Health Care Coverage

Your Health Care Coverage in Retirement

Currently SERS offers health care coverage, which includes medical and prescription drug coverage, to qualifying benefit recipients. When you enroll, you may cover your spouse, and children up to age 26.

To the extent that resources permit, SERS intends to continue offering access to health care coverage. However, SERS reserves the right to change or discontinue any plan or program at any time.

Health care coverage from a school employer is different than coverage available for retirees. Employers typically offer more generous health care benefits as part of their overall compensation package. Once you retire, you may find that your costs are higher.

Please see the Member Health Care Guide for a comprehensive guide to SERS’ health care program.

Health Care Eligibility

You are eligible for coverage if you have 10 years of qualified service credit.

Qualified service credit includes:

• Earned or restored service
• Contributing STRS, OPERS, Ohio Police & Fire, Ohio Highway Patrol Retirement System, and Cincinnati Retirement System service credit, provided the credit is not earned at the same time SERS service credit is earned
• Workers’ Compensation credit

Qualified service credit does not include:

• Military (other than free or interrupted military service credit)
• Federal government, private school, or out-of-state service
• Exempted service
• ERI (Early Retirement Incentive), or ‘buy out’

There are three times when you can enroll in SERS’ coverage:

• When you retire or begin receiving a disability benefit
• Within 90 days of becoming eligible for Medicare
• Within 31 days of the involuntary termination of health care coverage under another plan. Proof of involuntary termination is required.

Dental and Vision Coverage

SERS offers dental and vision coverage through Delta Dental of Ohio and VSP Vision Care. To sign up for dental and/or vision coverage, you must be eligible for, but you do not have to be enrolled in, SERS’ health care coverage.

You must enroll in dental/vision coverage to enroll your spouse and/or children.

If you do not enroll when you retire or begin receiving a disability benefit, you can only enroll:

• During the annual open enrollment period
• Within 31 days of an involuntary termination of another dental or vision plan
• At the time you enroll in SERS’ medical and prescription drug coverage due to an involuntary termination of health care coverage under another plan

You cannot cancel dental/vision coverage before the next Dental and Vision Open Enrollment unless you are also canceling SERS medical and prescription coverage.

Selecting Coverage Before Medicare

Before you reach Medicare eligibility, SERS offers two health care options.

The SERS Marketplace Wraparound Health Reimbursement Arrangement (HRA) is often the most affordable option. SERS helps you enroll in a federal Health Insurance Marketplace plan with an individualized premium based on household size and income. The Marketplace offers a variety of plans in every state, including Ohio. Marketplace premiums can be as low as $0.

SERS also offers traditional group plans, Aetna Choice POS II and AultCare PPO, that resemble employer coverage, but are generally more expensive.

The Aetna Choice POS II plan is the only enrollment option if you are enrolling a family member in SERS’ Aetna Medicare Plan (PPO).

Contact HealthSCOPE Benefits toll-free at 1-888-236-2377. Counselors will help you evaluate the costs and benefits of the SERS plan alternatives.

Effective June 1, 2023, non-Medicare members must participate in Marketplace counseling to explore their premium and plan options.  See page 8 of the Member Health Care Guide for more information.

SERS Traditional Plans and Premium Subsidies

SERS helps reduce health care premiums by providing a subsidy to those who qualify when enrolling in SERS’ traditional group plans.

To qualify for a premium subsidy, you must have at least 20 years of qualified service credit, or be receiving a disability benefit. In addition, at the time of retirement, disability, or separation from service, you must:

• be eligible to participate in the health care plan of your last school employer, or
• have been eligible to participate in the health care plan of your school employer at
  least three of the last five years of service

2023 Non-Medicare Premiums

2023 Medicare Premiums

Eligible for Medicare?

If you are retiring because you are nearing age 65 and will be eligible for Medicare, learn more about Medicare enrollment.

Things to Consider When Choosing Health Insurance