YOUR 2017

OPEN-ENROLLMENT GUIDE For Medical, Dental and Vision Coverage

DEADLINE TO RESPOND Nov. 22, 2016 You are eligible for STRS Ohio medical, dental and vision coverage in 2017. Whether you are currently enrolled in one or more of these plans or shopping for coverage, this guide and the enclosed materials will help you evaluate your options.

Welcome Open enrollment for the STRS Ohio Health Care Program is Nov. 1–22, 2016. This is your time to decide if you want to continue your coverage with STRS Ohio or enroll in a new plan for 2017. Open enrollment is offered each year for STRS Ohio’s medical plans and once every two years for the dental and vision plans. Other opportunities to join the STRS Ohio Health Care Program are limited, so please respond by Nov. 22, 2016, if you want to change your 2017 plan enrollment or add coverage effective Jan. 1, 2017. In this guide, you will find some information applies to current enrollees with coverage in 2016, while other details are for potential new enrollees. Please read the information that applies to you. Here’s some general information about the plans we offer: • Medical, dental and vision coverage is available to eligible STRS Ohio benefit recipients and their eligible family members. • All STRS Ohio medical plans include hospital, medical and prescription drug coverage. Enrollment in Medicare is required for all plan participants who are age 65 or older, or otherwise eligible for Medicare. • Dental and vision coverage is available under separate plans. You can enroll in either the dental or vision plan, or both plans. Enrollment in an STRS Ohio medical plan is not required to obtain dental and vision coverage. If you have any questions, please call STRS Ohio’s Member Services Center toll-free at 888-227-7877. The center’s hours are Monday–Friday, 8 a.m. to 5 p.m. Open-enrollment information is also available on our website at www.strsoh.org.

What’s Inside Eligibility and Enrollment..................................................................................................1 Key Program Changes for 2017........................................................................................1 Medical Coverage Which Medical Plans Are Available to You?...................................................................2 Coverage Considerations....................................................................................................3 Enrollment Factors...............................................................................................................3 Monthly Premiums and Financial Assistance................................................................4 Evaluating Your Medical Plans..........................................................................................4 Making Your Medical Plan Selection for 2017................................................................5 Prescription Drug Coverage...............................................................................................6 Non-Medicare Plan Features..............................................................................................7 Medicare Plan Features.......................................................................................................9 Medicare Enrollment.........................................................................................................11

Dental and Vision Coverage

About Your Personalized Letter

Two-Year Enrollment Contract Period...........................................................................13

STRS Ohio has prepared a personalized list of plans and premiums for you. The chart on the front of the letter shows your 2017 plan enrollment if no action is taken by Nov. 22.

Making Your Dental or Vision Plan Selection..............................................................13

Do you currently have STRS Ohio coverage in 2016?

CURRENT ENROLLEES You are a current enrollee with the option to remain enrolled

• Medical — Your 2017 medical plan enrollment is listed in the chart on the front of the letter. No action is required if you want to remain in this plan. If other plans are available (shown on the reverse side) and you want to select a different plan, contact us by the deadline.

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• Dental and/or vision — “Yes” in the chart on the front of the letter shows you are scheduled for continued enrollment in the dental and/or vision plan. If you do not want to continue coverage through Dec. 31, 2018, contact us by the deadline.

NEW ENROLLEES You are a new enrollee considering coverage

Monthly Premiums............................................................................................................13

Required Notices..................................................................................................................14 Notice of Medicare Part D Creditable Coverage..........................................................14 General Notice of COBRA Continuation Coverage Rights........................................15

Who to Contact .....................................................................................................................16

• Medical — No medical plan is listed in the chart on the front of the letter. Please refer to the reverse side for your plan options. To enroll in a plan, submit an enrollment application by the deadline. • Dental and/or vision — “No” in the chart on the front of the letter shows you are not currently enrolled in the dental and/or vision plan. To sign up for coverage, submit an enrollment application by the deadline.

Visit us online | Open-Enrollment Resource Center | www.strsoh.org

Eligibility and Enrollment Eligibility and enrollment guidelines are the same for the medical, dental and vision plans. Please review the guidelines in the enclosed enrollment application for specific information. These guidelines are also available on the STRS Ohio website. Dental and vision plan enrollment is separate from STRS Ohio medical coverage. Enrollment in an STRS Ohio medical plan is not required to obtain dental and/or vision coverage. Eligible dependents only qualify for coverage if the benefit recipient is also enrolled in the plan.

Key Program Changes for 2017 The 2017 changes help extend the solvency of the Health Care Fund. Due to increasing claims costs and the lack of a dedicated source of funding, STRS Ohio faces significant health care funding challenges. The changes below do not provide a long-term solution for health care. In the months ahead, the State Teachers Retirement Board will be exploring viable funding options. Throughout the discussions, we will use our website, newsletters, email news service and social media channels to keep you informed.

