Effective Jan. 1, 2015. STRS Ohio Health Care Program Guide

Effective Jan. 1, 2015 2015 STRS Ohio Health Care Program Guide

2 www.strsoh.org

Welcome Thank you for your interest in the STRS Ohio Health Care Program. We understand that choosing a health care plan is an important decision for you and your family. This is why we re dedicated to making your selection process as easy as possible. When you choose the STRS Ohio Health Care Program, you re choosing a program that is provided by one of the largest public retirement systems in the country. In 1974, STRS Ohio established itself as one of the nation s leaders by offering health care coverage to retired Ohio educators. Today, we continue our dedication to meeting your retirement needs by offering access to health care plans that include hospital, medical and prescription drug coverage. We also offer health management programs and dental and vision plans to supplement your hospital, medical and prescription drug coverage. In addition, we offer a subsidy based on years of service to eligible benefit recipients to help pay the cost of their monthly STRS Ohio health care premiums. Although access to health care is not guaranteed under Ohio law, STRS Ohio understands that quality health care in retirement is important to you. To find out which health care plans are available to you, please review your personalized list of plan options that you may have received with this publication. If you do not have a personalized list and would like to know which plans are available to you along with monthly premiums, please call STRS Ohio or register for a personal account on our website. Knowing your plan options will help you focus on the information in this publication that applies to you. If you have questions after reviewing the information in this publication, please call STRS Ohio. To stay up to date on health care program news throughout the year, sign up for STRS Ohio s email news service. To register, send an email to webmaster@strsoh.org. For enrollment and eligibility questions STRS Ohio Member Services Center...1-888-227-7877 STRS Ohio website... www.strsoh.org The STRS Ohio Health Care Program is authorized by Chapter 3307 of the Revised Code, which may be amended at any time by the Ohio General Assembly. Furthermore, coverage under the program may be modified or eliminated at any time by the State Teachers Retirement Board. Health care coverage is not guaranteed. STRS Ohio hopes to continue the program, but reserves the right to change or discontinue all or part of the program for all or a class of eligible benefit recipients and covered dependents at any time. Premiums, copayments/coinsurance, deductibles and all other charges or fees paid by an enrollee may change from year to year. This guidebook is an overview of the STRS Ohio Health Care Program. It is not a legal document. You will receive a separate document that explains the terms of your coverage after you enroll in a plan. 2015 STRS Ohio Health Care Program Guide 1

What s Inside Section 1: Selecting Your Plan... 3 Why Choose STRS Ohio for Your Health Care Needs?... 4 How STRS Ohio Health Care Is Funded... 4 Partners in Health... 5 STRS Ohio s Role... 5 Your Role... 5 Who Is Eligible for Coverage?... 5 Benefit Recipients... 5 Employed Enrollees Not Eligible for Medicare... 6 Eligible Dependents... 6 Beneficiaries and Survivors... 6 Premium Subsidy and Health Care Assistance Program... 7 Subsidy Rate... 7 Health Care Assistance Program... 7 Selecting a Plan for You and Your Family... 7 What s Most Important to You?... 7 Plan Features to Consider... 8 Understanding Your Plan Options... 8 Key Terms to Understand... 8 Which Plans Are Available to You?... 9 Types of Plans Offered... 9 Prescription Drug Coverage... 9 Enrolling in a Health Care Plan... 10 Enrolling as a New Benefit Recipient... 10 Enrolling After Monthly Benefits Begin... 10 Adding Eligible Dependents to Your Coverage... 10 Coverage Considerations...11 Changes in Eligibility...11 Foreign Travel...11 Coverage Under More Than One STRS Ohio Account...11 Coverage Under More Than One Ohio Public Retirement System...11 Changing Plans After Enrollment...11 Terminating Coverage...12 Your Enrollment Checklist...13 Service Retirement Applicants...13 Disability Benefit Applicants...13 Service Retirement Beneficiaries...13 Survivor Benefit Applicants...14 Enrolling After Retirement (Outside of Open Enrollment)...14 Section 2: Plans and Premiums Without Medicare... 15 Prescription Drug Reference Guide...15 Plan Features for 2015 Without Medicare... 16 Monthly Premiums for 2015 Without Medicare... 22 Section 3: Medicare Enrollment... 24 Understanding Medicare... 25 What Is Medicare?... 25 Medicare Parts... 25 What Parts Does STRS Ohio Require?... 25 How Medicare Works With Your STRS Ohio Coverage... 26 Why You Need to Enroll in Medicare Parts A & B... 26 What Happens With Your STRS Ohio Coverage if You Don t Enroll/Remain Enrolled in Medicare?... 26 Can You Delay Your Medicare Enrollment if You re Still Employed?... 26 Medicare Prior to Age 65... 26 Enrolling in Medicare... 27 When to Enroll in Medicare... 27 How to Enroll in Medicare... 27 Selecting Your New STRS Ohio Plan... 28 Your Plan Options Will Change... 28 Evaluating Your Plan Options... 28 Important Factors to Consider... 28 How to Select a New Plan... 28 After You Enroll in Medicare... 29 Paying Your Medicare Part B Premiums... 29 Understanding Your Medicare Part D Prescription Drug Coverage... 29 Medicare Late Enrollment Penalties... 29 Medicare Surcharges for Higher Incomes... 29 Partial Medicare Part B Premium Reimbursement... 30 Medicare Part B-Covered Drugs and Supplies... 30 Qualifying for Extra Help With Prescription Drug Costs... 30 Confused? We Can Help... 30 Section 4: Plans and Premiums With Medicare... 31 Prescription Drug Reference Guide... 31 Plan Features for 2015 With Medicare... 32 Monthly Premiums for 2015 With Medicare... 38 Section 5: Additional Information About Our Program... 40 Quality Standards... 40 Release of Information and Confidentiality Statement... 40 Affordable Care Act and Your STRS Ohio Health Care Plan... 41 Notice of Privacy Practices... 41 General Notice of COBRA Continuation Coverage Rights... 45 Notice of Medicare Part D Creditable Coverage... 46 Getting More Information... 47 Notes... 48 2 www.strsoh.org

Section 1: Selecting Your Plan This section provides an overview of the STRS Ohio Health Care Program. Inside you ll learn about: The advantages of enrolling in our program; Who s eligible to enroll in a plan; Premium subsidy and the Health Care Assistance Program; How to select the plan that s right for you; Which types of plans are offered; How to enroll; and What to expect during the enrollment process. 2015 STRS Ohio Health Care Program Guide 3

Why Choose STRS Ohio for Your Health Care Needs? All STRS Ohio health care plans are designed to meet the minimum essential coverage requirement under the Patient Protection and Affordable Care Act. Premium subsidy for benefit recipients STRS Ohio currently makes monthly health care premiums more affordable for eligible service retirement and disability benefit recipients by paying a portion of the costs. As a benefit recipient, if you participate in the Defined Benefit or Combined Plan and have 15 or more years of qualifying service credit, STRS Ohio will subsidize your individual monthly health care premium. The subsidy rate for 2015 is 2.2% for each year of service credit, up to a maximum of 66%. For example, if you have 30 years of service credit, STRS Ohio will pay 66% of your individual monthly premium cost in 2015. This means you pay only 34% of the premium cost if you receive the maximum subsidy. (In 2016, the subsidy rate per year of service will decrease to 2.1%.) STRS Ohio also offers a Health Care Assistance Program to qualified individuals. See Page 7 for details. Access for you and your family We offer you and your family your spouse and other eligible dependents access to quality health care coverage. Broad coverage All of the health care plans we offer include hospital, medical and prescription drug coverage. No need for additional Medicare Part D coverage When you re covered under an STRS Ohio health care plan, you should not purchase additional Medicare Part D prescription drug coverage. All of the health care plans we offer to enrollees with Medicare Parts A & B or Part B-only include Medicare Part D prescription drug coverage. Set annual premiums When you enroll in a plan, your monthly premium is fixed for the calendar year (unless there is a change in Medicare status or plan). This means your premium will not increase if a serious health issue arises or simply because you get older. Quality To be offered as an STRS Ohio health care plan option, a plan must adhere to and maintain quality standards. Our plans also offer special programs to help you better manage your health. Personalized planning and convenience We offer personal counseling before retirement to help you coordinate your pension benefit and health care coverage during retirement. We also make it easy for you to pay your and your family s monthly health care premiums by automatically deducting the amounts from your STRS Ohio benefit payment. How STRS Ohio Health Care Is Funded The State Teachers Retirement Board established the Health Care Fund in 1983 to help fund the STRS Ohio Health Care Program. Currently, there is no dedicated revenue source to fund health care for STRS Ohio retirees. Instead, funding comes from: (1) premiums paid by enrollees in the health care program; (2) annually determined employer contributions; (3) investment earnings on the health care fund; and (4) federal and pharmaceutical reimbursements for prescription drugs. The Retirement Board s primary responsibility is to ensure the long-term stability of the pension plan. Access to health care coverage is optional and is not guaranteed under Ohio law. However, the board recognizes that health care coverage is important and is focused on continuing access to health care for current and future retirees. Escalating health care costs continue to be a concern. Among STRS Ohio s expenses for health care are monthly premium subsidies, claims costs, Medicare Part B partial premium reimbursement and administrative expenses. The Retirement Board is working to ensure the stability of the pension plan and the health care program. You can keep up to date on health care funding issues through your STRS Ohio newsletters, the STRS Ohio website (www.strsoh.org) and STRS Ohio s email news service. To register for the news service, send an email to webmaster@strsoh.org. 4 www.strsoh.org

Partners in Health When you enroll in the STRS Ohio Health Care Program, you gain a partner in health. To benefit from this partnership, it s important to understand STRS Ohio s role and your role in the health care program. STRS OHIO S ROLE Financial As your health partner, STRS Ohio provides you and your family access to health care coverage for a monthly premium. We also provide partial Medicare Part B premium reimbursement to eligible benefit recipients who enroll in an STRS Ohio health care plan and provide proof of Medicare Part B enrollment. Premium assistance to low-income enrollees who meet the program s eligibility requirements is also available. In addition, prescription drug coverage is included in all of the health care plans we offer. This means you don t need to purchase additional prescription drug coverage. Managing Your Health All STRS Ohio health care plans include hospital, medical and prescription drug coverage so you can access the services you need to manage your health. In addition, prescription drug coverage includes convenient retail and home delivery programs. Disease management programs are available at no additional cost to plan enrollees to help those with chronic conditions manage and improve their health. Some of these conditions include congestive heart failure, diabetes, coronary artery disease, chronic obstructive pulmonary disease, and other chronic conditions such as end-stage renal disease, multiple sclerosis and rheumatoid arthritis. (See Page 40 for details about the release of enrollee information for disease management and wellness programs.) YOUR ROLE Financial As a health partner, you pay a monthly premium for health care coverage. You also pay other out-of-pocket expenses for hospital care, medical services and prescription drugs. These expenses may include an annual deductible, coinsurance and copayments. As a health care consumer, you can reduce your out-of-pocket expenses by using network providers, network pharmacies and generic drugs whenever possible. You can also save money by using the home delivery pharmacy for maintenance medications. In addition, you can lower your monthly STRS Ohio health care premium by signing up for Medicare when you turn age 65 or whenever you become eligible. Managing Your Health You can reduce your need for health care services by maintaining and improving your health. By using covered preventive services, your doctor can detect health problems earlier. In addition, proper diet and physical activity are key to overall good health. If you already have a chronic health condition, disease management programs can help you maintain and improve your health. Many STRS Ohio health care plans also offer wellness resources to assist you. Other steps you can take to manage your health include not smoking, limiting alcohol intake, maintaining a healthy weight, reducing stress levels and taking prescribed medications as indicated by your physician. By managing and improving your health, you can reduce your visits to the doctor and your need for multiple prescription drugs. This will save you money and help you enjoy a healthier retirement. Who Is Eligible for Coverage? If you have questions about eligibility, please call STRS Ohio s Member Services Center toll-free at 1-888-227-7877. BENEFIT RECIPIENTS Service Retirement A Defined Benefit Plan or Combined Plan member with 15 or more years of service credit who is granted service retirement with an effective date of Jan. 1, 2004, or later is eligible for coverage. In addition, a Defined Benefit Plan or Combined Plan member who is granted service retirement with an effective date before Jan. 1, 2004, is also eligible for coverage; however, they pay 100% of their health care premium if they have less than 15 years of 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 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 qualifying service credit, the recipient pays the full cost of their coverage. If the disability effective date is on or after Jan. 1, 2004, the recipient must have 15 or more years of qualifying service credit to have access to health care coverage if the recipient later applies for service retirement. Note: Members who retire Aug. 1, 2023, or later, will need 20 or more years of qualifying service to be eligible for health care coverage. 2015 STRS Ohio Health Care Program Guide 5

EMPLOYED ENROLLEES NOT ELIGIBLE FOR MEDICARE Coverage under the STRS Ohio Health Care Program is limited for non-medicare enrollees employed in public or private positions. Employed enrollees are eligible for only secondary health care coverage through STRS Ohio s Medical Mutual plans if they: (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 rule applies to all employed enrollees who are not eligible for Medicare, regardless of hire date or type of employment. In addition, the rule applies only when the employer plan provides both medical and prescription drug coverage. If you are employed and not eligible for Medicare, it is your responsibility to notify STRS Ohio by completing a Verification of Employment and Employer Health Care Access form (available in the Health Care section of our website or upon request). You must also inform STRS Ohio if you want secondary coverage through the Medical Mutual Basic Plan or Plus Plan, or if you prefer to opt out of secondary coverage by terminating your STRS Ohio health care plan enrollment. ELIGIBLE DEPENDENTS Once the benefit recipient enrolls, a spouse, child and/or sponsored dependent 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 spouse means a husband or wife of a primary service retirement benefit recipient, disability benefit recipient or active member at the time of the member s death. Child A child means a child of a primary service retirement benefit recipient, disability benefit recipient or active member at the time of the member s death. The child must be under age 26 and be a: Biological child; or Lawfully adopted child or a stepchild; or A child for whom the benefit recipient or member is legally appointed as guardian. Sponsored Dependent Category 1 One person age 26 or older who is permanently living in the home (or has moved temporarily to a convalescent center or any other type of institution that retains a person temporarily) of an unmarried primary service retirement benefit recipient, an unmarried disability benefit recipient or an unmarried member at the time of the member s death. Category 2 (Disabled Adult Child) A person age 26 or older who is permanently and totally disabled and: Is a biological child, child lawfully adopted before age 18 or stepchild of a primary service retirement benefit recipient, disability benefit recipient or active member at the time of the member s death; or a child for whom the primary service retirement benefit recipient, disability benefit recipient or deceased active member was legally appointed as guardian before the child attained age 18; and Meets the following requirements: Person has never been married and has been adjudged physically or mentally incompetent by a court before age 18 or age 22 if attending school on at least twothirds-of-a-full-time basis and has been continuously disabled; or Person has never been married and has been unable to earn a living because of a mental or physical condition that was disabling before age 18 or age 22 if attending school on at least two-thirds-of-a-full-time basis and has been continuously disabled. (This means the person is incapable of earning 150% of the federal minimum wage multiplied by 2,080 hours and rounded to the nearest $1,000 as of Jan. 1 of the prior year, as well as the current year and for each year thereafter. Currently this amount is $23,000.) BENEFICIARIES AND SURVIVORS Beneficiaries of Service Retirement Benefit Recipients A beneficiary means a spouse, child or sponsored dependent receiving benefits under a Joint and Survivor Annuity or Annuity Certain plan of payment who was eligible for coverage as a dependent of the primary 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 on Page 5 for eligibility criteria.) Survivors of Active Members or Disability Benefit Recipients A survivor means a spouse, child or sponsored dependent 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, or later, 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. 6 www.strsoh.org

