retirement; and (5) survivor benefit recipients of active or disabled teachers not eligible for service retirement. Beginning Jan. 1, 2016, new applicants must be eligible for a subsidy under the STRS Ohio Health Care Program to qualify for HCAP enrollment. This means the assistance program will be available to service retirement benefit recipients with 25 or more years of qualifying service credit and disability benefit recipients receiving STRS Ohio benefits. Benefit recipients, survivors and beneficiaries who are enrolled in HCAP as of Dec. 31, 2015, 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. Eligibility for the program is based on an annual family income limit of $23,800, including any cost-of-living adjustments, and a household liquid asset limit of $23,800. (A home is not considered a liquid asset.) Depending on Medicare status, approved individuals may enroll in the Medical Mutual Health Care Assistance Plan or the Aetna Medicare Plan. Participants must maintain their Medicare Parts A & B or Part B-only enrollment to remain eligible for HCAP. If you believe you qualify for assistance, visit our website or call STRS Ohio for an application.
5 Section 5: Making Your Selection for 2015 To enroll in a plan, call STRS Ohio toll-free at , Monday Friday, 8 a.m. to 5 p.m. Please have the enclosed information available when you call. We suggest you visit the plan administrator s website listed on Page 7 or request a provider directory from the plan. Note: If you already received these health care selection materials with your application for survivor benefits, you do not need to call STRS Ohio to enroll in a plan. Instead, complete the health care enrollment section of the survivor benefits application to select a plan. If you do not make a plan selection, you will be enrolled in the Medical Mutual Basic Plan. Return the completed survivor benefits application to STRS Ohio. If you re enrolled in Medicare Parts A & B or Part B-only, you must send STRS Ohio a copy of your Medicare card with your application. If you re selecting the Aetna Medicare Plan, be aware your enrollment request cannot be submitted to Aetna until STRS Ohio receives a copy of your Medicare card showing the effective dates of Parts A & B or Part B-only coverage. Proof of Medicare enrollment must be received by the 15th of the month. Any delay in submitting proof of Medicare enrollment to STRS Ohio will delay your enrollment in the Aetna Medicare Plan. You re not officially enrolled in the Aetna plan until Medicare approves your enrollment. Aetna will send you confirmation of enrollment after you re approved. To remain eligible for the Aetna plan, you must remain enrolled in Medicare Part B and continue to pay your monthly Medicare Part B premium before the due date. Late payment of Part B premiums will cause disruption to your Aetna coverage. You must not subsequently enroll in another Medicare Advantage plan. If you do, your Aetna coverage will be canceled. If you re selecting a Paramount HMO plan, you ll also need to request an HMO enrollment application from Paramount and submit it to the plan before the selection deadline. You will not be enrolled in the HMO until Paramount receives and approves your completed application before the deadline. If you do not submit a completed HMO application by the deadline, you will be enrolled in the Medical Mutual Basic Plan. If you ll be turning age 65 or older during the coming year, Medicare enrollment is required. See the next page for important information about Medicare. Your 2015 Health Care Selection Guide 4
6 Section 6: Attention Enrollees Age 65 or Older If you are age 65 or will turn age 65 during the coming year, please read this important information about Medicare. Medicare Enrollment Is Required All eligible STRS Ohio health care plan participants are required to enroll in Medicare Part B by age 65 or whenever eligible. You must pay a monthly premium to Medicare for Part B coverage. You are also required to enroll in Medicare Part A if it is available to you at no cost from Medicare. Some Ohio educators may think they do not qualify for Medicare because they did not contribute to Social Security. However, you qualify for Medicare at age 65 even if you are not eligible for Social Security retirement benefits. MEDICARE BASICS You qualify for Medicare at age 65 even if you did not contribute to Social Security. Coverage type Part A (hospital) Part B (medical) Part C (Medicare Advantage) Part D (prescription) Am I required to enroll? Yes Enroll if it s available at no cost from Medicare. No Do not enroll if you must pay a premium to Medicare. Yes You must enroll and pay a monthly premium to Medicare. (Benefit recipients enrolled in an STRS Ohio health care plan may receive partial reimbursement for their Part B premium cost.) No Enrollment in Parts A & B or Part B-only qualifies you for coverage under STRS Ohio s Medicare Advantage plans. You must not enroll in any other Medicare Advantage plan if you want to keep your coverage under the Medicare Advantage plans administered by Aetna and Paramount. No Part D prescription drug coverage is included in your health care plan. Do not enroll in any other Part D plan. If you do, your STRS Ohio coverage will be canceled. When to Enroll in Medicare Initial enrollment period You have a seven-month initial enrollment period in which to sign up for Medicare Parts A & B or Part B-only. Your initial enrollment period begins three months before you turn age 65, includes the month you turn age 65, and ends three months after the month of your birthday. STRS Ohio will send you a Medicare information packet three months before you turn age 65. This information explains the importance of enrolling in Medicare and how Medicare enrollment affects your STRS Ohio health care coverage. Your health care plan options, premiums and prescription drug coverage change when you become eligible for Medicare. Enroll in Medicare before your 65th birthday to avoid any delay in Medicare coverage. For coverage to be effective the month you turn age 65, you must sign up during the first three months of the initial enrollment period (one to three months before the month of your birthday). If you wait to sign up during the last four months of the period, your effective date of coverage under Medicare will be delayed. General enrollment period If you miss the initial enrollment period, you can enroll during a general enrollment period from Jan. 1 through March 31 each year. However, coverage is not effective until July 1 and late enrollment penalties will apply. See Page 6 for details. Special enrollment period If you delay enrollment at age 65 