SUMMARY OF CHANGES BEGINNING JAN. 1, 2017 • Emergency room copayments will increase to $75 from $65 for Medicare plans.

Medical Coverage

• Urgent care copayments will increase to $40 from $35 for all plans.

Medical Coverage

• Medical Mutual non-Medicare enrollees residing outside of Ohio will move to a Basic Plan administered by Aetna. The Aetna Basic Plan provides more network coverage for non-Ohio residents.

STRS Ohio offers medical plans that include hospital, medical and prescription drug coverage. This coverage is separate from STRS Ohio dental and vision coverage.

• The Alere disease management program for non-Medicare enrollees will be discontinued. • Medical plans offered by HealthSpan are discontinued.

Please review your personalized letter for your medical plan options and monthly premiums. Then review Pages 6–10 for the main coverage features of the plans available to you. (Current STRS Ohio Health Care Assistance Program enrollees should refer to the enclosed green plan overview chart.) Be sure to review the plan features that apply to you and your eligible dependents based on each individual’s Medicare status.

• Coverage for proton pump inhibitors (PPIs) will be discontinued for non-Medicare enrollees.

Prescription Drug Coverage

• Preferred network for retail pharmacies will be adopted and copayments/coinsurance at non-preferred network pharmacies will increase by $10. See Page 6 for details. • The one-half copayment program for diabetic prescriptions will be discontinued. Enrollees will pay the full copayment for all diabetic medications and supplies. • Specialty drugs coinsurance percentage will increase to 13% from 10%, and the per prescription maximum will increase to $550 from $500. • Medicare Part B premium reimbursements will be discontinued for survivors and beneficiaries who were age 65 by 2008 and either receiving a benefit or named as a beneficiary as of Jan. 1, 2008.

Eligibility

• Coverage for sponsored dependents of unmarried retired teachers will no longer be offered. This does not include disabled adult children. • Premiums for dependent children will change to a per child rate. • The subsidy multiplier for non-Medicare benefit recipients will be reduced to 1.9% per year of service from 2.1%. (Benefit recipients with Medicare will continue to receive a 2.1% subsidy per year of service.)

Subsidy

1

Your 2017 Open-Enrollment Guide

• The Medicare Part B premium reimbursement will be phased out over a three-year period. In 2017, eligible benefit recipients will receive between $35.22 and $29.90 monthly based on years of service. In 2018, all eligible benefit recipients will receive $29.90 per month. Reimbursements will be discontinued effective Jan. 1, 2019.

Which Medical Plans Are Available to You? Refer to your personalized letter for your 2017 medical plans and premiums. The plans you are eligible for are determined by the ZIP code of your permanent residence and your Medicare status on file with STRS Ohio. If your most recent eligibility information has changed, your plan options may differ from those listed in the letter.

Current Enrollees Your plan enrollment for 2017 is listed on the front of your personalized letter. No action is required if you want to remain in this plan. If you want to select a different plan (if available) or cancel your coverage for 2017, contact STRS Ohio by Nov. 22. Note: If your current plan is not listed on the front of the letter, it is not available to you next year due to a change in the plan’s availability or eligibility.

New Enrollees Your plan options and premiums are listed on the back of your personalized letter. To enroll yourself and any eligible dependents in a plan, you must submit an enrollment application to STRS Ohio by Nov. 22.

Reminders 4 If you are a current Medical Mutual Basic Plan enrollee without Medicare who resides outside of Ohio, you will be moved to the Aetna Basic Plan in 2017. 4 You and your eligible dependents must enroll in the same option. If two plans are listed under a single option, you and your dependents are eligible for different plans under that option based on Medicare status. 4 If you recently enrolled in Medicare and notified us after Sept. 1, contact STRS Ohio for your plans and premiums as they may differ from those listed in your personalized letter.

www.strsoh.org

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Coverage Considerations Coverage Under More Than One Account or Retirement System If you are eligible for medical 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. It is your responsibility to contact STRS Ohio each year to indicate from which account your monthly premium should be deducted. Additionally, if you are eligible for medical coverage through more than one Ohio public retirement system, guidelines determine which system is responsible for your coverage. Contact STRS Ohio for details.

Limited Coverage for Employed Non-Medicare Enrollees 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 coverage through STRS Ohio’s Basic Plan if they: (1) are eligible for medical and prescription drug coverage through their employer, or (2) hold a position for which other similarly situated employees are eligible for

Monthly Premiums and Financial Assistance medical or prescription drug coverage. The rule applies to all employed enrollees who are not eligible for Medicare, regardless of hire date or type of employment. If you think you might be affected, contact STRS Ohio. Failure to report employment can result in retroactive cancellation of your coverage and liability for any claims paid.