Premium Subsidy and Health Care Assistance Program SUBSIDY RATE STRS Ohio subsidizes individual monthly health care premiums for eligible service retirement and disability benefit recipients. Covered dependents do not receive a premium subsidy. Additionally, beginning Jan. 1, 2015, new beneficiaries and survivors will not receive a premium subsidy. The premium subsidy rate for 2015 is 2.2% for each year of service credit, up to a maximum of 66%. The subsidy rate per year of service will decrease to 2.1% in 2016. HEALTH CARE ASSISTANCE PROGRAM STRS Ohio offers a Health Care Assistance Program to qualified individuals who need financial assistance paying the monthly premium for an STRS Ohio health care plan. The assistance program currently provides qualifying participants with hospital/medical and prescription drug coverage for no monthly premium. Although covered family members may receive the same plan of coverage as the qualifying recipient, they are not eligible for the $0 premium and must pay the full cost of their coverage. Approved individuals may enroll in the Medical Mutual Health Care Assistance Plan. Individuals with Medicare Parts A & B or Part B-only may also be eligible to enroll in the Aetna Medicare Plan. Individuals must maintain their Medicare Parts A & B or Part B-only enrollment to remain eligible for the Health Care Assistance Program. The assistance program is available to: Service retirement benefit recipients with 25 or more years of Ohio-valued* service; Disability benefit recipients currently receiving STRS Ohio benefits; Beneficiaries of retired teachers with at least 25 years of Ohio-valued* service at retirement (if there are multiple beneficiaries on the account, only one beneficiary is eligible for a $0 monthly premium contact STRS Ohio for details); Survivor benefit recipients of active or disabled teachers eligible to retire with at least 25 years of Ohio-valued* service at retirement; and Survivor benefit recipients of active or disabled teachers not eligible for service retirement. * Note: Please call STRS Ohio s Member Services Center to determine if you have at least 25 years of Ohio-valued service. Examples of Ohio-valued service include earned STRS Ohio, OPERS, SERS, Ohio Police & Fire Pension Fund, and Highway Patrol Retirement System service, as well as certain types of purchased service. To be eligible for the program: Your total annual family gross income must fall at or below $23,800 for you, your spouse and any dependent children; and Liquid assets or funds readily available to your family, such as cash, savings, money market and checking accounts, trust funds, publicly traded securities and other investment vehicles, must not exceed $23,800. (A home is not considered a liquid asset.) To apply for the program, you must submit a completed application to STRS Ohio along with a copy of the previous year s federal tax return. Applications must be received no later than the 15th of the month to be considered for approval for an effective date starting the next month. STRS Ohio will requalify participants annually. For more information about the program, please call STRS Ohio. 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? 2015 STRS Ohio Health Care Program Guide 7

PLAN FEATURES TO CONSIDER After you decide what s most important to you, you should begin 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. Understanding Your Plan Options Now that you ve reviewed some features to consider, you should understand which plans you re eligible to enroll in for health care coverage. The plan options available to you depend on the geographic location of your permanent residence and your Medicare status on file with STRS Ohio and Medicare. As a result, you may find that some plans may not be available to you or your family. You and your family must enroll in a plan offered by the same plan administrator unless you have Medicare and non- Medicare enrollees on your account. In this case, Medicareeligible individuals may choose the Aetna Medicare Plan while other non-medicare family members choose a Medical Mutual plan. Keep in mind, if Medicare-eligible individuals choose the Aetna Medicare Plan, all non-medicare family members must choose the same Medical Mutual plan Basic or Plus. Enrollment in separate plans is only permitted when all Medicare enrollees on the account select the Aetna Medicare Plan. If the Aetna Medicare Plan is not selected, all members on the account must choose the Basic Plan or a regional plan if available. In addition, if you re enrolling in the Medical Mutual Basic or Plus Plan, you and your family must enroll in the same plan. For example, if you decide the Medical Mutual Basic Plan is right for you, you and all your eligible dependents must enroll in the Medical Mutual Basic Plan. Eligibility for indemnity and PPO plans is determined individually based on where you live and your Medicare status. This means, for example, it s possible for you to be enrolled in a PPO plan and an eligible dependent to be enrolled in an indemnity plan offered by the same plan administrator. When comparing plans, keep in mind that prescription drug coverage is included in all of the health care plans we offer. This means you do not need to purchase additional prescription drug coverage. This is especially important for Medicare enrollees, who must not enroll in any other Medicare Part D plan if they want to remain enrolled in an STRS Ohio health care plan. KEY TERMS TO UNDERSTAND When reviewing plan types, it s important to understand the following key terms: Annual deductible This is the dollar amount you must pay before the plan pays a portion of your hospital/medical and/or prescription drug costs. Coinsurance This is the percentage of covered charges you must pay after you have met your annual deductible, such as 20% for a physician office visit or 10% for a specialty drug. Copayment This is the fixed amount you pay for a specific service, such as $15 for a primary care physician office visit or $10 for a generic drug at retail. Enrollee s maximum annual expense This is the maximum annual amount an enrollee with Express Scripts coverage will pay for prescription drugs. Once the maximum annual expense limit is met, the enrollee pays nothing for covered drugs for the remainder of the year. Monthly premium This is the fixed amount you pay monthly for health care coverage under the plan. This amount must be paid even if you don t use any of the services. Out-of-pocket maximum This is the amount you must pay in a calendar year before the plan pays 100% of remaining expenses for covered hospital/medical services that year. This amount does not include prescription drug costs and any charges exceeding allowed/noncontracting provider amounts set by the health care plan administrator, unless otherwise noted. Allowed/noncontracting provider amounts This is the predetermined amount a plan will pay a provider for medically necessary services as established by the health care plan administrator. 8 www.strsoh.org

WHICH PLANS ARE AVAILABLE TO YOU? Your eligibility for plans is determined by the geographic location of your permanent residence and your Medicare status on file with STRS Ohio and Medicare. To find out the specific plans available to you, please review your personalized list of plan options that you may have received with this publication. If you do not have a personalized list, please call STRS Ohio for your plan options or register for a personal account on our website. Then see Section 2 and/or Section 4 for the coverage features and monthly premiums of your plan options based on Medicare status. TYPES OF PLANS OFFERED Five types of plans are offered under the STRS Ohio Health Care Program. Each plan includes prescription drug coverage. See Prescription Drug Coverage on this page for details. 1. Indemnity (administered by Medical Mutual) An indemnity plan is traditional health care coverage in which reimbursement is made either to you or directly to your provider, up to an allowed dollar amount or coverage limit determined by the plan administrator. You are responsible for any charges exceeding this amount or limit. As an enrollee, you can use any health care provider. 2. PPO (administered by AultCare and Medical Mutual) A preferred provider organization (PPO) is a group of selected health care providers who have agreed to offer comprehensive services at preset reimbursement levels. These providers including physicians, hospitals and other health care providers are referred to as in-network providers. As an enrollee, you can use out-ofnetwork providers, but your out-of-pocket expenses will be higher. 3. Medicare Advantage (administered by Aetna and Paramount) A Medicare Advantage plan is a health care plan approved by Medicare in which the federal government reimburses a private company to provide the enrollee with basic Medicare coverage and other services. These plans, which are sometimes referred to as Medicare Part C plans or MA plans, can be PPO plans, HMO plans, private fee-for-service plans or Medicare special needs plans. A Medicare Advantage plan covers all of the services that Medicare Parts A & B cover and may provide additional coverage for services not typically covered by Medicare, such as preventive services, and vision and hearing services. When you enroll in a Medicare Advantage plan, your Medicare Parts A & B benefits are assumed by the Medicare Advantage plan. You must remain enrolled in Medicare Part B and pay your monthly Part B premium to Medicare when enrolled in a Medicare Advantage plan. 4. HMO(administered by HealthSpan and Paramount) A health maintenance organization (HMO) is a health plan in which physicians, hospitals and other health care providers either contract with or are employed directly by the HMO to provide services. 5. Medicare HMO (administered by HealthSpan) A Medicare health maintenance organization (HMO) is a health care plan in which the federal government reimburses the HMO to provide the enrollee with basic Medicare coverage and other services. This type of plan covers all of the services that Medicare Parts A & B cover and may provide additional coverage for services not typically covered by Medicare, such as preventive services, as well as vision and hearing services. When you enroll in a Medicare HMO, your Medicare Parts A & B benefits are assumed by the Medicare HMO plan. You must remain enrolled in Medicare Part B and pay your monthly Part B premium to Medicare when enrolled in a Medicare HMO. PRESCRIPTION DRUG COVERAGE Enrollees Without Medicare Express Scripts administers prescription drug coverage for Medical Mutual, AultCare and Paramount enrollees without Medicare. HealthSpan administers coverage for its enrollees. Enrollees With Medicare If you re enrolled in Medicare Parts A & B or Part B-only, the prescription drug coverage included in your STRS Ohio health care plan is provided under a Medicare Part D plan. A Medicare Part D plan is a prescription drug plan approved by Medicare in which the federal government reimburses a private company to provide the enrollee with prescription drug coverage. Express Scripts administers Medicare Part D prescription drug coverage for Aetna, Medical Mutual, AultCare and Paramount enrollees. HealthSpan administers coverage for its enrollees. 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 any other Medicare Part D plan, your STRS Ohio hospital/medical and prescription drug coverage will be canceled. In addition, if you decline or lose coverage under the Medicare Part D plan included in your STRS Ohio health care plan, your STRS Ohio hospital/medical coverage will be canceled. 2015 STRS Ohio Health Care Program Guide 9

Enrolling in a Health Care Plan 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 elect to enroll and have not previously selected a plan, information about your plan options and monthly premiums will be mailed to you after your benefit application has been processed. Review your health care plan options and the monthly premiums charged for coverage. If you have not previously selected a plan in writing or on your online application, call STRS Ohio to select your plan. (See Your Enrollment Checklist on Page 13 for more information.) 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. Important: Be sure to verify the date your employersponsored coverage will end. The effective date of STRS Ohio coverage cannot be changed after premium deductions and coverage have begun. Also, any amounts you have accumulated toward an annual deductible or out-of-pocket maximum do not transfer from your employer plan. ENROLLING AFTER MONTHLY BENEFITS BEGIN If you do not enroll in an STRS Ohio health care plan when monthly benefits begin, you may request enrollment for yourself and/or an eligible dependent under the following circumstances. To enroll a dependent, the benefit recipient must also be enrolled. Termination of other coverage You may enroll yourself and/or an eligible dependent if other health care coverage is terminating. Coverage becomes effective the first of the month following termination of other coverage if STRS Ohio receives the enrollment application within 31 days of the date your other coverage ended. If you do not request enrollment within 31 days, you will need to wait until open enrollment to enroll. Medicare enrollment You may enroll yourself or an eligible dependent upon initial eligibility and enrollment in Medicare Parts A & B or Part B-only. If you do not request enrollment within 31 days of enrolling in Medicare, you will need to wait until open enrollment to enroll. See Section 3 for information about Medicare enrollment. Open enrollment STRS Ohio currently offers an open-enrollment period each year from Nov. 1 through the Tuesday before Thanksgiving. During this time, benefit recipients can change their health care plan or enroll for the first time. As a benefit recipient, you may enroll yourself and/or an eligible dependent during the open-enrollment period, provided eligibility guidelines are met. Coverage becomes effective Jan. 1 following open enrollment. ADDING ELIGIBLE DEPENDENTS TO YOUR COVERAGE An enrollment application is required for dependents. To request an application, call STRS Ohio or visit our website to print the form. See Page 6 for dependent eligibility guidelines. Spouse Service retirement or disability recipients can enroll a spouse upon marriage. The enrollment application must be received within 31 days of marriage for coverage to be effective the first of the month following the marriage. Child Benefit recipients can enroll a child who is under age 26 upon birth, adoption, placement for adoption or legal guardianship. The enrollment application must be received within 31 days of the birth, adoption, placement for adoption or legal guardianship for coverage to be effective the first of the month following the event. 10 www.strsoh.org

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 a Medicare HMO and you notify us at the end of the month, your termination 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 enrollees not eligible for Medicare 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 Page 6 for additional information. Moving to a new residence If you are moving, contact STRS Ohio as soon as you know your new address. STRS Ohio will let you know if your health care 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 about emergency coverage while you re 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 determine 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, you are limited to coverage under only one system. Guidelines determine which system is responsible for your health care coverage. Contact STRS Ohio for details. Note: 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. CHANGING PLANS AFTER ENROLLMENT When you enroll in an STRS Ohio health care plan, you will remain in the health care 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 health care 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; (2) birth, adoption, placement for adoption or legal guardianship of a child; (3) death; (4) divorce or dissolution; (5) legal separation; or (6) 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 before the effective date of Medicare or three months after the effective date of Medicare. Note: If you are enrolled in a Medical Mutual plan, you will be enrolled in the Aetna Medicare Plan, if eligible, unless you specify a different plan when you submit proof of Medicare Parts A & B or Part B-only enrollment to STRS Ohio. Enrollee is a new retiree. The new enrollee must request to change plans within 31 days of receiving a first full benefit payment. A PPO or an HMO enrollee experiences the loss of a key provider from the network. An enrollee moves to another service area, which results in different plan options being available. Furthermore: An Aetna Medicare Plan enrollee may terminate coverage at the end of any month and enroll in the Medical Mutual Basic Plan or a regional plan if available. The request to terminate coverage must be sent to STRS Ohio before the effective termination date and received by the 15th of the month to stop the next month s premium deduction from the STRS Ohio benefit payment. The request to enroll in another STRS Ohio plan must be received by STRS Ohio within 31 days of the termination effective date. A HealthSpan Medicare Plus or Paramount Elite HMO enrollee may terminate coverage at any time and enroll in the Aetna Medicare Plan or Medical Mutual Basic Plan. A written request to terminate coverage must be sent to STRS 2015 STRS Ohio Health Care Program Guide 11