because you or your spouse is still employed and covered by a group health plan through the employer, you can enroll in Medicare Part B during a special enrollment period. Special enrollment allows you to enroll without paying a Part B late enrollment penalty during either of the following time frames: At any time while you have employer health coverage (your own or through your spouse); or During the eight-month period that begins the month employer health coverage ends or the month employment ends (whichever comes first). If you do not enroll by the end of the eighth month, general enrollment guidelines apply. How to Enroll in Medicare To enroll in Medicare, visit your local Social Security Administration office or call Social Security toll-free at If you are eligible for both Medicare Parts A & B, you can also enroll online at If you believe you are not eligible for Medicare, STRS Ohio will require a letter from your local Social Security Administration office confirming ineligibility. Sending Proof of Medicare Enrollment After you enroll in Medicare Parts A & B or Part B-only, you must send STRS Ohio a copy of your Medicare card to verify Medicare enrollment. Your health care plan options, monthly premiums and prescription drug coverage change after STRS Ohio receives this verification. 5 Your 2015 Health Care Selection Guide
7 Note: All participants who fail to provide proof of Medicare enrollment will be enrolled in the Medical Mutual Basic Plan. You will also be responsible for 80% of all allowed claim expenses, including physician claims. Paying Your Medicare Part B Premium Your Medicare Part B premium is not included in your monthly STRS Ohio health care premium. It is a separate premium that must be paid to Medicare, not to STRS Ohio. If your Medicare Part B premium is not automatically deducted from a monthly Social Security, Railroad Retirement or Civil Service Retirement payment, we recommend signing up for the Medicare Easy Pay plan. Through the Medicare Easy Pay plan, Medicare automatically deducts the premium payment from your savings or checking account so your payment is always on time. To sign up for this free service, call Medicare toll-free at Remember, you must pay your monthly Medicare Part B premium before the due date to avoid cancellation of your Medicare Part B coverage. If your Part B coverage is canceled, you will be enrolled in the Medical Mutual Basic Plan. You will also be responsible for 80% of all allowed claim expenses, including physician claims. Understanding Your Medicare Part D Prescription Drug Coverage The prescription drug coverage included in your STRS Ohio health care plan is provided under a Medicare Part D prescription drug plan. To be eligible, you must be enrolled in Medicare Parts A & B or Part B-only. Do not enroll in any other Medicare Part D plan. Medicare does not allow enrollment in more than one Medicare Part D plan. If you enroll in another Medicare Part D plan, your STRS Ohio medical and prescription drug coverage will be canceled. Additionally, if you decline coverage under the Medicare Part D plan included in your STRS Ohio health care plan, your STRS Ohio medical coverage will be canceled. Medicare Late Enrollment Penalties If you delay enrollment in Medicare Part B or Part D, the Centers for Medicare & Medicaid Services (CMS) charges a late enrollment penalty. Medicare Part B Every year you delay enrolling in Medicare Part B results in an additional 10% of the premium being added to your monthly payment. This additional cost will be charged for as long as you have Medicare Part B coverage. You must pay this penalty amount directly to Medicare or have it automatically deducted from Social Security. Medicare Part D You could also incur a penalty if you go 63 days or more without Medicare Part D or creditable coverage. CMS charges this penalty to STRS Ohio, and we make payment on your behalf. STRS Ohio subsequently deducts the Part D late enrollment penalties from your monthly STRS Ohio benefit payment. Affected individuals will be notified before penalties are deducted. Medicare Surcharges for Higher Incomes Medicare Part B and Part D enrollees with higher annual incomes are subject to monthly Medicare surcharges. Surcharges vary by income levels set by Medicare (currently $85,000+ for individuals; $170,000+ for married couples). For more information, visit STRS Ohio does not provide subsidies to offset surcharges. Any Part B and Part D surcharges will be deducted from your monthly Social Security, Railroad Retirement or Civil Service Retirement payment. If you do not receive such payments, you will receive a bill from Medicare. You must pay all applicable surcharges to maintain your Medicare Part B and/or Part D coverage. Failure to pay surcharges will result in cancellation of your STRS Ohio health care coverage. Payments are made directly to Medicare, not to your plan administrator or STRS Ohio. Contact Medicare toll-free at with questions. Qualifying for Extra Help With Prescription Drug Costs Medicare offers a Low-Income Subsidy program to qualified participants in a Medicare Part D prescription drug plan. Under the Low-Income Subsidy program (also called Extra Help), participants may pay a lower deductible and lower copayment amounts for covered prescription drugs. Medicare, not STRS Ohio, determines if participants qualify for the subsidy program. Under the Medicare Modernization Act of 2003, Medicare works directly with your prescription drug plan administrator to determine if you qualify for assistance. If you qualify, Express Scripts will send you a letter informing you about the program. If you receive a letter from Express Scripts, you will be automatically enrolled in the subsidy program offered by Medicare. If you do not receive a letter and believe you may qualify for assistance, you can call Medicare directly tollfree at for more information or to request an application. Your 2015 Health Care Selection Guide 6
8 Section 7: Who to Contact At-a-Glance 1. To ask specific coverage questions... Visit the plan s website or call the plan administrator 2. To obtain provider information... Visit the plan s website or call the plan administrator 3. To ask general enrollment questions... Visit our website or call STRS Ohio 4. To obtain an HMO enrollment application... Call Paramount Phone Numbers and Websites Contact Toll-Free Number Website Aetna AultCare (Local Canton area) (All other areas) Express Scripts (Non-Medicare enrollees) (Medicare enrollees) Medical Mutual Medicare Paramount STRS Ohio E. Broad St., Columbus, OH , 8/15/50 7 Your 2015 Health Care Selection Guide
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