Prescription Drug Coverage Express Scripts prescription drug coverage is included in all STRS Ohio medical plans. Enrollees with Medicare are automatically covered by a Medicare Part D plan provided by Express Scripts. See Page 6 for information about your prescription drug plan.

Affordable Care Act All STRS Ohio medical plans meet the Affordable Care Act’s minimum essential coverage requirement. You are considered covered and should not be assessed a fee.

Foreign Travel Before traveling to a foreign country, check with your medical and prescription drug plan administrators to learn about emergency coverage while you are abroad.

Enrollment Factors Family Accounts With Different Medicare Statuses For families with Medicare and non-Medicare enrollees, enrollment in separate plans is permitted only 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 select the same plan — the Basic Plan or a regional plan if available. Be aware, coverage features under the same plan could differ based on Medicare status. Be sure to review the plan features for Medicare and non-Medicare enrollees.

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Your 2017 Open-Enrollment Guide

Proof of Medicare Enrollment If you are age 65 or older, STRS Ohio requires you to be enrolled in Medicare Part B and pay a monthly premium to Medicare. If premium-free Part A is available from Medicare based on your or your spouse’s (living, deceased or divorced) employment history, STRS Ohio also requires you to be enrolled in Medicare Part A. You must provide proof of Medicare enrollment to STRS Ohio by sending us a copy of your Medicare card or submitting your Medicare information through your STRS Ohio Online Personal Account. Your plan options and monthly premiums change after Medicare enrollment is confirmed. Failure to provide proof of Medicare enrollment will affect your STRS Ohio coverage. See Page 11 for important information about Medicare.

Medical Premiums Review the monthly premium for each medical plan available to you. If you elect coverage, your 2017 monthly premium will be deducted from your STRS Ohio benefit payment beginning January 2017. If your monthly premium exceeds your benefit payment, the balance must be paid in full through a direct debit account with your financial institution and STRS Ohio. (A direct debit account allows premium payments to be withdrawn automatically from your checking or savings account.)

Health Care Assistance Program (HCAP) The STRS Ohio Health Care Assistance Program (HCAP) is designed to help qualified benefit recipients who need financial assistance paying for their STRS Ohio medical plan. The assistance program currently includes a $0 monthly premium for the benefit recipient and often lower out-ofpocket costs for all enrollees in the plan. Although covered family members may receive the same plan of coverage as the qualifying recipient, they are not eligible for the $0 premium and must pay the full cost of their coverage.

Ways to Reduce Your Health Expenses 1. Use network physicians and preferred pharmacies. You will pay less for services and supplies obtained from network providers. 2. Use generic drugs when possible. You will pay less for generic drugs compared to brand-name drugs. 3. Use the home delivery pharmacy for medications taken on a regular basis. You will receive a 90-day supply for a lower copayment than three fills at a retail pharmacy.

The assistance program is currently available to: (1) service retirement benefit recipients with 25 or more years of qualifying service credit; (2) disability benefit recipients receiving STRS Ohio benefits; and (3) beneficiaries and survivors who are otherwise eligible for subsidized premiums. New applicants must be eligible for a subsidy under the STRS Ohio Health Care Program to qualify for HCAP enrollment. Benefit recipients, survivors and beneficiaries who were enrolled in HCAP as of Dec. 31, 2015, are not subject to the subsidy requirement — as long as they continue to meet all other HCAP requirements and remain continuously enrolled in the program. Eligibility for the program limits annual family income to $23,800 and household liquid assets to $23,800. (A home is not considered a liquid asset.) Depending on Medicare status, approved individuals may enroll in the Medical Mutual Health Care Assistance Plan or the Aetna Medicare Plan. Medicare-eligible participants must maintain their Medicare Parts A & B or Part B-only enrollment to remain eligible for HCAP. If you believe you qualify for assistance, visit our website or call STRS Ohio for an HCAP enrollment application. Current HCAP enrollees: Please refer to the enclosed plan overview chart for the main coverage features of the plans available to you.

1 2 3 Evaluating Your Medical Plans Step 1

Step 2

Step 3

Review your personalized letter to find out which plans are available to you and the monthly premium for each plan.

Review Pages 6–10 for the main coverage features of the plans available to you. Be sure to review the features that apply to you and your eligible dependents based on each individual’s Medicare status.