Ohio before the termination date becomes effective. The letter must be signed by the benefit recipient and any other covered enrollees on the account. The request to enroll in another STRS Ohio plan must be received by STRS Ohio within 31 days of the termination effective date. 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 the Aetna Medicare Plan and a Medical Mutual plan. TERMINATING COVERAGE Terminating coverage at any time You may terminate your or your dependent s STRS Ohio health care coverage at any time. All termination requests must be received by the 15th of the month to stop the next month s premium deduction from your STRS Ohio benefit payment. Aetna, AultCare and Medical Mutual enrollees may terminate coverage by calling STRS Ohio. HealthSpan and Paramount enrollees may terminate coverage by sending a written request to STRS Ohio. The letter must be signed by the benefit recipient and any other covered enrollees on the account. If applicable, Medicare coverage assumed by the plan will be reinstated effective immediately so there is no gap in health care coverage. Please note, there are limited opportunities to reenroll in an STRS Ohio health care plan after you terminate coverage. See Page 10 for details. Terminating your dependent s coverage due to loss of eligibility Spouse In the event of a divorce, your spouse s health care coverage terminates the first of the month following finalization of the divorce. The termination 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 terminations. 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 health care 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 health care plan at the time of your death, dependent health care coverage will terminate at the end of the month in which your death occurred. Your dependents should contact STRS Ohio for information about COBRA continuation coverage. 12 www.strsoh.org

Your Enrollment Checklist This section walks you through the health care plan enrollment process from your initial contact with STRS Ohio to receipt of ID cards. The following steps vary depending on your status when monthly benefits begin. Please review the information that applies to your situation. If you re enrolling in an HMO plan, you must also submit any separate applications required by the plan administrator. You will be enrolled in the Medical Mutual Basic Plan if you do not specify a plan, submit required HMO applications or submit required Medicare information. Call STRS Ohio if you have questions about how to enroll in a plan. Note: Your monthly health care 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 premium to be paid in full through the establishment of a direct debit account through your financial institution. If payment is not received by the first business day of the month the premium is due, your health care coverage may be canceled. SERVICE RETIREMENT APPLICANTS q Participate in a preretirement counseling session with an STRS Ohio benefits counselor and receive general information about the STRS Ohio Health Care Program. To make a counseling appointment, call STRS Ohio s Member Services Center toll-free at 1-888-227-7877. q Verify the date your employer-sponsored health care coverage will end. Knowing this information will help you determine an accurate start date of STRS Ohio health care coverage. The effective date of STRS Ohio coverage cannot be changed after premium deductions and coverage have begun. q Submit a Service Retirement Application to STRS Ohio before the desired start date of monthly benefits and health care coverage. This application can also be completed online via the secure Personal Account Information area of our website. q STRS Ohio sends selection materials for the health care plans available to you. The plan options and monthly premiums are based on your Medicare status at the time the estimate is prepared. q Review all materials, including coverage information and monthly premiums, and follow enrollment instructions. (Please read the materials even if you ve already selected a plan.) If applicable, send STRS Ohio a copy of your Medicare Parts A & B or Part B-only card and complete a separate HMO application that may be required by a plan administrator. q You will receive written confirmation from STRS Ohio of enrollment in the health care plan you select. (Aetna plan enrollees will receive confirmation from Aetna.) q You will receive ID cards and plan coverage information from your plan administrator. Note: When you retire and enroll in an STRS Ohio health care plan, any amounts you have accumulated toward an annual deductible or out-of-pocket maximum do not transfer from your employer plan. DISABILITY BENEFIT APPLICANTS q Submit a Disability Benefit Application to STRS Ohio. q If the application is approved, complete the Disability Information for Payment of Benefit form and indicate your desire to enroll in a health care plan. q STRS Ohio sends selection materials for the health care plans available to you. The plan options and monthly premiums are based on your Medicare status at the time the estimate is prepared. q Review all materials, including coverage information and monthly premiums, and follow enrollment instructions. (Please read the materials even if you ve already selected a plan.) If applicable, send STRS Ohio a copy of your Medicare Parts A & B or Part B-only card and complete a separate HMO application that may be required by a plan administrator. q You will receive written confirmation from STRS Ohio of enrollment in the health care plan you select. (Aetna plan enrollees will receive confirmation from Aetna.) q You will receive ID cards and plan coverage information from your plan administrator. SERVICE RETIREMENT BENEFICIARIES q Notify STRS Ohio of the benefit recipient s death. q Submit a health care enrollment application to STRS Ohio. Also send STRS Ohio a copy of your Medicare Parts A & B or Part B-only card if applicable. If you were enrolled as a dependent at the time of the benefit recipient s death, you may remain in your current plan if you were enrolled in the Aetna Medicare Plan or a Medical Mutual plan, unless you indicate otherwise. If you were enrolled in a Paramount plan, you must submit a new HMO application directly to Paramount to continue coverage. If you were enrolled in a HealthSpan plan, you must select a new plan. (HealthSpan does not allow new enrollments.) 2015 STRS Ohio Health Care Program Guide 13

If you were not enrolled as a dependent at the time of the benefit recipient s death, submit a health care enrollment application to STRS Ohio indicating your plan choice. Remember, the benefit recipient must have been eligible for coverage at the time of death for a beneficiary to qualify for coverage. q STRS Ohio processes and approves the application. q You will receive written confirmation from STRS Ohio of enrollment in the health care plan you select. (Aetna Medicare Plan enrollees will receive confirmation from Aetna.) q You will receive ID cards and plan coverage information from your plan administrator. SURVIVOR BENEFIT APPLICANTS q Notify STRS Ohio of the member s or disability benefit recipient s death. q If eligible, STRS Ohio sends you an application for survivor benefits and health care enrollment materials. The plan options and monthly premiums are based on your Medicare status at the time the estimate is prepared. Remember, to be eligible for health care coverage, you must have been eligible as a dependent at the time of the member s or disability benefit recipient s death. q Submit a survivor benefits application and health care enrollment application to STRS Ohio. Also send STRS Ohio a copy of your Medicare Parts A & B or Part B-only card if applicable. q STRS Ohio processes and approves the applications. q You will receive written confirmation from STRS Ohio of enrollment in the health care plan you select. (Aetna Medicare Plan enrollees will receive confirmation from Aetna.) q You will receive ID cards and plan coverage information from your plan administrator. ENROLLING AFTER RETIREMENT (OUTSIDE OF OPEN ENROLLMENT) If you decline enrollment in an STRS Ohio health care plan at retirement, there are limited opportunities, called qualifying events, that allow you and your dependents to enroll (see Enrolling After Monthly Benefits Begin on Page 10). q If you experience a qualifying event, contact STRS Ohio to request information about your health care plan options and monthly premiums. q STRS Ohio sends you a health care enrollment application and selection materials. (Please read the materials even if you ve already selected a plan.) The plan options and monthly premiums are based on your Medicare status at the time the estimate is prepared. q Submit a health care enrollment application to STRS Ohio within 31 days of the qualifying event. If the event is the termination of other coverage, the following documentation is required: 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 health care coverage terminated. The certificate or letter should also include the names of any covered dependents and the dates their coverage terminated. If applicable, you must send STRS Ohio a copy of your Medicare Parts A & B or Part B-only card. If you are selecting a Paramount plan, you must also submit an HMO enrollment application to Paramount. q STRS Ohio reviews your enrollment application and verification of prior coverage. q You will receive written confirmation from STRS Ohio of enrollment in the health care plan you select. (Aetna plan enrollees will receive confirmation from Aetna.) q You will receive ID cards and plan coverage information from your plan administrator. 14 www.strsoh.org

Section 2: Plans and Premiums Without Medicare If you re not eligible for Medicare, this section is for you. Inside you ll find the coverage features of the plans available to enrollees without Medicare. You ll also find monthly premiums for benefit recipients based on years of service, as well as premiums for spouses, children and sponsored dependents without Medicare. Review the personalized list of plan options you may have received with this publication to find out the specific plans available to you and your family. (If you did not receive a personalized list, please call STRS Ohio s Member Services Center for your plan options.) Keep in mind, you and your family members 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. Please review this section for the features and premiums of the plans for enrollees without Medicare. If you have Medicare-eligible family members, also review Section 4 (Page 31) for the features and premiums of the plan options for enrollees with Medicare. Be aware coverage features under the same plan could differ based on Medicare status. Premiums also differ. If you have specific questions about plan features, please contact the plan administrator directly (Page 47). If you have questions about monthly premiums, call STRS Ohio. PRESCRIPTION DRUG REFERENCE GUIDE Express Scripts administers the prescription drug plan for the Medical Mutual, AultCare and Paramount plans described in this section. When reviewing prescription drug coverage for these plans, it s important to understand the following key terms. KEY TERM Annual deductible Generic Covered brand-name Specialty Over-the-counter PPI DESCRIPTION The amount an enrollee must pay for drugs classified as covered brand-name, including specialty, before the plan begins paying a portion of the costs for these drugs. Generic drug costs do not apply to the deductible. Generic medications available for the lowest copayment. Brand-name medications available for a copayment after the deductible is met. Specialty medications available for a 10% coinsurance up to a maximum cost of $500 per fill (after the deductible is met if applicable). These highcost medications typically include infused, injectable and oral drugs that are used to treat chronic and life-threatening diseases; are often difficult to administer; may cause adverse reactions; may require temperature control or other special handling; and/or may have restrictions as determined by the Food and Drug Administration. Over-the-counter proton pump inhibitor (PPI) medication, such as Prilosec OTC, which is available for the generic copayment with a prescription. 2015 STRS Ohio Health Care Program Guide 15

Plan Features for 2015 Without Medicare You may be eligible for these plans if you are not yet eligible for Medicare. Medical Mutual Basic (Indemnity or PPO) Medical Mutual Plus (Indemnity or PPO) PLAN FEATURES In-network and Indemnity 1 Out-of-network 1 In-network and Indemnity 1 Out-of-network 1 Enrollee Eligibility Available in any location Available in any location Annual Deductible per Enrollee 2 $2,250 $4,500 $2,000 $4,000 Out-of-Pocket Maximum 2 (Excludes prescription drug costs. Amounts included are noted for each plan.) Lifetime Benefits Maximum per Enrollee Health Provider Access $3,700 per enrollee (includes coinsurance and primary care physician copayments) Use network provider (PPO); use any covered provider (indemnity) Unlimited PHYSICIAN, HOSPITAL, SKILLED NURSING AND HOME HEALTH CARE Primary Care Physician Office Visit Enrollee pays $20 per visit for first two visits per year (no deductible); 20% thereafter (after deductible) $7,400 per enrollee (includes coinsurance) Use any covered provider Enrollee pays 50% after deductible $3,400 per enrollee (includes coinsurance) Use network provider (PPO); use any covered provider (indemnity) Unlimited $6,800 per enrollee (includes coinsurance) Use any covered provider Enrollee pays 20% Enrollee pays 50% Specialist Physician Office Visit Enrollee pays 20% Enrollee pays 50% Enrollee pays 20% Enrollee pays 50% Urgent Care Enrollee pays $35 Enrollee pays $35 Hospital Inpatient Services Enrollee pays 20% Enrollee pays 50% Enrollee pays 20% Enrollee pays 50% Hospital Charges for Outpatient Surgery and Preadmission Testing Enrollee pays 20% Enrollee pays 50% Enrollee pays 20% Enrollee pays 50% Emergency Room Care Enrollee pays $150; waived if admitted Enrollee pays $150; waived if admitted Skilled Nursing Facility (Benefit period varies by plan administrator.) Inpatient Mental Health Home Health Care Enrollee pays 20% (90 days per benefit period); after 90 days, enrollee pays 100% Enrollee pays 20%; no limit on days Enrollee pays 20%; no visit limit Enrollee pays 50% (90 days per benefit period); after 90 days, enrollee pays 100% Enrollee pays 50%; no limit on days Enrollee pays 50%; no visit limit Enrollee pays 20% (90 days per benefit period); after 90 days, enrollee pays 100% Enrollee pays 20%; no limit on days Enrollee pays 20%; no visit limit Enrollee pays 50% (90 days per benefit period); after 90 days, enrollee pays 100% Enrollee pays 50%; no limit on days Enrollee pays 50%; no visit limit 1 Indemnity and out-of-network payments are based on allowed/noncontracting provider amounts for medically necessary services as established by the health care plan administrator. If nonparticipating 1 providers charge in excess of these amounts, the enrollee is responsible for the excess charges. 2 Annual deductible must be met before plan begins making payments, unless otherwise noted. In-network and out-of-network accumulations are separate. 16 www.strsoh.org

Plan Features for 2015 Without Medicare AultCare PPO In-network Out-of-network 1 HealthSpan (HMO) Closed to new enrollments in 2015 Paramount Health Care (HMO) Available in select northeastern Ohio area ZIP codes Available in select Cleveland, Ohio, area ZIP codes Available in select northwestern Ohio and southern Michigan area ZIP codes $1,000 $2,000 No deductible No deductible $2,100 per enrollee (includes coinsurance) $4,200 per enrollee (includes coinsurance) $2,500 per enrollee (includes copayments) $1,500 per enrollee (includes copayments and coinsurance) Unlimited Unlimited Unlimited Use network provider Use any covered provider Use HMO network provider Use HMO network provider Enrollee pays 20% Enrollee pays 50% Enrollee pays $15 Enrollee pays $15 Enrollee pays 20% Enrollee pays 50% Enrollee pays $15 Enrollee pays $25 Enrollee pays $35 Enrollee pays $35 Enrollee pays $35 Enrollee pays 20% Enrollee pays 50% Enrollee pays 0% Enrollee pays 10% Enrollee pays 20% Enrollee pays 50% Enrollee pays $15 Enrollee pays 10% Enrollee pays $150; waived if admitted Enrollee pays $150; waived if admitted Enrollee pays $150; waived if admitted Enrollee pays 20% (90 days per benefit period); after 90 days, enrollee pays 100% Enrollee pays 20%; no limit on days Enrollee pays 20%; no visit limit Enrollee pays 50% (90 days per benefit period); after 90 days, enrollee pays 100% Enrollee pays 50%; no limit on days Enrollee pays 50%; no visit limit Enrollee pays 0% for up to 100 days per calendar year; after 100 days, enrollee pays 100% Enrollee pays 0%; no limit on days Enrollee pays 0%; no visit limit Enrollee pays 0% per benefit period for days 1 20; $75 for days 21 100; after 100 days, enrollee pays 100% Enrollee pays 10%; no limit on days Enrollee pays 10%; no visit limit 2015 STRS Ohio Health Care Program Guide 17

Plan Features for 2015 Without Medicare You may be eligible for these plans if you are not yet eligible for Medicare. Medical Mutual Basic (Indemnity or PPO) Medical Mutual Plus (Indemnity or PPO) PREVENTIVE SERVICES In-network and Indemnity 1 Out-of-network 1 In-network and Indemnity 1 Out-of-network 1 Services such as a routine physical exam, bone density screening, mammogram, routine prostatic specific antigen (PSA), colorectal cancer screening, Pap smear and immunizations/ inoculations may be covered. Contact the plan administrator for details. Enrollee pays 0% (no deductible); limit one per calendar year (colorectal cancer screening limit one per 24 months if high risk or one per 10 years if not high risk) Enrollee pays 0% (no deductible); limit one per calendar year (colorectal cancer screening limit one per 24 months if high risk or one per 10 years if not high risk) OUTPATIENT SERVICES Diagnostic X-ray and Lab Testing Enrollee pays 20% Enrollee pays 50% Enrollee pays 20% Enrollee pays 50% Outpatient Mental Health ADDITIONAL SERVICES Enrollee pays 20%; no visit limit Enrollee pays 50%; no visit limit Enrollee pays 20%; no visit limit Dental Care No coverage No coverage Vision Care No coverage No coverage Enrollee pays 50%; no visit limit 1 Indemnity and out-of-network payments are based on allowed/noncontracting provider amounts for medically necessary services as established by the health care plan administrator. If nonparticipating 1 providers charge in excess of these amounts, the enrollee is responsible for the excess charges. 18 www.strsoh.org

Plan Features for 2015 Without Medicare AultCare PPO In-network Out-of-network 1 HealthSpan (HMO) Closed to new enrollments in 2015 Paramount Health Care (HMO) Enrollee pays 0% (no deductible); limited designated services; frequency/age/gender limitations apply Enrollee pays 0%; limited designated services; frequency/age/gender limitations apply Enrollee pays 0%; limited designated services; frequency/age/gender limitations apply Enrollee pays 20% Enrollee pays 50% Enrollee pays 0% Enrollee pays 10% Enrollee pays 20%; no visit limit Enrollee pays 50%; no visit limit Enrollee pays $15; no visit limit Enrollee pays $25; no visit limit No coverage No coverage No coverage No coverage Enrollee pays $15 for annual eye exam at EyeMed Enrollee pays $25 for annual eye exam at participating providers 2015 STRS Ohio Health Care Program Guide 19

Plan Features for 2015 Without Medicare You may be eligible for these plans if you are not yet eligible for Medicare. Medical Mutual Basic (Indemnity or PPO) Medical Mutual Plus (Indemnity or PPO) PRESCRIPTION DRUG COVERAGE Retail Network Provider Express Scripts Express Scripts Annual Brand-name Deductible per Enrollee (Generic drug costs do not apply to deductible.) Standard (Network) Retail/Nursing Home Pharmacy Copayments/Coinsurance $200 for covered brand-name drugs, including specialty Generic: $10 (includes over-the-counter PPI with prescription) Covered brand-name: $30 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Out-of-network pharmacies and pharmacies outside the U.S. and Puerto Rico: Reimbursed the amount STRS Ohio would have been charged at a standard (network) pharmacy, less copayment $200 for covered brand-name drugs, including specialty Generic: $10 (includes over-the-counter PPI with prescription) Covered brand-name: $30 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Out-of-network pharmacies and pharmacies outside the U.S. and Puerto Rico: Reimbursed the amount STRS Ohio would have been charged at a standard (network) pharmacy, less copayment Maximum Day Supply Retail: 31 days; Mail: 90 days Retail: 31 days; Mail: 90 days Home Delivery Provider Express Scripts Express Scripts Home Delivery Copayments/Coinsurance Low-Cost Generic Drug Program medications: $9 Generic: $25 (includes over-the-counter PPI with prescription) Covered brand-name: $75 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Low-Cost Generic Drug Program medications: $9 Generic: $25 (includes over-the-counter PPI with prescription) Covered brand-name: $75 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Maximum Annual Expense per Enrollee If an enrollee pays a total of $4,700 out of pocket in copayments/coinsurance/deductible for generic, covered brand-name and specialty medications, that enrollee pays nothing for covered medications for the remainder of the year. If an enrollee pays a total of $4,700 out of pocket in copayments/coinsurance/deductible for generic, covered brand-name and specialty medications, that enrollee pays nothing for covered medications for the remainder of the year. 20 www.strsoh.org

Plan Features for 2015 Without Medicare AultCare PPO HealthSpan (HMO) Closed to new enrollments in 2015 Paramount Health Care (HMO) Express Scripts $200 for covered brand-name drugs, including specialty Generic: $10 (includes over-the-counter PPI with prescription) Covered brand-name: $30 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Out-of-network pharmacies and pharmacies outside the U.S. and Puerto Rico: Reimbursed the amount STRS Ohio would have been charged at a standard (network) pharmacy, less copayment HealthSpan Medical Facilities and other network pharmacies Formulary generic: $15 No deductible Formulary brand-name: $30 Services must be received by pharmacies participating in the HMO network. Express Scripts $200 for covered brand-name drugs, including specialty Generic: $10 (includes over-the-counter PPI with prescription) Covered brand-name: $30 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Out-of-network pharmacies and pharmacies outside the U.S. and Puerto Rico: Reimbursed the amount STRS Ohio would have been charged at a standard (network) pharmacy, less copayment Retail: 31 days; Mail: 90 days Retail: 30 days; Mail: 90 days Retail: 31 days; Mail: 90 days Express Scripts HealthSpan Mail Order Express Scripts Low-Cost Generic Drug Program medications: $9 Generic: $25 (includes over-the-counter PPI with prescription) Covered brand-name: $75 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Formulary generic: $15 Formulary brand-name: $30 Low-Cost Generic Drug Program medications: $9 Generic: $25 (includes over-the-counter PPI with prescription) Covered brand-name: $75 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) If an enrollee pays a total of $4,700 out of pocket in copayments/coinsurance/deductible for generic, covered brand-name and specialty medications, that enrollee pays nothing for covered medications for the remainder of the year. No limit If an enrollee pays a total of $4,700 out of pocket in copayments/coinsurance/deductible for generic, covered brand-name and specialty medications, that enrollee pays nothing for covered medications for the remainder of the year. 2015 STRS Ohio Health Care Program Guide 21

Monthly Premiums for 2015 Without Medicare You may be eligible for these plans if you are not yet eligible for Medicare. Medical Mutual Basic (Indemnity or PPO) Medical Mutual Plus (Indemnity or PPO) AultCare PPO ELIGIBILITY GROUP TOTAL COST: $698 TOTAL COST: $1,255 TOTAL COST: $891 Available in any location Available in any location Available in select northeastern Ohio area ZIP codes BENEFIT RECIPIENT YEARS OF SERVICE STRS OHIO PAYS YOU PAY STRS OHIO PAYS YOU PAY STRS OHIO PAYS YOU PAY 30+ 461 237 828 427 588 303 29 445 253 801 454 568 323 28 430 268 773 482 549 342 27 415 283 745 510 529 362 26 399 299 718 537 510 381 25 384 314 690 565 490 401 24 369 329 663 592 470 421 23 353 345 635 620 451 440 22 338 360 607 648 431 460 21 322 376 580 675 412 479 20 307 391 552 703 392 499 19 292 406 525 730 372 519 18 276 422 497 758 353 538 17 261 437 469 786 333 558 16 246 452 442 813 314 577 15 230 468 414 841 294 597 Less Than 15 Years of Service 1 0 698 0 1,255 0 891 Spouse 0 698 0 1,255 0 891 Children 0 264 0 429 0 311 Sponsored Dependents 0 698 0 1,255 0 891 1 Members who retired before Jan. 1, 2004, with less than 15 years of service credit have access to the STRS Ohio Health Care Program but pay the full cost of their premium. Members who retire on or after Jan. 1, 2004, and before Aug. 1, 2023, must have at least 15 years of qualifying service credit to access coverage. Members who retire on or after Aug. 1, 2023, must have at least 20 years of qualifying service credit to access coverage. 22 www.strsoh.org

Monthly Premiums for 2015 Without Medicare HealthSpan (HMO) Closed to new enrollments in 2015 TOTAL COST: $868 Available in select Cleveland, Ohio, area ZIP codes Paramount Health Care (HMO) TOTAL COST: $860 Available in select northwestern Ohio and southern Michigan area ZIP codes STRS OHIO PAYS YOU PAY STRS OHIO PAYS YOU PAY 573 295 568 292 554 314 549 311 535 333 530 330 516 352 511 349 496 372 492 368 477 391 473 387 458 410 454 406 439 429 435 425 420 448 416 444 401 467 397 463 382 486 378 482 363 505 359 501 344 524 341 519 325 543 322 538 306 562 303 557 286 582 284 576 0 868 0 860 0 868 0 860 0 295 0 301 0 868 0 860 2015 STRS Ohio Health Care Program Guide 23

All STRS Ohio health care plan enrollees are required to enroll in Medicare at age 65 or whenever eligible. This section provides details about Medicare coverage, the enrollment process and STRS Ohio requirements. Inside you ll learn about: Medicare eligibility; What parts of Medicare STRS Ohio requires; When and how to enroll in Medicare; Selecting a new health care plan after you enroll in Medicare; Paying your Medicare Part B premium; Medicare Part D prescription drug coverage; Partial Medicare Part B premium reimbursement for eligible benefit recipients enrolled in an STRS Ohio health care plan; and Other important facts about Medicare coverage. Section 3: Medicare Enrollment 24 www.strsoh.org

Understanding Medicare This section explains what Medicare is, what parts STRS Ohio requires and the importance of signing up for coverage. Keep in mind, you re eligible for Medicare even if you did not contribute to Social Security. STRS Ohio requires you to enroll in Medicare Parts A & B or Part B-only. WHAT IS MEDICARE? Medicare is a federal health insurance program for people age 65 and older, some people with disabilities under age 65 and people with end-stage renal disease or amyotrophic lateral sclerosis (ALS). A common misconception is that Ohio educators do not qualify for Medicare because they did not contribute to Social Security. However, you re eligible for Medicare when you turn age 65 even if you are not eligible for Social Security retirement benefits. MEDICARE PARTS Part A (hospital insurance) Most people age 65 or older are eligible for Medicare Part A (hospital insurance) at no cost based on their own or their spouse s employment. You are eligible at age 65 if you are a citizen or permanent resident of the United States and: You receive Social Security or Railroad Retirement benefits, or you have worked long enough to be eligible for them. You would be entitled to Social Security benefits based on your spouse s (or divorced spouse s) employment history, and that spouse is at least age 62. (Your spouse does not need to apply for Social Security benefits for you to be eligible based on your spouse s work record.) You worked long enough in a federal, state or local government job (including public education) to be insured under Medicare. If you aren t yet age 65, you may qualify for Medicare coverage if you have a qualifying disability, end-stage renal disease or ALS. Part B (medical insurance) Almost every U.S. citizen or permanent resident who is age 65 or older (or under age 65 but eligible for Medicare Part A) can enroll in Medicare Part B. A monthly premium is required. Important: If you believe you are not eligible for Medicare Part B, STRS Ohio will require a letter from your local Social Security Administration office confirming ineligibility. Part C (Medicare Advantage plans) In addition to Parts A & B, Medicare offers Part C (Medicare Advantage plans). Medicare Advantage plans are approved by Medicare and administered by private companies. You do not need to enroll in Part C enrollment in Parts A & B or Part B-only qualifies you for coverage under our group Medicare Advantage plan. Part D (prescription drug insurance) Medicare also offers Part D (prescription drug plans). If you want to remain enrolled in an STRS Ohio plan, you should not enroll in any other Part D plan all of the health care plans we offer for enrollees with Medicare Parts A & B or Part B-only already include Medicare Part D prescription drug coverage. Enrollment in any other Part D plan will cancel your STRS Ohio health care enrollment. See Page 29 for details. WHAT PARTS DOES STRS OHIO REQUIRE? While there are several parts to Medicare, you only need to sign up for two: Part A (hospital insurance) if it s available at no cost from Medicare and Part B (medical insurance). While most people do not have to pay a premium for Part A, everyone must pay for Part B. It s important to understand if premium-free Part A is available from Medicare, STRS Ohio requires you to enroll in Part A. STRS Ohio also requires you to sign up for Medicare Part B and continue to pay a monthly premium to Medicare. 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. 2015 STRS Ohio Health Care Program Guide 25

HOW MEDICARE WORKS WITH YOUR STRS OHIO COVERAGE Medicare Parts A & B do not replace your STRS Ohio coverage. Instead, Medicare works with your STRS Ohio health care plan to provide maximum hospital and medical coverage. In general, when you enroll in Medicare Parts A & B, Medicare becomes the primary payer of your hospital and medical expenses; STRS Ohio becomes the secondary payer. If you re enrolled in a Medicare Advantage plan or a Medicare HMO, the plan assumes responsibility for paying for covered services and receives payment from Medicare. After you enroll in Medicare, you will pay two separate monthly premiums: A premium for STRS Ohio coverage (paid to STRS Ohio), and A premium for Medicare Part B coverage (paid to Medicare). WHY YOU NEED TO ENROLL IN MEDICARE PARTS A & B Enrollment in Medicare Parts A & B will determine your eligibility for the plans offered by STRS Ohio. If you do not enroll or you enroll only in Medicare Part A, your only plan option will be the Medical Mutual Basic Plan. You will also be responsible for paying medical charges normally paid by Medicare. When you enroll in Medicare, STRS Ohio s health care costs are reduced, and you pay a lower monthly premium for STRS Ohio health care coverage. If you re a benefit recipient enrolled in an STRS Ohio health care plan, you may also be eligible to receive partial reimbursement from STRS Ohio for your standard Medicare Part B premium. Benefit recipients will not receive partial reimbursement for their Medicare Part B premiums until enrollment in Medicare Part B is confirmed. WHAT HAPPENS WITH YOUR STRS OHIO COVERAGE IF YOU DON T ENROLL/REMAIN ENROLLED IN MEDICARE? Beginning the month of your 65th birthday, you will be considered eligible for Medicare in determining claims paid under the Medical Mutual plans. As a result, your claims will be processed as if you were enrolled in Medicare. This means you will be responsible for 80% of all allowed claim expenses, including physician claims. You will not be eligible to receive partial reimbursement from STRS Ohio to offset the cost of your standard monthly Medicare Part B premium (benefit recipients only). If you don t sign up or don t provide STRS Ohio with proof of Medicare coverage by the end of your Medicare enrollment period, you will be enrolled in the Medical Mutual Basic Plan if you want to continue your STRS Ohio coverage. If you stop paying your monthly Medicare Part B premium, you will lose your Part B coverage. If this occurs, you must apply for reinstatement of coverage with Medicare. (See Page 29 for details about late enrollment penalties.) In addi tion, STRS Ohio will change your enrollment to the Medical Mutual Basic Plan until you provide a current dated letter verifying the effective date of reinstatement. You will be responsible for paying any charges normally paid by Medicare until you provide a letter of reinstatement to STRS Ohio. If your Part B coverage lapses for any reason, you must notify STRS Ohio immediately as it affects plan eligibility and Part B reimbursement. Please request a letter from the Social Security Administration that states the date your coverage ended and send a copy of this letter to STRS Ohio. CAN YOU DELAY YOUR MEDICARE ENROLLMENT IF YOU RE STILL EMPLOYED? If you or your spouse is still employed and covered by a group health plan through the employer, you may choose to delay your enrollment in Medicare Parts A & B or Part B-only. However, if you delay your enrollment, you should be aware of the following: You will have an eight-month special enrollment period in which to sign up for Medicare Part B after the employer health coverage ends or employment ends (whichever comes first). See Page 27 for details. You will not pay a Medicare Part B late enrollment penalty if you sign up during this special enrollment period. If the employer has more than 20 employees, your employer health plan will be the primary payer of covered hospital and medical expenses. Your STRS Ohio plan will be the secondary payer. If you discontinue the employer health coverage and fail to enroll in Medicare, your claims will be processed by your STRS Ohio plan as if you were enrolled in Medicare. This means you will be responsible for 80% of all allowed claim expenses, including physician claims. MEDICARE PRIOR TO AGE 65 Some people under age 65 qualify for Medicare due to a qualifying disability benefit through the Social Security Administration, end-stage renal disease (permanent kidney failure requiring dialysis or kidney transplant) or ALS (a progressive neurodegenerative disease often referred to as Lou Gehrig s disease). If you enroll in Medicare prior to age 65, you must send STRS Ohio proof of Medicare Parts A & B enrollment. 26 www.strsoh.org