If you want information about specific coverage features not listed in this guide, call the plans directly. Also call the plans or visit the plans’ websites to find out if the providers and hospitals you use participate in their networks. (See Page 16 for contact information.)

www.strsoh.org

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Making Your Medical Plan Selection for 2017

Prescription Drug Coverage

CURRENT ENROLLEES

About Your Prescription Drug Plan

Do you want to remain in the option listed as your 2017 plan enrollment? • To remain in your 2017 plan enrollment option, you do not need to contact STRS Ohio. You will be enrolled automatically in this plan. We suggest you visit the plan administrator’s website listed on Page 16 or request an updated provider directory from the plan. • Basic Plan enrollees: If you are turning age 65 and you are eligible for the Aetna Medicare Plan, you will be enrolled in the Aetna Medicare Plan after STRS Ohio receives proof of Medicare coverage and Medicare approves your enrollment request. If you do not want to be enrolled in the Aetna Medicare Plan, notify us when you submit a copy of your Medicare card or select “AMA Opt Out” when you submit your Medicare information through your STRS Ohio Online Personal Account.

Do you want to select a different plan? To select a different plan, call STRS Ohio or email [email protected] between Nov. 1–22, 2016. No plan selections will be accepted after Nov. 22. • If you are selecting the Aetna Medicare Plan, be aware your enrollment request cannot be submitted to Aetna until STRS Ohio receives proof of Medicare coverage. Any delay in submitting this proof to STRS Ohio will delay your enrollment in the Aetna Medicare Plan. Please note, you are not officially enrolled in the plan until Medicare approves your enrollment request.

Additionally, if you choose the Aetna Medicare Plan, you must not subsequently enroll in another Medicare Advantage plan. If you do, your Aetna coverage will be canceled. • If you are selecting a Paramount HMO plan, you will also need to request an HMO enrollment application from Paramount and submit it to the plan before Nov. 22. You will not be enrolled in the HMO until Paramount receives and approves your application before the deadline. If you do not submit a completed HMO application by Nov. 22, you will remain enrolled in the option listed on the front of your personalized letter. • If you are currently enrolled in a Paramount HMO plan and you want to select a different plan, you will need to send a written request to STRS Ohio to cancel coverage under the HMO after you contact STRS Ohio to select your new plan. As required by the Centers for Medicare & Medicaid Services, the letter must be signed by the benefit recipient and any other covered Medicare enrollees on the account.

Do you want to add a dependent? To enroll an eligible dependent who is not currently covered by your plan, submit an enrollment application to STRS Ohio by Nov. 22. The application must be received by the deadline to be eligible to enroll during the openenrollment period. If applicable, enclose a copy of the individual’s Medicare card with the application.

• If you are selecting the Aetna Medicare Plan, be aware your enrollment request cannot be submitted to Aetna until STRS Ohio receives proof of Medicare enrollment. Any delay in submitting this proof to STRS Ohio will delay your enrollment in the Aetna Medicare Plan. Please note, you are not officially enrolled in the

Important: Enrollees with Medicare are covered by a Medicare Part D plan administered by Express Scripts. See Page 14 for important information about your Medicare Part D coverage.

Where You Can Purchase Prescription Drugs You can purchase covered prescription medications for a copayment/coinsurance through Express Scripts’ network retail pharmacies or the Express Scripts Home Delivery Pharmacy, which offers a convenient mail-order option. No claim form is needed when you use a network retail pharmacy or home delivery. • Network: There are two types of network retail pharmacies — preferred and non-preferred. You can use either type of network pharmacy; however, if you use a non-preferred pharmacy, you will pay a $10 fee per fill in addition to the applicable copayment/coinsurance. (This fee does not apply to the annual deductible or maximum annual expense.) Contact Express Scripts or visit www.express-scripts.com to check the network status of your pharmacy. • Out-of-Network: If you use an out-of-network pharmacy, you must pay the full cost of the prescription at time of purchase and then submit a claim form to Express Scripts. If the drug is covered, you will be reimbursed the amount STRS Ohio would have paid at a preferred network pharmacy, less the applicable copayment/coinsurance. If an out-of-network pharmacy charges more than this amount, you are responsible for excess charges.

Prescription Drug Plan Features Annual Brand-Name Deductible per Enrollee (Generic drug costs and non-preferred pharmacy fees do not apply to the deductible.)

Standard (Network) Retail/Nursing Home Pharmacy Copayments/Coinsurance per 31-day Supply

NEW ENROLLEES To enroll yourself and any eligible dependents in a plan, submit an enrollment application to STRS Ohio by Nov. 22. The application must be received by the deadline to be eligible to enroll during the open-enrollment period. Remember, to enroll an eligible dependent, the benefit recipient must also enroll in the plan option. If applicable, enclose a copy of each individual’s Medicare card with the application.