Enrolling in Medicare This section walks you through the Medicare enrollment process. Remember, the process is not complete until you send STRS Ohio a copy of your Medicare Parts A & B or Part B-only card. 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. Take action Enroll in Medicare before your 65th birthday to avoid a 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 Medicare will be delayed. Initial Enrollment Period for Medicare Begins three months before and ends three months after the month you turn age 65 You will have NO DELAY in coverage if you enroll: Three months before you turn 65 The month you turn 65 Coverage begins one month after the month you enroll You will have a DELAY in coverage if you enroll: One month after you turn 65 Coverage begins two months after the month you enroll Two months before you turn 65 Coverage begins the month you turn 65 (If your birthday is the first of the month, coverage begins the first day of the previous month.) Two months after you turn 65 Coverage begins three months after the month you enroll One month before you turn 65 Three months after you turn 65 Coverage begins three months after the month you enroll 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 a late enrollment penalty will apply. See Page 29 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. See Page 26 for additional information about delaying Medicare enrollment while employed. HOW TO ENROLL IN MEDICARE Enrolling in Medicare is an easy two-step process. However, it may take more than one month for the entire application process to be completed, so be sure to start the process before your 65th birthday. Step 1 Sign up for Medicare. To enroll in Medicare, visit your local Social Security Administration office or call Social Security toll-free at 1-800-772-1213. If you are eligible for both Medicare Parts A & B, you can also enroll online at www.ssa.gov. If you visit your local office, find out which documents to bring with you to your appointment. Be sure to apply for Medicare before your 65th birthday so there is no delay in Medicare coverage. Step 2 Send a copy of your Medicare card to STRS Ohio. After you enroll in Medicare Parts A & B or Part B-only, you must send STRS Ohio a copy of your Medicare card or a copy of a letter from Social Security confirming Medicare enrollment. If you do not have a Medicare card or a letter from Social Security, you can send STRS Ohio a copy of any of the following Social Security Administration forms: Retirement, Survivors and Disability Insurance Notice of Award; Report of Confidential Social Security Benefit Information; or Notice of Health Insurance Entitlement. 01-01-2015 01-01-2015 These are the only documents STRS Ohio can accept in lieu of a copy of your Medicare card or enrollment confirmation letter. Note: STRS Ohio will not accept a letter acknowledging Medicare s receipt of your enrollment application. Also, please check the name on your Medicare card for accuracy. If it is incorrect, contact Medicare. Medicare will issue you a new card with the correct name. Send a copy of the revised card to STRS Ohio. The information you send to STRS Ohio must include your Medicare Parts A & B or Part B-only effective date and your Medicare claim number. Write your STRS Ohio account number on any documents you submit. (If you re unsure of your account number, call STRS Ohio.) STRS Ohio must receive a copy of your Medicare card by the 15th of the month to begin your enrollment in the Aetna Medicare Plan and/or the Medicare Part B partial premium reimbursement program the first of the following month. 2015 STRS Ohio Health Care Program Guide 27

Selecting Your New STRS Ohio Plan This section explains how to select a new STRS Ohio health care plan after you enroll in Medicare. YOUR PLAN OPTIONS WILL CHANGE After you enroll in Medicare Parts A & B or Part B-only, the STRS Ohio plans available to you will change. Call STRS Ohio toll-free at 1-888-227-7877 to learn about your new plan options and premiums. You can also review this information in the secure Personal Account Information area of our website at www.strsoh.org. IMPORTANT: If you do not send STRS Ohio proof of Medicare Parts A & B or Part B-only enrollment, your only plan option will be the Medical Mutual Basic Plan. You will be enrolled in the Basic Plan at the end of your initial enrollment period for Medicare and will remain in this plan until STRS Ohio receives proof of Medicare Part B coverage. In addition, your claims will be processed as if you were enrolled in Medicare. This means you will be responsible for 80% of all allowed claim expenses, including physician claims. EVALUATING YOUR PLAN OPTIONS Your plan options as a Medicare enrollee are based on your Medicare status and the location of your permanent residence. Plan options for most Medicare enrollees include the Aetna Medicare Plan, Medical Mutual Basic Plan or a regional plan if available in your area. If you reside outside the United States, your STRS Ohio plan options are limited to the Medical Mutual Plus or Basic Plan. Medicare generally does not cover health care items and services furnished or delivered outside the United States. As a result, you will be responsible for submitting all claims to your plan administrator and for paying 80% of all claims expenses that would have been covered by Medicare. Attention Medical Mutual enrollees: If you re eligible for the Aetna Medicare Plan, you will be enrolled in the Aetna plan after STRS Ohio receives a copy of your Medicare card and Medicare approves your enrollment request. If you do not want the Aetna plan, you must submit your request to be enrolled in the Medical Mutual Basic Plan (or a regional plan if available) when you send us a copy of your Medicare Parts A & B or Part B-only card. IMPORTANT FACTORS TO CONSIDER 1. You are limited to health care coverage under only one STRS Ohio account (e.g., you cannot be covered as both a benefit recipient and a survivor of a benefit recipient). You are responsible for contacting STRS Ohio to determine from which account your monthly premium should be deducted. Also, 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. Guidelines determine which system is responsible for your coverage. Contact STRS Ohio for details. 2. If you change plan administrators, your medical deductible and out-of-pocket maximums will transfer to the new plan administrator only if you move between the Aetna Medicare Plan and a Medical Mutual plan. 3. If you are currently enrolled in a Medical Mutual plan, your medical deductible and out-of-pocket maximums will transfer if you remain enrolled with Medical Mutual. HOW TO SELECT A NEW PLAN To select a new health care plan, call STRS Ohio toll-free at 1-888-227-7877. You may select a new plan up to three months after your 65th birthday. The effective date of coverage under your new plan will be the first of the month following notification to STRS Ohio, if submitted by the 15th of the month. There will be no interruption in your health care coverage. If you re selecting the Aetna Medicare Plan, your enrollment request cannot be submitted to Aetna until STRS Ohio receives a copy of your Medicare Parts A & B or Part B-only card. 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. Please note that you re not officially enrolled in the plan until Medicare approves your enrollment request. Once enrolled, you must not enroll in another Medicare Advantage plan. If you do, your Aetna Medicare Plan coverage will be canceled. If you re selecting Paramount Elite, you ll also need to request an enrollment application from Paramount and return it to the plan. An enrollment application is required even if you had coverage through a Paramount plan prior to Medicare enrollment. You will not be enrolled in the Medicare HMO until Paramount receives and approves your application. Contact Paramount directly to request an application. If your Part B coverage is terminated and later reinstated, you must complete a new Paramount Medicare HMO enrollment application. If you re currently enrolled in a Paramount plan and you want to select a different plan, you ll also need to send a written request to STRS Ohio to terminate coverage. The letter must be signed by the benefit recipient and any other covered enrollees on the account. If you re enrolled in a HealthSpan plan, call STRS Ohio to select a new plan. HealthSpan is closed to new enrollments in 2015. This includes current HealthSpan enrollees who become eligible for Medicare or lose their Medicare coverage on or after Jan. 1, 2015. 28 www.strsoh.org

After You Enroll in Medicare This section covers important financial and coverage-related topics for new Medicare enrollees. PAYING YOUR MEDICARE PART B PREMIUMS 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 you receive a monthly Social Security, Railroad Retirement or Civil Service Retirement payment, your Medicare Part B premium will be automatically deducted from this payment. Otherwise, Medicare will send you a bill for your Part B premium every three months. Another payment option is to have your Part B premium automatically deducted through the Medicare Easy Pay plan. This is a free, electronic payment option offered by Medicare. Through the Medicare Easy Pay plan, Medicare automatically deducts the premium payment from your savings or checking account. To sign up for the Medicare Easy Pay plan, call Medicare toll-free at 1-800-633-4227. 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. Take action Sign up for the Medicare Easy Pay plan if your Part B premium is not automatically deducted from a federal retirement payment. UNDERSTANDING YOUR MEDICARE PART D PRESCRIPTION DRUG COVERAGE After you enroll in Medicare, the prescription drug coverage included in your STRS Ohio health care plan will be 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. Express Scripts administers the Medicare Part D plan for Aetna, Medical Mutual, AultCare and Paramount enrollees. HealthSpan administers the plan for its enrollees. 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 hospital/medical and prescription drug coverage will be canceled. If you decline coverage under the Medicare Part D plan included in your STRS Ohio health care plan, your STRS Ohio hospital/medical coverage will be canceled. IMPORTANT: Before making any changes to your Medicare Part D prescription drug plan coverage, call STRS Ohio to find out how your STRS Ohio health care coverage will be affected. If you have specific questions about your prescription drug coverage, please call your prescription drug plan administrator. 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. For example, if your monthly Part B premium would have been $120 if you had signed up during your initial enrollment period, every year you delay adds another $12 late enrollment penalty to your monthly cost. 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 late enrollment penalty if you go 63 days or more without Medicare Part D or creditable coverage. (Creditable coverage means prescription drug coverage that is as good as or better than the standard Medicare Part D prescription drug coverage.) CMS charges this penalty to STRS Ohio, and we make payment on your behalf. STRS Ohio subsequently deducts Part D late enrollment penalties for Aetna, Medical Mutual, AultCare and Paramount enrollees from their monthly STRS Ohio benefit payment. (HealthSpan bills its enrollees for the fees.) This additional cost will be charged for as long as you have Medicare Part D coverage. This penalty could increase if another 63-day lapse in creditable coverage occurs in the future. The cost of paying Medicare late enrollment penalties can add up quickly. To minimize your costs, enroll in Part B when eligible and maintain the Part D coverage included in your STRS Ohio plan to avoid incurring late enrollment penalties. MEDICARE SURCHARGES FOR HIGHER INCOMES Medicare Part B and Medicare 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 www.ssa.gov. STRS Ohio does not provide subsidies to offset surcharges. Any Part B and Part D sur charges will be deducted from your monthly Social Security, Railroad Retirement or Civil Service Retirement payment. If you do not receive such payments, you 2015 STRS Ohio Health Care Program Guide 29

will receive a bill from Medicare. You must pay all applicable surcharges to maintain your Medicare Part B and Part D coverage. Failure to pay sur charges will result in cancellation of your STRS Ohio health care coverage. Payments are made directly to Medi care, not to your plan administrator or STRS Ohio. PARTIAL MEDICARE PART B PREMIUM REIMBURSEMENT Service retirement and disability benefit recipients who are enrolled in Medicare Part B and provide proof of Medicare Part B enrollment may be eligible to receive partial reimbursement to offset the standard monthly premium charged by Medicare for Part B coverage. You must be enrolled in an STRS Ohio health care plan to receive partial premium reimbursement. If you re eligible to receive a Medicare Part B premium reimbursement through more than one Ohio public retirement system, specific guidelines apply. It s your responsibility to contact STRS Ohio to determine which system is responsible for providing your reimbursement; you may not receive more than one Part B premium reimbursement. You must also provide STRS Ohio with proof of your Medicare Part B enrollment. If STRS Ohio receives documentation of your Medicare Part B enrollment by the 15th of the month, partial reimbursement of the benefit recipient s future standard Medicare Part B premium cost will begin the first of the following month. If documentation is received after the 15th of the month, partial premium reimbursement will begin the first of the second following month. Partial reimbursement is not retroactive. For information about Medicare Part B partial premium reimbursement guidelines, call STRS Ohio s Member Services Center toll-free at 1-888-227-7877. Call Medicare directly at 1-800-633-4227 to learn what amount you will pay for your Medicare Part B coverage. MEDICARE PART B-COVERED DRUGS AND SUPPLIES Medicare Part B covers a limited number of drugs/supplies as determined by the Centers for Medicare & Medicaid Services. Following are examples of drugs/supplies covered by Medicare Part B: Diabetic supplies such as blood sugar monitors, test strips, lancets and lancet devices, and blood sugar control solutions. Injections administered in a doctor s office. Certain oral cancer drugs. Drugs used with some types of durable medical equipment, such as a nebulizer or external infusion pump. Under limited circumstances, certain drugs administered in a hospital outpatient setting. If you are enrolled in a plan administered by Aetna or Medical Mutual, the STRS Ohio Health Care Program will pay your portion of costs for select Medicare Part B-covered drugs/supplies that are coordinated with Medicare. When a claim for a covered drug or supply is coordinated with Medicare Part B, the claim is submitted to Medicare first for primary payment and then to the medical plan for secondary payment, leaving you with no copayment for drugs/supplies dispensed by a participating Medicare retail pharmacy. 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, your prescription drug plan administrator will send you a letter informing you about the program. If you receive a letter from your prescription drug plan admin istrator, 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 toll-free at 1-800-633-4227 for more information or to request an application. CONFUSED? WE CAN HELP Understanding Medicare and its requirements can sometimes be confusing. That s why we offer the webinar, Medicare Enrollment and STRS Ohio. We ll guide you through the Medicare enrollment process, provide information specific to new Medicare enrollees and address any questions you submit during the live presentation. To register for this free webinar, visit the Counseling & Seminars section of our website at www.strsoh.org. 30 www.strsoh.org

Section 4: Plans and Premiums With Medicare If you re eligible for Medicare (Parts A & B, Part A-only or Part B-only), this section is for you. Inside you ll find the coverage features of the plans available to enrollees with Medicare. You ll also find monthly premiums for benefit recipients based on years of service, as well as premiums for spouses, children and sponsored dependents with Medicare. Review the personalized list of plan options you may have received with this publication to find out the specific plans available to you and your family. (If you did not receive a personalized list, please call STRS Ohio s Member Services Center for your plan options.) Keep in mind, you and your family members 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. Please review this section for the features and premiums of the plans for enrollees with Medicare. If you have family members on your account without Medicare, also review Section 2 (Page 15) for features and premiums of the plan options for non-medicare enrollees. Be aware coverage features under the same plan could differ based on Medicare status. Premiums also differ. If you have specific questions about plan features, please contact the plan administrator directly (Page 47). If you have questions about monthly premiums, call STRS Ohio. PRESCRIPTION DRUG REFERENCE GUIDE Express Scripts administers the Medicare Part D prescription drug plan for the Aetna, Medical Mutual, AultCare and Paramount plans described in this section. When reviewing prescription drug coverage for these plans, it s important to understand the following key terms. KEY TERM Annual deductible Generic Covered brand-name Specialty Over-the-counter PPI DESCRIPTION The amount an enrollee must pay for drugs classified as covered brand-name, including specialty, before the plan begins paying a portion of the costs for these drugs. Generic drug costs do not apply to the deductible. Generic medications available for the lowest copayment. Brand-name medications available for a copayment after the deductible is met. Specialty medications available for a 10% coinsurance up to a maximum cost of $500 per fill (after the deductible is met if applicable). These highcost medications typically include infused, injectable and oral drugs that are used to treat chronic and life-threatening diseases; are often difficult to administer; may cause adverse reactions; may require temperature control or other special handling; and/or may have restrictions as determined by the Food and Drug Administration. Over-the-counter proton pump inhibitor (PPI) medication, such as Prilosec OTC, which is available for the generic copayment with a prescription. 2015 STRS Ohio Health Care Program Guide 31

Plan Features for 2015 With Medicare You may be eligible for these plans if you are enrolled in Medicare. If you have Part A-only, your only option is Medical Mutual Basic. If you live outside the United States, you may be eligible for Medical Mutual Plus. Contact STRS Ohio for details. Note: Sponsored dependents with Medicare Part B-only may enroll only in the Aetna Medicare Plan or Medical Mutual Basic. PLAN FEATURES Aetna Medicare Plan 1 (Medicare Advantage PPO) In-network (PPO) or Extended Service Area (ESA PPO) Out-of-network (PPO) Medical Mutual Basic (Indemnity or PPO) In-network and Indemnity 2,4 Out-of-network 2,4 Enrollee Eligibility Available in any location in the United States Available in any location Annual Deductible per Enrollee 3 $300 $500 $2,250 $4,500 Out-of-Pocket Maximum 3 (Excludes prescription drug costs. Amounts included are noted for each plan.) $1,500 per enrollee (includes deductible, copayments and coinsurance) $2,000 per enrollee (includes deductible, copayments and coinsurance) $3,700 per enrollee (includes coinsurance and primary care physician copayments) Lifetime Benefits Maximum per Enrollee Unlimited Unlimited Health Provider Access Use network provider (PPO); use any provider that accepts Medicare (ESA PPO) PHYSICIAN, HOSPITAL, SKILLED NURSING AND HOME HEALTH CARE Primary Care Physician Office Visit Specialist Physician Office Visit Enrollee pays $15 (no deductible) Enrollee pays $25 (no deductible) Use any provider that accepts Medicare Enrollee pays $40 after deductible Enrollee pays $50 after deductible Use network provider (PPO); use any covered provider (indemnity) Enrollee pays $20 per visit for first two visits per year (no deductible); 20% thereafter (after deductible) $7,400 per enrollee (includes coinsurance) Use any covered provider Enrollee pays 50% after deductible Enrollee pays 20% Enrollee pays 50% Urgent Care Enrollee pays $35 (no deductible) Enrollee pays $35 Hospital Inpatient Services Enrollee pays 4% Enrollee pays 6% Enrollee pays 20% 5 Enrollee pays 50% 5 Hospital Charges for Outpatient Surgery and Preadmission Testing Emergency Room Care Enrollee pays 4% Enrollee pays 6% Enrollee pays 20% Enrollee pays $65 (no deductible); waived if admitted Enrollee pays $150; waived if admitted Skilled Nursing Facility (Benefit period varies by plan administrator.) Enrollee pays 0% for up to 100 days per benefit period after deductible; after 100 days, enrollee pays 100% Enrollee pays 20% (90 days per benefit period); after 90 days, enrollee pays 100% Enrollee pays 50% (90 days per benefit period); after 90 days, enrollee pays 100% Inpatient Mental Health Enrollee pays 4% Enrollee pays 6% Home Health Care Enrollee pays 0% after deductible; no visit limit Enrollee pays 20%; no limit on days Enrollee pays 50%; no limit on days Enrollee pays 20%; no visit limit 1 If providers do not accept Medicare assignment or charge in excess of Medicare payments, the enrollee is responsible for the excess charges. 2 Indemnity and out-of-network payments are based on allowed/noncontracting provider amounts for medically necessary services as established by the health care plan administrator. If nonparticipating 1 providers or providers that do not accept Medicare assignment charge in excess of these amounts, the enrollee is responsible for the excess charges. 3 Annual deductible must be met before plan begins making payments, unless otherwise noted. For the Aetna Medicare Plan, emergency room and urgent care copayments apply to the deductible. In-network and out-ofnetwork accumulations are separate, except for the Aetna Medicare Plan. 4 Benefits are payable after Medicare payments. 5 Enrollees with Medicare Part B-only must use in-network providers for hospital services to receive maximum claims payment. 32 www.strsoh.org

Plan Features for 2015 With Medicare AultCare PPO In-network 4 Out-of-network 2,4 HealthSpan Medicare Plus (HMO) Closed to new enrollments in 2015 Paramount Elite HMO (Medicare Advantage) Available in select northeastern Ohio area ZIP codes Available in select Cleveland, Ohio, area ZIP codes Available in select northwestern Ohio and southern Michigan area ZIP codes $500 $1,000 No deductible No deductible $1,500 per enrollee (includes coinsurance) $3,000 per enrollee (includes coinsurance) $2,500 per enrollee (includes copayments) $1,500 per enrollee (includes copayments) Unlimited Unlimited Unlimited Use network provider Use any covered provider Use HMO network provider Use HMO network provider Enrollee pays 20% Enrollee pays 50% Enrollee pays $15 Enrollee pays $15 Enrollee pays 20% Enrollee pays 50% Enrollee pays $15 Enrollee pays $20 Enrollee pays $35 Enrollee pays $35 Enrollee pays $25 Enrollee pays 20% 5 Enrollee pays 50% 5 Enrollee pays 0% Enrollee pays 0% Enrollee pays 20% Enrollee pays 50% Enrollee pays $15 Enrollee pays 0% Enrollee pays $65; waived if admitted Enrollee pays $65; waived if admitted Enrollee pays $65; waived if admitted Enrollee pays 20% (90 days per benefit period); after 90 days, enrollee pays 100% Enrollee pays 50% (90 days per benefit period); after 90 days, enrollee pays 100% Enrollee pays 0% for up to 100 days per benefit period; after 100 days, enrollee pays 100% Enrollee pays 0% per benefit period for days 1 20; $75 for days 21 100; after 100 days, enrollee pays 100% Enrollee pays 20%; no limit on days Enrollee pays 50%; no limit on days Enrollee pays 0%; no limit on days Enrollee pays 0%; no limit on days Enrollee pays 20%; no visit limit Enrollee pays 50%; no visit limit Enrollee pays 0%; no visit limit Enrollee pays 0%; no visit limit 2015 STRS Ohio Health Care Program Guide 33

Plan Features for 2015 With Medicare You may be eligible for these plans if you are enrolled in Medicare. If you have Part A-only, your only option is Medical Mutual Basic. If you live outside the United States, you may be eligible for Medical Mutual Plus. Contact STRS Ohio for details. Note: Sponsored dependents with Medicare Part B-only may enroll only in the Aetna Medicare Plan or Medical Mutual Basic. PREVENTIVE SERVICES Services such as a routine physical exam, bone density screening, mammogram, routine prostatic specific antigen (PSA), colorectal cancer screening, Pap smear and immunizations/inoculations may be covered. Contact the plan administrator for details. OUTPATIENT SERVICES Aetna Medicare Plan 1 (Medicare Advantage PPO) In-network (PPO) or Extended Service Area (ESA PPO) Out-of-network (PPO) Enrollee pays 0% (no deductible); some limitations may apply Medical Mutual Basic (Indemnity or PPO) In-network and Indemnity 2,3 Out-of-network 2,3 Enrollee pays 0% (no deductible); limit one per calendar year (colorectal cancer screening limit one per 24 months if high risk or one per 10 years if not high risk) Diagnostic X-ray and Lab Testing Enrollee pays 4% for diagnostic X-ray after deductible; 0% for lab testing (no deductible) Enrollee pays 6% for diagnostic X-ray after deductible; 0% for lab testing after deductible Enrollee pays 20% Outpatient Mental Health Enrollee pays $25 (no deductible); no visit limit Enrollee pays $50 after deductible; no visit limit Enrollee pays 20%; no visit limit ADDITIONAL SERVICES Dental Care No coverage No coverage Vision Care Enrollee pays 0% for annual eye exam; eyewear discounts available at participating providers No coverage 1 If providers do not accept Medicare assignment or charge in excess of Medicare payments, the enrollee is responsible for the excess charges. 2 Indemnity and out-of-network payments are based on allowed/noncontracting provider amounts for medically necessary services as established by the health care plan 1 administrator. If nonparticipating providers or providers that do not accept Medicare assignment charge in excess of these amounts, the enrollee is responsible for the excess charges. 3 Benefits are payable after Medicare payments. 34 www.strsoh.org

Plan Features for 2015 With Medicare AultCare PPO In-network 3 Out-of-network 2,3 HealthSpan Medicare Plus (HMO) Closed to new enrollments in 2015 Paramount Elite HMO (Medicare Advantage) Enrollee pays 0% (no deductible); limited designated services; frequency/age/gender limitations apply Enrollee pays 0%; limited designated services; frequency/age/gender limitations apply Enrollee pays 0%; limited designated services; frequency/age/gender limitations apply Enrollee pays 20% Enrollee pays 50% Enrollee pays 0% Enrollee pays 0% Enrollee pays 20%; no visit limit Enrollee pays 50%; no visit limit Enrollee pays $15; no visit limit Enrollee pays $20; no visit limit No coverage No coverage No coverage No coverage Enrollee pays $15 for annual eye exam at EyeMed Enrollee pays $20 for annual eye exam at participating providers 2015 STRS Ohio Health Care Program Guide 35

Plan Features for 2015 With Medicare You may be eligible for these plans if you are enrolled in Medicare. If you have Part A-only, your only option is Medical Mutual Basic. If you live outside the United States, you may be eligible for Medical Mutual Plus. Contact STRS Ohio for details. Note: Sponsored dependents with Medicare Part B-only may enroll only in the Aetna Medicare Plan or Medical Mutual Basic. MEDICARE PART D PRESCRIPTION DRUG COVERAGE Aetna Medicare Plan (Medicare Advantage PPO) Medical Mutual Basic (Indemnity or PPO) Retail Network Provider Express Scripts Express Scripts Annual Brand-name Deductible per Enrollee (Generic drug costs do not apply to deductible.) Standard (Network) Retail/Nursing Home Pharmacy Copayments/Coinsurance per 31-day Supply Maximum Day Supply $200 for covered brand-name drugs, including specialty Generic: $10 (includes over-the-counter PPI with prescription) Covered brand-name: $30 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Out-of-network pharmacies and pharmacies outside the U.S. and Puerto Rico: Reimbursed the amount STRS Ohio would have been charged at a standard (network) pharmacy, less copayment Retail: 90 days; Mail: 90 days $200 for covered brand-name drugs, including specialty Generic: $10 (includes over-the-counter PPI with prescription) Covered brand-name: $30 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Out-of-network pharmacies and pharmacies outside the U.S. and Puerto Rico: Reimbursed the amount STRS Ohio would have been charged at a standard (network) pharmacy, less copayment Retail: 90 days; Mail: 90 days Home Delivery Provider Express Scripts Express Scripts Home Delivery Copayments/Coinsurance Low-Cost Generic Drug Program medications: $9 Generic: $25 (includes over-the-counter PPI with prescription) Covered brand-name: $75 after deductible is met Diabetic medications: No deductible; Generic: $12.50; Covered brand-name: $37.50 If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Low-Cost Generic Drug Program medications: $9 Generic: $25 (includes over-the-counter PPI with prescription) Covered brand-name: $75 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Maximum Annual Expense per Enrollee If an enrollee pays a total of $4,700 out of pocket in copayments/coinsurance/deductible for generic, covered brand-name and specialty medications, that enrollee pays nothing for covered medications for the remainder of the year. If an enrollee pays a total of $4,700 out of pocket in copayments/coinsurance/deductible for generic, covered brand-name and specialty medications, that enrollee pays nothing for covered medications for the remainder of the year. 36 www.strsoh.org

Plan Features for 2015 With Medicare AultCare PPO HealthSpan Medicare Plus (HMO) Closed to new enrollments in 2015 Paramount Elite HMO (Medicare Advantage) Express Scripts $200 for covered brand-name drugs, including specialty Generic: $10 (includes over-the-counter PPI with prescription) Covered brand-name: $30 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Out-of-network pharmacies and pharmacies outside the U.S. and Puerto Rico: Reimbursed the amount STRS Ohio would have been charged at a standard (network) pharmacy, less copayment Retail: 90 days; Mail: 90 days HealthSpan Medical Facilities and other network pharmacies Formulary generic: $15 No deductible Formulary brand-name: $30 Services must be received by pharmacies participating in the HMO network. Retail: 90 days; Mail: 90 days Express Scripts $200 for covered brand-name drugs, including specialty Generic: $10 (includes over-the-counter PPI with prescription) Covered brand-name: $30 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Out-of-network pharmacies and pharmacies outside the U.S. and Puerto Rico: Reimbursed the amount STRS Ohio would have been charged at a standard (network) pharmacy, less copayment Retail: 90 days; Mail: 90 days Express Scripts HealthSpan Mail Order Express Scripts Low-Cost Generic Drug Program medications: $9 Generic: $25 (includes over-the-counter PPI with prescription) Covered brand-name: $75 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) Formulary generic: $15 Formulary brand-name: $30 Low-Cost Generic Drug Program medications: $9 Generic: $25 (includes over-the-counter PPI with prescription) Covered brand-name: $75 after deductible is met If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug. Specialty: 10% up to a maximum of $500 per fill (after deductible is met if applicable) If an enrollee pays a total of $4,700 out of pocket in copayments/coinsurance/deductible for generic, covered brand-name and specialty medications, that enrollee pays nothing for covered medications for the remainder of the year. No limit If an enrollee pays a total of $4,700 out of pocket in copayments/coinsurance/deductible for generic, covered brand-name and specialty medications, that enrollee pays nothing for covered medications for the remainder of the year. 2015 STRS Ohio Health Care Program Guide 37