Prescription drug coverage is included in all STRS Ohio medical plans. Express Scripts administers two plans for STRS Ohio enrollees: (1) Express Scripts Prescription Drug Plan for enrollees without Medicare, and (2) Express Scripts Medicare Part D Prescription Drug Plan for enrollees with Medicare. The plan formularies are similar and the coverage features are the same for non-Medicare and Medicare enrollees, except for the retail maximum day supply.

plan until Medicare approves your enrollment request. Additionally, if you choose the Aetna Medicare Plan, you must not subsequently enroll in another Medicare Advantage plan. If you do, your Aetna coverage will be canceled. • If you are selecting a Paramount HMO plan, you will also need to request an HMO enrollment application from Paramount and submit it to the plan before Nov. 22. You will not be enrolled in the HMO until Paramount receives and approves your application before the deadline. If you do not submit a completed HMO application by Nov. 22, you will be enrolled in the Basic Plan.

(If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug.)

Maximum Day Supply

Home Delivery Copayments/Coinsurance (If the cost of the drug is less than the copayment, the enrollee pays the cost of the drug.)

(Non-preferred pharmacy fees do not apply to the maximum annual expense.)

Your 2017 Open-Enrollment Guide

$250 for covered brand-name drugs, including specialty Preferred Pharmacies Generic: Enrollee pays $10 Covered brand-name: Enrollee pays $30 after deductible is met Specialty: Enrollee pays 13% up to a maximum of $550 per fill (after deductible is met, if applicable)

Non-Preferred Pharmacies Enrollee pays the copayment/ coinsurance charged at a preferred pharmacy, plus a $10 fee per fill

Non-Medicare Retail: 31 days Home delivery: 90 days

Medicare Retail: Up to 90* Home delivery: 90 days

*Prior to acceptance in Express Scripts Medicare Part D plan, maximum retail supply is 31 days

Enrollee’s Maximum Annual Expense

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Express Scripts Prescription Drug Plan (Non-Medicare) Express Scripts Medicare Part D Plan (Medicare)

Low-Cost Generic Drug Program medications: Enrollee pays $9 Generic: Enrollee pays $25 Covered brand-name: Enrollee pays $75 after deductible is met Specialty: Enrollee pays 13% up to a maximum of $550 per fill (after deductible is met, if applicable) If an enrollee pays a total of $4,950 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. www.strsoh.org

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NON-MEDICARE Plan Features Medical Mutual Basic (Indemnity or PPO) Aetna Basic (Indemnity or PPO) Major Hospital/Medical Plan Features Enrollee Eligibility Annual Deductible per Enrollee2 Out-of-Pocket Maximum2 (Excludes prescription drug costs. Amounts included are noted for each plan.)

In-Network and Indemnity1

Medical Mutual Basic: Available in any location in Ohio Aetna Basic: Available in any location except Ohio

Emergency Room

Specialist Physician Office Visit

Out-of-Network1

Available in select northeastern Ohio area ZIP codes

Available in select northwestern Ohio and southern Michigan area ZIP codes

$5,000

$2,500

$5,000

$2,000

$6,500 per enrollee (includes deductible, coinsurance and primary care physician copayments)

$13,000 per enrollee (includes deductible and coinsurance)

$6,500 per enrollee (includes deductible, coinsurance and primary care physician copayments)

$13,000 per enrollee (includes deductible and coinsurance)

$4,000 per enrollee (includes deductible, copayments and coinsurance)

Unlimited

Unlimited

Enrollee pays 20%

Enrollee pays 50%

Enrollee pays 20%

Unlimited

Enrollee pays 50%

Enrollee pays 20%

Enrollee pays $150; waived if admitted

Enrollee pays $150; waived if admitted

Enrollee pays $150; waived if admitted

Enrollee pays $40

Enrollee pays $40

Enrollee pays $40

Urgent Care

Primary Care Physician Office Visit

In-Network

Paramount Health Care (HMO)

$2,500

Lifetime Benefits Maximum per Enrollee Hospital Services (Inpatient and Outpatient)

Out-of-Network1

AultCare PPO

Enrollee pays $20 per visit for the first two visits per year (no deductible); thereafter 20% (after deductible)

Enrollee pays 50% after deductible

Enrollee pays $20 per visit for the first two visits per year (no deductible); thereafter 20% (after deductible)

Enrollee pays 50%

Enrollee pays $10; no deductible

Enrollee pays 20%

Enrollee pays 50%

Enrollee pays 20%

Enrollee pays 50%

Enrollee pays $20; no deductible

Preventive Services (Limited designated services, e.g., routine physical, bone density screening, mammogram, routine PSA, colorectal cancer screening, Pap smear and immunizations/inoculations; frequency/age/gender limitations apply.)

7

Enrollee pays 0%; no deductible

1

Indemnity and out-of-network payments are based on allowed/noncontracting provider amounts for medically necessary services as established by the plan administrator. If nonparticipating 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 indicated. In-network and out-of-network accumulations are separate.