Monthly Premiums for 2015 With Medicare You may be eligible for these plans if you are enrolled in Medicare. If you have Part A-only, your only option is Medical Mutual Basic. If you live outside the United States, you may be eligible for Medical Mutual Plus. Contact STRS Ohio for details. Note: Sponsored dependents with Medicare Part B-only may enroll only in the Aetna Medicare Plan or Medical Mutual Basic. ELIGIBILITY GROUP Aetna Medicare Plan (Medicare Advantage PPO) TOTAL COST: $345 Available in any location in the United States Medical Mutual Basic (Indemnity or PPO) TOTAL COST: $258 Available in any location BENEFIT RECIPIENT YEARS OF SERVICE STRS OHIO PAYS YOU PAY STRS OHIO PAYS YOU PAY 30+ 228 117 170 88 29 220 125 165 93 28 213 132 159 99 27 205 140 153 105 26 197 148 148 110 25 190 155 142 116 24 182 163 136 122 23 175 170 131 127 22 167 178 125 133 21 159 186 119 139 20 152 193 114 144 19 144 201 108 150 18 137 208 102 156 17 129 216 96 162 16 121 224 91 167 15 114 231 85 173 Less Than 15 Years of Service 1 0 345 0 258 Spouse 0 345 0 258 Children 0 345 0 258 Sponsored Dependents 0 345 0 258 1 Members who retired before Jan. 1, 2004, with less than 15 years of service credit have access to the STRS Ohio Health Care Program but pay the full cost of their premium. Members who retire on or after Jan. 1, 2004, and before Aug. 1, 2023, must have at least 15 years of qualifying service credit to access coverage. Members who retire on or after Aug. 1, 2023, must have at least 20 years of qualifying service credit to access coverage. 38 www.strsoh.org

Monthly Premiums for 2015 With Medicare AultCare PPO TOTAL COST: $387 Available in select northeastern Ohio area ZIP codes HealthSpan Medicare Plus (HMO) Closed to new enrollments in 2015 TOTAL COST: $381 Available in select Cleveland, Ohio, area ZIP codes Paramount Elite HMO (Medicare Advantage) TOTAL COST: $375 Available in select northwestern Ohio and southern Michigan area ZIP codes STRS OHIO PAYS YOU PAY STRS OHIO PAYS YOU PAY STRS OHIO PAYS YOU PAY 228 159 228 153 228 147 220 167 220 161 220 155 213 174 213 168 213 162 205 182 205 176 205 170 197 190 197 184 197 178 190 197 190 191 190 185 182 205 182 199 182 193 175 212 175 206 175 200 167 220 167 214 167 208 159 228 159 222 159 216 152 235 152 229 152 223 144 243 144 237 144 231 137 250 137 244 137 238 129 258 129 252 129 246 121 266 121 260 121 254 114 273 114 267 114 261 0 387 0 381 0 375 0 387 0 381 0 375 0 387 0 381 0 375 0 387 0 381 0 375 2015 STRS Ohio Health Care Program Guide 39

Section 5: Additional Information About Our Program Quality Standards To be offered as an STRS Ohio health care plan option, a plan must meet the following quality standards: 1. Adhere to performance standards related to enrollees access to medical providers, claims payment accuracy, processing time and the quality of service provided by the plan s customer service department. 2. Allow medical providers to talk with plan enrollees about reasonable care options, including those not covered by the plan, and about how services are reimbursed. 3. Support surveys of enrollees to assess satisfaction with the plan. Use survey results to improve customer service and the quality of health care provided. 4. Provide a coverage-appeal process for enrollees that includes, as a final level of appeal, deliberation by an independent health care professional(s). 5. Show a commitment to improving the health of the plan s older adult enrollees. 6. Have business associate agreements that require safeguarding protected health information and are in compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations. In addition, HMO and PPO plans are encouraged to have or be pursuing accreditation by the National Committee for Quality Assurance (NCQA) or the American Accreditation Health Care Commission (URAC), or have programs in place to ensure the delivery of quality care to enrollees. NCQA and URAC use nationally recognized standards to measure plan performance in the areas of quality of care, access to care, utilization management and consumer satisfaction. Release of Information and Confidentiality Statement By accepting coverage under an STRS Ohio health care plan, all enrollees, including any enrolled dependents, shall: 1. Furnish STRS Ohio or its designees any and all information STRS Ohio may reasonably require pertaining to health care coverage and the operations of its health care plan. 2. Enroll in Medicare Part A (if applicable) and Medicare Part B at age 65 or whenever eligible, and provide STRS Ohio with a copy of your Medicare card. 3. Authorize and direct any physician or other health care provider, health plan, pharmacy, pharmacy benefits manager or program administrator to furnish STRS Ohio or its designees any and all information and records (or copies of records) relating to care or services provided directly to the enrollee or services provided indirectly to the enrollee related to the administration of the health care program. Any and all records pertaining to health care services that STRS Ohio in its sole discretion determines are necessary 40 www.strsoh.org

to implement and administer the terms of health care coverage and/or are necessary for the appropriate review and management of its health care plans may be used by and released to STRS Ohio and its designees, or used by and released among STRS Ohio designees. All individually identifiable information and records pertaining to health care coverage and services are considered by STRS Ohio to be confidential and will not be given, sold or transferred to any person or organization not designated by STRS Ohio. STRS Ohio designees include but are not limited to disease management and wellness program plan administrators, data warehouses, and actuarial and consulting firms that STRS Ohio has contracted with and holds business associates agreements. Affordable Care Act and Your STRS Ohio Health Care Plan The federal Affordable Care Act requires nearly all Americans to have health insurance. If you do not have coverage, you will pay a penalty. All STRS Ohio health care plans meet the Affordable Care Act s minimum essential requirement, so you are considered covered and should not be assessed a fee. If you do not want coverage through STRS Ohio, other options may be available. Some options may include coverage through an employer, COBRA, other retirement plan, private health policy or public program such as Medicare, Medicaid or the Veterans Health Administration. Individuals who are not eligible for Medicare can also purchase coverage through the Health Insurance Marketplace. The Marketplace offers a convenient way to find and compare private health policies. A tax credit lowering your monthly premium may also be available. For information about enrollment options through the Health Insurance Marketplace, visit www.healthcare.gov. Notice of Privacy Practices This notice describes how medical information about you can be used and disclosed and how you can obtain access to this information. This privacy notice applies to enrollees in the State Teachers Retirement System of Ohio ( STRS Ohio ) self-funded health care plans and the self-funded prescription drug program (the Plan ). The Plan is required by law to: maintain the privacy of protected health information (as defined below, the PHI ); provide individuals with notice of the Plan s legal duties and privacy practices with respect to PHI; abide by the terms of such privacy notice currently in effect; and notify individuals following a breach of unsecured PHI. STRS Ohio s philosophy on member privacy STRS Ohio is committed to member service and privacy. As part of your participation in the Plan, STRS Ohio and its business partners, who we use to administer and deliver health care coverage, receive enrollee PHI through the operation and administration of the Plan. PHI means any information, transmitted or maintained in any form or medium, which the Plan creates or receives that relates to your physical or mental health, the delivery of health care services to you or payment for health care services and that identifies you or could be used to identify you. All PHI and other Plan records are maintained in compliance with state and federal laws, as well as our own privacy policies. If you have questions or want further information about this privacy notice, please contact the HIPAA contact person or the Privacy Officer by mail addressed to the STRS Ohio Health Care Program, 275 E. Broad St., Columbus, OH 43215-3771 or by phone toll-free at 1-888-227-7877. The policies and procedures outlined in this privacy notice originally became effective April 14, 2003. How the Plan uses and discloses your PHI To provide your health care and prescription drug coverage and administer the Plan, the Plan needs access to some of your PHI. In administering your health care and prescription drug coverage, the Plan may use and disclose your PHI in the various ways described below. Not every possible use or disclosure in a category is listed; however, all of the ways the Plan is permitted to use and disclose information fall into one of these categories. A. Uses and Disclosures of Your PHI for Treatment, Payment and Health Care Operations The law permits the Plan to use and disclose your PHI without your authorization as follows: (i) (ii) Treatment To health care providers who are involved in your care, for purposes such as verifying eligibility, Medicare status and effective date of coverage, in order to facilitate treatment and care. For example, the Plan may make disclosures to physicians, nurses and other health care professionals involved in your care. To Obtain Payment To STRS Ohio business partners that administer the Plan, a governmental payer or other responsible third party for the purpose of billing or collecting payment for the medical treatment or prescription drugs you have received or to provide your health care provider with necessary eligibility information. For example, the Plan 2015 STRS Ohio Health Care Program Guide 41

42 (iii) www.strsoh.org may need to share your health information with a provider to verify the delivery of services or items that you received so that the Plan s claims administrator can pay the provider or reimburse you for the cost of the services or items. Health Care Operations The Plan may use and disclose PHI for health care operations, which include, but are not limited to, use and disclosures: (1) by Plan health care representatives who disclose the minimum amount of PHI to STRS Ohio personnel who need to know that information to administer the Plan; (2) by Plan health care representatives who act as a liaison between the enrollee and various health plan administrators; (3) for quality assessment of the Plan through distribution and analysis of enrollee satisfaction surveys; (4) in connection with the performance of disease management functions; and (5) for general administrative activities, including customer service, cost-management functions, data management, communications, claims and operational audits and legal services. In addition, the Plan may send you information based on your own health information to tell you about possible treatment options or alternatives or other health-related benefits or services that may be of interest to you. The Plan may also combine your health information with that of other enrollees in the Plan to evaluate the coverage provided by the Plan and to evaluate the quality of care the Plan enrollees receive as a whole. B. Other Uses and Disclosures of Your PHI for Which Your Authorization Is Not Necessary In limited instances, the law allows the Plan to use and disclose your PHI without your authorization in the following situations: (i) (ii) (iii) (iv) Family The Plan may disclose your PHI to a family member who is directly involved with your medical care or with the payment related to your care. The Plan may request that your family members verify their own identity and otherwise demonstrate that they are acting on your behalf. Disaster Relief Purposes For the limited circumstances of disaster relief efforts to a public or private disaster relief entity and for purposes of notifying your family of your condition and location. Required by Law For compliance with federal, state or local law, which disclosures will be limited to the minimum amount of information necessary to comply with applicable legal requirements. Public Health Activities The Plan may disclose PHI about you for public health activities including activities related to preventing or (v) (vi) (vii) (viii) (ix) (x) controlling disease, or, when required by law, to notify public authorities concerning cases of abuse or neglect. Victims of Abuse, Neglect or Domestic Violence To a government authority, including a social service or protective agency, if the Plan reasonably believes you to be a victim of abuse, neglect or domestic violence. Health Oversight Activities To a health oversight agency for oversight activities authorized by law, including claims and operational audits; civil, administrative or criminal investigations; inspections; or licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws. Judicial and Administrative Proceedings If you are involved in a lawsuit or dispute, the Plan may disclose PHI about you in response to a court or administrative order. The Plan may also disclose PHI about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. Law Enforcement Purposes If requested by a law enforcement official for limited law enforcement purposes. For instance, pursuant to laws that require the reporting of wounds or other physical injuries; pursuant to a court order, court-ordered warrant, subpoena or summons; in response to a law enforcement official s request for the purpose of identifying or locating a suspect, fugitive, material witness or missing person; in response to a law enforcement official s request for information about an individual who is suspected to be a victim of a crime; to a law enforcement official about an individual who has died if the Plan has a suspicion the death may have resulted from criminal conduct; or to law enforcement officials if the Plan believes in good faith criminal conduct occurred on its premises. Uses and Disclosures About Decedents To a coroner or medical examiner for the purpose of identifying a deceased person, determining the cause of death or other duties as authorized by law. The Plan may also release medical information to funeral directors as necessary to carry out their duties. Uses and Disclosures for Cadaveric Organ, Eye or Tissue Donation Purposes To organ procurement organizations or other entities engaged in the procurement, banking or transplantation of cadaveric organs, eyes or tissue

(xi) (xii) (xiii) (xiv) (xv) (xvi) (xvii) for the purpose of facilitating organ, eye or tissue donation and transplantation. Uses and Disclosures to Avert a Serious Threat to Health or Safety The Plan may use or disclose medical information about you if it reasonably believes, in good faith, that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person. Specialized Government Functions For specialized government functions allowed by law, such as for national security and intelligence purposes; disclosure to authorized federal officials for the provision of protective services to the President or other authorized persons; disclosure of health information about an inmate or other individual to a correctional institution or a law enforcement official. Workers Compensation For compliance with laws relating to workers compensation or other similar programs that provide benefits for workrelated injuries or illness. Business Associates The Plan contracts with parties who provide services necessary for operation of the Plan. For example, the Plan is assisted in its operations by third-party administrators. These persons who assist the Plan are called business associates. At times, the Plan may disclose PHI to its business associates so they can provide services to the Plan. The Plan will require that any business associates who receive PHI safeguard the privacy of that information. Military and Veterans If you are a member of the armed forces, the Plan may release PHI about you as required by military command authorities. Underwriting The Plan may use or disclose your PHI for underwriting purposes, but the Plan is prohibited from using or disclosing PHI that is genetic information for underwriting purposes. Underwriting purposes include, for example, the computation of premium or contribution amounts under the Plan and the application of any preexisting condition exclusion under the Plan, but do not include determinations of medical appropriateness where an individual seeks a benefit under the Plan. Notifying the sponsor of the Plan The Plan may disclose your PHI to STRS Ohio, the sponsor of the Plan. (xviii) Disclosures to the Secretary of the U.S. Department of Health and Human Services The Plan is required to disclose your PHI to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining the Plan s compliance with the Privacy Rule. C. Other Uses and Disclosures of Your PHI Requiring Your Written Authorization In all situations other than those described previously, we will ask for your written authorization before using or disclosing your PHI. If you have given us authorization, you may revoke it in writing at any time, unless the Plan has already disclosed the information. D. More Stringent Ohio Laws Certain provisions of Ohio law may now, or in the future, impose greater restrictions on uses and/or disclosures of PHI or otherwise be more stringent than federal rules protecting the privacy of PHI. If such provisions of Ohio law apply to a use or disclosure of PHI or under other circumstances described in this privacy notice, the Plan must comply with those provisions. Your legal rights Federal privacy regulations give enrollees the right to make certain requests regarding their health information. You may ask the Plan to: Restrict the uses or disclosures of your PHI to carry out treatment, payment and health care operations. You also have the right to request a limit on your PHI that the Plan discloses about you to someone who is involved in your care, such as a family member or friend. For example, you could ask that the Plan not disclose or use information about a certain medical treatment you received. IMPORTANT NOTE: The Plan is not required to agree to your request, unless the health information pertains solely to a health care item or service for which you, and not the Plan, have paid in full. To request restrictions on the use or disclosure of your PHI, mail your request to: Privacy Officer, STRS Ohio Health Care Program, 275 E. Broad St., Columbus, OH 43215-3771. In your request, please provide: What PHI you want to limit; Whether you want to limit the Plan s use, disclosure or both; and To whom you want the disclosure limits to apply (for example, a family member). Communicate with you about your PHI in a certain way or at a certain location. For example, you can ask that the Plan contact you only at a certain phone number or mailing address. To request confidential communications, mail your request to: Privacy Officer, STRS Ohio Health Care Program, 275 E. Broad St., Columbus, OH 43215-3771. The Plan will accommodate all reasonable requests. Your request must specify how or where you would like to be contacted. After the Plan receives your request, the information may be forwarded to third- 2015 STRS Ohio Health Care Program Guide 43

party administrators of the Plan. As a result, additional reasonable information may be required from you by the third-party administrator to process your request. Inspect and copy your PHI that may be used to make decisions about payment and your care. To inspect and copy your PHI, mail your request to: Privacy Officer, STRS Ohio Health Care Program, 275 E. Broad St., Columbus, OH 43215-3771. If you request a copy of the information, the Plan may charge a reasonable fee for the costs of preparing a summary or explanation of your PHI or for the costs of copying, mailing or other supplies associated with your request. If you agree in advance, the Plan may instead provide you with a summary or explanation of your PHI. Under Ohio and federal law, the Plan may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your PHI, in many instances you may request that the denial be reviewed. Request an amendment to your PHI if you think the information is incomplete or incorrect for as long as the information is maintained by the Plan. To request an amendment, mail your request to: Privacy Officer, STRS Ohio Health Care Program, 275 E. Broad St., Columbus, OH 43215-3771. If the Plan rejects your amendment for any reason allowable under state or federal law, STRS Ohio will permit you to submit a written statement of disagreement to be kept with your PHI. The Plan may reasonably limit the length of such statement of disagreement. Provide a listing of any disclosures of your PHI in the six years prior to the date on which the listing is requested. You have the right to request an accounting of disclosures. This is a list of certain disclosures of PHI the Plan has made about you. The Plan is not required to account for certain disclosures such as those made for the purposes of treatment, payment or health care operations, pursuant to a prior authorization by you or for certain law enforcement purposes. You may obtain a list or accounting of disclosures of PHI by submitting a written request to: Privacy Officer, STRS Ohio Health Care Program, 275 E. Broad St., Columbus, OH 43215-3771. Your request must state the time period for which you desire the accounting, which may not be longer than six (6) years and may not include dates before April 14, 2003. Your request should also specify the format of response you prefer (i.e., on paper or electronically). The first list of disclosures you request within a 12-month period is free. For additional lists within the same 12-month period, the Plan may charge you for the costs of providing the list. The Plan will notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Obtain a paper copy of this privacy notice. Even if you have agreed to receive this privacy notice electronically, you may nonetheless obtain a paper copy of this privacy notice by submitting a written request to: Privacy Officer, STRS Ohio Health Care Program, 275 E. Broad St., Columbus, OH 43215-3771. This privacy notice is subject to change The Plan may change the terms of this privacy notice and its privacy practices at any time. If such a change is made, the new terms and policies will be effective for all of the information that the Plan already has about you, as well as any information that it may receive or hold in the future. STRS Ohio will post a copy of the current privacy notice on its website at www.strsoh.org and at the office located at 275 E. Broad St., Columbus, OH 43215-3771. You may request a paper copy of this privacy notice by submitting a written request to Privacy Officer, STRS Ohio Health Care Program, 275 E. Broad St., Columbus, OH 43215-3771 or by calling STRS Ohio s Member Services Center toll-free at 1-888-227-7877. Please note that STRS Ohio does not destroy your PHI when you terminate coverage with the Plan. It may be necessary to use and disclose this information for the purposes described in this privacy notice even after your coverage terminates, although policies and procedures will remain in place to protect you against inappropriate use or disclosure. Complaints If you believe your privacy rights have been violated, you may file a complaint with the STRS Ohio Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with the Plan, mail your comments to: Privacy Officer, STRS Ohio Health Care Program, 275 E. Broad St., Columbus, OH 43215-3771. To file a complaint with the Secretary of the U.S. Department of Health and Human Services, contact the Office of Civil Rights, U.S. Department of Health and Human Services, 233 N. Michigan Ave., Suite 240, Chicago, IL 60601; (312) 886-2359; www.hhs.gov/ocr. You will not be penalized in any way for filing a complaint. 44 www.strsoh.org

General Notice of COBRA Continuation Coverage Rights This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under an STRS Ohio health plan (the Plan). When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. COBRA continuation coverage can become available to qualified beneficiaries (spouses and children) who lose health coverage under the Plan due to certain events. For additional information about your rights and obligations under the Plan and under federal law, please contact your COBRA Administrator. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a qualifying event. Specific qualifying events are listed below. After a qualifying event, COBRA continuation coverage must be offered to each person who is a qualified beneficiary. A covered spouse or dependent child of a member could become a qualified beneficiary if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage are required to pay for the coverage. If you are a covered spouse, you may become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: (1) your spouse dies; or (2) you become divorced or legally separated from your spouse. If you are a covered child (biological or adopted), you may become a qualified beneficiary if you lose coverage under the Plan because of the following qualifying events: (1) your parent dies; (2) your parents become divorced or legally separated; or (3) you are no longer eligible for coverage under the Plan as a dependent child. Notifying STRS Ohio of COBRA qualifying event The Plan will offer COBRA continuation coverage to qualified beneficiaries only after STRS Ohio has been notified that a qualifying event has occurred. It is the beneficiary s responsibility to notify STRS Ohio within 60 days of the occurrence of the qualifying event. The 60-day notification period begins the date the qualifying event occurs. After the beneficiary notifies STRS Ohio, the COBRA Administrator will be informed that a qualifying event has occurred. The COBRA Administrator will then send the beneficiary an informational packet within 30 days after receiving notification from STRS Ohio. How is COBRA coverage provided? Once the COBRA Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered members may elect COBRA continuation coverage on behalf of their spouse, and parents may elect COBRA continuation coverage on behalf of their children. How long does COBRA coverage last? COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the member, divorce or legal separation, or a child losing eligibility as a dependent child, COBRA continuation coverage may last for up to a total of 36 months. COBRA continuation coverage begins on the date that Plan coverage would otherwise have been lost by reason of a qualifying event and stops at the end of the maximum period. It may stop earlier if: (1) premiums are not paid on a timely basis; (2) after the COBRA election, coverage is obtained with another group health plan (e.g., through an employer) that does not contain any exclusion or limitation with respect to any preexisting condition of such beneficiary; or (3) after the COBRA election, a beneficiary becomes entitled to Medicare coverage. (Note: If Medicare coverage is obtained before COBRA election, COBRA coverage may not be discontinued, even if the other coverage continues after the COBRA election.) Other coverage options Other coverage options may be available for you and your family. You may be able to enroll in another group health plan for which you are eligible, such as a spouse s plan, if you request enrollment within 30 days of loss of coverage. Additionally, you may be eligible to enroll in an individual plan through Medicaid or the Health Insurance Marketplace. By enrolling through the Marketplace, you may qualify for lower monthly premiums and lower out-of-pocket costs. Being eligible for COBRA coverage does not limit your eligibility for coverage or a tax credit through the Marketplace. You can learn more about these options at www.healthcare.gov. For more information For more information about your COBRA rights under the Public Health Services Act, contact the Centers for Medicare & Medicaid Services (CMS) toll-free at 1-800-633-4227 or visit www.cms.gov Specific questions about your COBRA continuation coverage rights as an STRS Ohio enrollee should be addressed to your COBRA Administrator: Mutual Health Services, A Division of Medical Mutual Services, LLC, P.O. Box 5700, Cleveland, OH 44101. Phone: 1-800-367-3762 (toll-free); fax: (330) 666-6685. Notify your COBRA Administrator of address changes To protect your family s rights, you should keep the COBRA Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the COBRA Administrator. 2015 STRS Ohio Health Care Program Guide 45

Notice of Medicare Part D Creditable Coverage This notice provides important information about prescription drug coverage through STRS Ohio health care plans and Medicare Part D. Please read this notice carefully and keep a copy for your records. As an enrollee in an STRS Ohio health care plan, you should not enroll in more than one Medicare Part D plan. STRS Ohio has received an actuarial determination that the prescription drug coverage included in the STRS Ohio health care plans is creditable, meaning it is as good as or better than the standard Medicare Part D prescription drug coverage. Required information from the Centers for Medicare & Medicaid Services If you are eligible for Medicare Parts A & B or Part B-only, you have an opportunity to enroll in Medicare Part D each year from Oct. 15 through Dec. 7. If you are not currently eligible for Medicare, you can enroll in Medicare Part D when you turn age 65. Keep in mind, however, that creditable prescription drug coverage is included in your STRS Ohio health care plan. This means you should not enroll in more than one Medicare Part D plan. If you are not currently enrolled in Medicare Parts A & B or Part B-only, the initial enrollment period is the sevenmonth period that begins three months before you first meet eligibility requirements and ends three months after the month of first eligibility. You will pay a higher Medicare Part D premium if you go without creditable prescription drug coverage for 63 consecutive days or longer after your initial enrollment period ends. Information for enrollees with Medicare Parts A & B or Part B-only You will automatically be enrolled in a Medicare Part D prescription drug plan for no additional monthly premium as part of your STRS Ohio health care plan s coverage. Express Scripts administers the Medicare Part D plan for Aetna, Medical Mutual, AultCare and Paramount enrollees. HealthSpan administers the plan for its enrollees. Because Medicare Part D coverage is already included in your STRS Ohio health care plan, you should not enroll in any other Medicare Part D plan. If you enroll in another Medicare Part D plan, your STRS Ohio medical and prescription drug coverage will be canceled. Medicare does not allow enrollment in more than one Medicare Part D plan. In addition, 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. Before making any changes to your Medicare Part D prescription drug plan coverage, call STRS Ohio to find out how your STRS Ohio health care coverage will be affected. If you have specific questions about your prescription drug coverage, contact your prescription drug plan administrator. Please note that if you terminate health care coverage under STRS Ohio, you will lose medical and prescription drug coverage provided by STRS Ohio. In addition, you will have only the coverage you qualify for under Medicare Parts A & B or Part B-only unless you purchase a separate supplemental plan. Keep in mind that Medicare Parts A & B do not cover most prescription drugs. Keep this notice for your records. If you decide to enroll in Medicare Part D in the future, you may need to present a copy of this notice to avoid paying a higher monthly premium amount under Medicare. You may request a copy of this document from STRS Ohio at any time or visit www.strsoh.org. For more information 1. Call STRS Ohio s Member Services Center toll-free at 1-888-227-7877 for information about this notice or to request additional copies. 2. Contact your prescription drug plan administrator directly for information about your current prescription drug plan coverage through an STRS Ohio health care plan. Aetna, Medical Mutual, AultCare or Paramount enrollees: Call Express Scripts toll-free at 1-888-416-3326. HealthSpan enrollees: Call HealthSpan toll-free at 1-800-493-6004. 3. Call Medicare toll-free at 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov for information about your options under Medicare Part D. 4. Call the Social Security Administration toll-free at 1-800-772-1213 or visit www.ssa.gov to find out if you qualify for extra assistance to help pay for Medicare prescription drug plan costs. 46 www.strsoh.org

Aetna Getting More Information WEBSITE MAILING ADDRESS CUSTOMER SERVICE www.aetnamedicare.com Claims Address: P.O. Box 981106 El Paso, TX 79998-1106 1-866-282-0631 (toll-free) Hours: Weekdays, 8 a.m. 8 p.m. Prescription Drug Plan Information: Contact Express Scripts AultCare www.aultcare.com Mailing Address: P.O. Box 6910 Canton, OH 44706-0910 Express Scripts www.express-scripts.com HealthSpan Closed to new enrollments in 2015 Claims Address Non-Medicare enrollees: Medicare enrollees: Commercial Claims P.O. Box 2872 Clinton, IA 52733 Medicare Part D Claims P.O. Box 2858 Clinton, IA 52733 www.healthspan.org Claims Address: P.O. Box 5316 Cleveland, OH 44101-0316 Medical Mutual www.medmutual.com Claims Address: P.O. Box 6018 Cleveland, OH 44101-1018 Medicare www.medicare.gov Paramount www.paramounthealthcare.com Mailing Address: P.O. Box 928 Toledo, OH 43697-0928 Social Security Administration www.ssa.gov STRS Ohio www.strsoh.org Mailing Address: Health Care Services Department 275 E. Broad St. Columbus, OH 43215-3771 Canton area: 330-363-6360 All other areas: 1-800-344-8858 (toll-free) Hours: Weekdays, 7:30 a.m. 5 p.m. Prescription Drug Plan Information: Contact Express Scripts Non-Medicare enrollees: 1-866-685-2792 (toll-free) Medicare enrollees: 1-888-416-3326 (toll-free) Hours: 7 days a week, 24 hours a day Non-Medicare enrollees: 1-800-686-7100 (toll-free) Hours: Monday Thursday, 8:15 a.m. 5 p.m. Friday, 9:15 a.m. 5 p.m Medicare enrollees: 1-800-493-6004 (toll-free) Hours: 7 days a week, 8 a.m. 8 p.m. Prescription Drug Plan Information: Contact HealthSpan 1-877-520-6727 (toll-free) Hours: Monday Thursday, 7:30 a.m. 7:30 p.m. Hours: Friday, 7:30 a.m. 6 p.m. Hours: Saturday, 9 a.m. 1 p.m. Prescription Drug Plan Information: Contact Express Scripts 1-800-633-4227 (toll-free) Hours: 7 days a week, 24 hours a day 1-800-462-3589 (toll-free) Hours: Weekdays, 8:30 a.m. 5 p.m. Prescription Drug Plan Information: Contact Express Scripts 1-800-772-1213 (toll-free) Hours: Weekdays, 7 a.m 7 p.m. 1-888-227-7877 (toll-free) Hours: Weekdays, 8 a.m. 5 p.m. 2015 STRS Ohio Health Care Program Guide 47

Notes 48 www.strsoh.org

Notes 2015 STRS Ohio Health Care Program Guide 49

12-229, 10/14/18M 275 E. Broad St., Columbus, OH 43215-3771 1-888-227-7877 www.strsoh.org