Your 2017 Open-Enrollment Guide

Enrollee pays 0%; no deductible

Enrollee pays 0%; no deductible

www.strsoh.org

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MEDICARE Plan Features Aetna Medicare Plan1 (Medicare Advantage PPO) Major Hospital/Medical Plan Features Enrollee Eligibility (STRS Ohio requires enrollment in Medicare Parts A & B or Part B-only.)

Annual Deductible per Enrollee4 Out-of-Pocket Maximum4 (Excludes prescription drug costs. Amounts included are noted for each plan.)

In-Network (PPO) or Extended Service Area (ESA PPO)

Emergency Room

Urgent Care

In-Network and Indemnity2,3

Available in any location in the United States Not available if you have Medicare Part A-only

AultCare PPO

Out-of-Network2,3

In-Network3

Paramount Elite HMO (Medicare Advantage)

Out-of-Network2,3

Available in select northeastern Ohio area ZIP codes Not available if you have Medicare Part A-only

Available in any location

Available in select northwestern Ohio and southern Michigan area ZIP codes Not available if you have Medicare Part A-only

$150

$500

$2,500

$5,000

$150

$500

$150

$1,500 per enrollee (includes deductible, copayments and coinsurance)

$2,500 per enrollee (includes deductible, copayments and coinsurance)

$6,500 per enrollee (includes deductible, coinsurance and primary care physician copayments)

$13,000 per enrollee (includes deductible and coinsurance)

$1,500 per enrollee (includes deductible, copayments and coinsurance)

$2,500 per enrollee (includes deductible, copayments and coinsurance)

$1,500 per enrollee (includes deductible, copayments and coinsurance)

Lifetime Benefits Maximum per Enrollee Hospital Services (Inpatient and Outpatient)

Out-of-Network (PPO)

Medical Mutual Basic (Indemnity or PPO)

Unlimited

Enrollee pays 4%

Unlimited

Enrollee pays 8%

Enrollee pays 20%5

Unlimited

Enrollee pays 50%5

Enrollee pays 4%5

Unlimited

Enrollee pays 8%5

Enrollee pays 4%

Enrollee pays $75; no deductible; waived if admitted

Enrollee pays $150; waived if admitted

Enrollee pays $75; no deductible; waived if admitted

Enrollee pays $75; waived if admitted

Enrollee pays $40; no deductible

Enrollee pays $40

Enrollee pays $40; no deductible

Enrollee pays $40; no deductible

Primary Care Physician Office Visit

Enrollee pays $15; no deductible

Enrollee pays $40 after deductible

Enrollee pays $20 per visit for the first two visits per year (no deductible); thereafter 20% (after deductible)

Enrollee pays $15; no deductible Enrollee pays $40; no deductible

Enrollee pays $15; no deductible

Specialist Physician Office Visit

Enrollee pays $25; no deductible

Enrollee pays $55 after deductible

Enrollee pays 20%

Enrollee pays $25; no deductible Enrollee pays $55; no deductible

Enrollee pays $25; no deductible

Enrollee pays 0%; no deductible

Enrollee pays 0%; no deductible

Enrollee pays 0%; no deductible

Preventive Services (Limited designated services, e.g., routine physical, bone density screening, mammogram, routine PSA, colorectal cancer screening, Pap smear and immunizations/inoculations; frequency/age/gender limitations apply.)

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 plan 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

9

Enrollee pays 0%; no deductible

4

Annual deductible must be met before plan begins making payments, unless otherwise indicated. In-network and out-of-network accumulations are separate, except for the Aetna Medicare Plan.

5

Enrollees with Medicare Part B-only must use in-network providers for hospital services to receive maximum claims payment.

Benefits are payable after Medicare payments.

Your 2017 Open-Enrollment Guide

www.strsoh.org

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Medicare Enrollment If you are age 65 or will turn age 65 during the coming year, Medicare enrollment is required. Please read this important overview. For additional information, visit our website or contact STRS Ohio. What Is Medicare? Medicare is a federal health insurance program for people age 65 or older, some people with disabilities under age 65 and people with end-stage renal disease or amyotrophic lateral sclerosis (ALS). You are eligible for Medicare when you turn age 65 even if you are not eligible for Social Security retirement benefits.

Medicare Enrollment Is Required STRS Ohio requires all eligible plan participants to be enrolled in Medicare Part B (medical insurance) and pay a monthly premium to Medicare. If premium-free Part A (hospital insurance) is available from Medicare, STRS Ohio also requires you to be enrolled in Medicare Part A. If you do not qualify for premium-free Part A based on your own employment history, you may qualify based on your spouse’s work history if: (1) you are currently married and your spouse is age 62 or older; (2) you are divorced and you were married for at least 10 years; or (3) you are widowed and you were married for at least nine months before your spouse died. Be aware, if you decline Medicare coverage for any reason, you may not be eligible for an STRS Ohio medical plan.

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)

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Am I required to enroll? Yes — You must enroll if it is 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.

Part C (Medicare Advantage)

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.

Part D (prescription)

No — Part D prescription drug coverage is included in your medical plan. Do not enroll in any other Part D plan. If you do, your STRS Ohio coverage will be canceled.

Your 2017 Open-Enrollment Guide

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 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 are enrolled in a Medicare Advantage plan or a Medicare HMO, such as the Aetna Medicare Plan or Paramount Elite, the plan assumes responsibility for paying for covered services and receives payment from Medicare.

You must enroll in Medicare before the month you turn age 65 to avoid a delay in Medicare coverage.

1 2 Step 1

Sign up for Medicare. To enroll in Medicare, visit your local Social Security Administration office or call Social Security toll-free at 800-772-1213. If you are eligible for both Medicare Parts A & B, you can also complete your Medicare application online at www.ssa.gov.

Step 2

Send STRS Ohio proof of Medicare enrollment. After you enroll in Medicare Parts A & B or Part B-only, you must provide proof of coverage by sending STRS Ohio a copy of your Medicare card or submitting your Medicare information through your STRS Ohio Online Personal Account.

After you enroll in Medicare, you must 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). Visit our website for information about paying your Medicare Part B premiums.

If you miss your initial enrollment period, you can sign up during a general enrollment period from Jan. 1 through March 31 each year. However, Medicare coverage is not effective until July 1 and Medicare late enrollment penalties will apply.

How to Enroll in Medicare

Additionally, 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 without penalty 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.

STRS Ohio will send you a Medicare information packet three months before you turn age 65 notifying you it is time to enroll. 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 it is best to start the process three months before your 65th birthday. You have a seven-month initial enrollment period in which to sign up for Medicare. This 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.

After You Enroll in Medicare After you enroll in Medicare Parts A & B or Part B-only and submit proof of coverage to STRS Ohio, the plans available to you will change. Call STRS Ohio to learn about your new plan options and premiums or log in to your STRS Ohio Online Personal Account to review this information.

Visit the STRS Ohio website for more information about Medicare.

Key

Reminders STRS Ohio requires all eligible participants to enroll in Medicare. If you decline Medicare coverage, you may not be eligible for an STRS Ohio medical plan. Pay your Medicare Part B premiums. Your Medicare Part B premium is not included in your monthly STRS Ohio premium. It is a separate premium that must be paid to Medicare, not to STRS Ohio. Do not enroll in any other Medicare Part D prescription drug plan. As a Medicare enrollee, the prescription drug coverage included in your STRS Ohio plan is provided under a Medicare Part D prescription drug plan. Medicare does not allow enrollment in more than one Medicare Part D plan. If you enroll in another Medicare Part D plan, your STRS Ohio medical and prescription drug coverage will be canceled. Medicare charges extra fees for late enrollments and higher incomes. Medicare charges late enrollment penalties if you delay enrollment in Medicare Part B or go 63 days or more without Medicare Part D or creditable prescription drug coverage. Also, Medicare Part B and Part D enrollees with higher annual incomes are subject to monthly Medicare surcharges. Surcharges vary by income levels set by Medicare (currently $85,000+ for individuals; $170,000+ for married couples). Visit www.ssa.gov for more information. Extra help may be available for prescription drug costs. Medicare offers a low-income subsidy program (also called Extra Help) to qualified participants in a Medicare Part D prescription drug plan. If you qualify, you will receive a letter from Express Scripts informing you about the program. If you are enrolled in Medicare Part B-only and your spouse becomes eligible for Medicare Parts A & B, you must contact Social Security to sign up for Medicare Part A at no cost. Once you become enrolled in Part A, you must send STRS Ohio a copy of your new Medicare card or submit your updated Medicare information through your STRS Ohio Online Personal Account.

www.strsoh.org

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Required Notices Notice of Medicare Part D Creditable Coverage This notice provides important information about prescription drug coverage through STRS Ohio medical plans and Medicare Part D. Please read this notice carefully and keep a copy for your records.

Dental and Vision Coverage STRS Ohio offers dental coverage through Delta Dental and vision coverage through Vision Service Plan (VSP). This coverage is separate from STRS Ohio medical coverage. Please review the dental and vision brochure for plan features and monthly premiums.

Two-Year Enrollment Contract Period Coverage is effective for two years from Jan. 1, 2017, through Dec. 31, 2018. Once you are enrolled in the dental and/or vision plan, you must remain enrolled through Dec. 31, 2018, and pay monthly premiums even if you no longer need or use the services under the plan (e.g., you get dentures, laser vision correction or other insurance). Early contract cancellation is not permitted.

Monthly Premiums Monthly premiums are listed on the back of your personalized letter, as well as in the dental and vision brochure. Separate monthly premiums apply for each plan. If you elect coverage, monthly premiums will be deducted from your STRS Ohio benefit payment beginning January 2017 through December 2018. If your monthly premium exceeds your benefit payment, the balance must be paid in full through a direct debit account with your financial institution and STRS Ohio. (A direct debit account allows premium payments to be withdrawn automatically from your checking or savings account.)

Making Your Dental or Vision Plan Selection You can choose coverage under either the dental or vision plan, or both plans.

Current Enrollees • To remain enrolled in the dental and/or vision plan for 2017–2018, you do not need to contact STRS Ohio. Your coverage will be extended automatically through Dec. 31, 2018. To enroll an eligible dependent who is not currently covered by your plan, submit an enrollment application to STRS Ohio by Nov. 22. The application must be received by the deadline to be eligible to enroll during the open-enrollment period. • If you do not want to remain enrolled in the dental and/or vision plan for 2017–2018, you must call STRS Ohio or email [email protected] by Nov. 22. Your coverage will then end on Dec. 31, 2016. If you do not contact STRS Ohio by the deadline, your coverage will be extended automatically through Dec. 31, 2018. Early contract cancellation is not permitted.

As an enrollee in an STRS Ohio medical 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 medical 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, Part A-only 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 medical plan. This means you should not enroll in more than one Medicare Part D plan. If you currently are not enrolled in Medicare Parts A & B, Part A-only or Part B-only, the initial enrollment period is the seven-month 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, Part A-only or Part B-only You will be enrolled automatically in a Medicare Part D prescription drug plan administered by Express Scripts for no additional monthly premium as part of your STRS Ohio medical plan’s coverage.

Before making any changes to your Medicare Part D prescription drug plan coverage, call STRS Ohio to find out how your STRS Ohio medical coverage will be affected. If you have specific questions about your prescription drug coverage, contact Express Scripts. Please note that if you cancel medical 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, Part A-only or Part B-only unless you purchase a separate supplemental plan. Keep in mind that Medicare Parts A & B cover only a few 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 • Call STRS Ohio toll-free at 888-227-7877 for information about this notice or to request additional copies. • Contact Express Scripts toll-free at 888-416-3326 for information about your prescription drug plan coverage. • Call Medicare toll-free at 800-MEDICARE (800-633-4227) or visit www.medicare.gov for information about your options under Medicare Part D. • Call the Social Security Administration toll-free at 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.

Because Medicare Part D coverage is already included in your STRS Ohio medical 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 medical plan, your STRS Ohio medical coverage will be canceled.

New Enrollees To enroll yourself and any eligible dependents in one or both plans, submit an enrollment application to STRS Ohio by Nov. 22. The application must be received by the deadline to be eligible to enroll during the open-enrollment period. Remember, to enroll an eligible dependent, the benefit recipient must also enroll in the plan. 13

Your 2017 Open-Enrollment Guide

www.strsoh.org

14

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 15

Your 2017 Open-Enrollment Guide

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 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: 800-367-3762 (toll-free); fax: 330-666-2845.

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.

Who to Contact At-a-Glance 1. To ask enrollment or eligibility questions...................... Call STRS Ohio or email [email protected] 2. To obtain an enrollment application............................... Visit our website or call STRS Ohio 3. To ask specific coverage questions.................................. Visit the plan’s website or call the plan administrator 4. To obtain provider information........................................ Visit the plan’s website or call the plan administrator 5. To obtain an HMO enrollment application..................... Call Paramount

Phone Numbers and Websites Contact

Toll-Free Number

Aetna Basic

800-645-5677

Aetna Medicare Plan

866-282-0631

AultCare PPO

330-363-6360 (Local — Canton area) 800-344-8858 (All other areas)

Delta Dental

866-349-1286

Express Scripts

866-685-2792 (Non-Medicare enrollees) 888-416-3326 (Medicare enrollees)

Website www.aetna.com www.aetnamedicare.com www.aultcare.com www.deltadentaloh.com www.express-scripts.com

Medical Mutual Basic

877-520-6727

www.medmutual.com

Medicare

800-633-4227

www.medicare.gov

Paramount Health Care Paramount Elite HMO

800-462-3589

www.paramounthealthcare.com

STRS Ohio

888-227-7877

www.strsoh.org

Vision Service Plan (VSP)

800-877-7195 800-428-4833 (Hearing impaired)

www.vsp.com

www.strsoh.org

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275 E. Broad St., Columbus, OH 43215-3771 • 888-227-7877 • www.strsoh.org

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