Health Care Coverage

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
• Service credit purchased by a school employer under an Early Retirement Incentive Plan (ERI)
• Additional service credit purchased under OPERS by an elected or appointed official

When You Can Enroll

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

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

For more information, see page 8 of the Member Health Care Guide.

SERS Marketplace Wraparound Health Reimbursement Arrangement (HRA)

This is often the most affordable option for non-Medicare retirees. SERS helps you enroll in a federal Health Insurance Marketplace plan, with premiums based on your household size and income. The Marketplace offers a wide range of plans in every state, including Ohio.

Traditional Group Plans

SERS also offers two traditional group health plans, Aetna Choice POS II and AultCare PPO. These plans are similar to employer coverage, but are generally more expensive.

Required Non-Medicare Consultation

Applicants planning to enroll in non-Medicare coverage must call UMR at 1-888-236-2377 to review their Marketplace plan options.

• Counseling is not required if a family member enrolls in the Aetna Medicare Plan (PPO)
• For non-Medicare family members, Aetna Choice POS II is the only available enrollment option

Before calling, you can review the Non-Medicare Counseling Checklist or watch the video below.

SERS helps lower health care costs for eligible members by offering a premium subsidy when you enroll in one of SERS’ traditional group health plans.

You may qualify for this subsidy if you have at least 20 years of qualified service credit or if you are receiving a disability benefit.

In addition, at the time of your retirement, disability, or separation from service, you must meet one of the following conditions:

• You were eligible to participate in the health care plan offered by your last school employer, or
• You were eligible to participate in your school employer’s health care plan for at least three of your last five years of service

2026 Non-Medicare Monthly Premiums

*If you do not qualify for a premium subsidy, you must pay the full premium regardless of your qualified years of service credit.

2026 Medicare Monthly Premiums

*If you do not qualify for a premium subsidy, you must pay the full premium regardless of your qualified years of service credit.

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

SERS currently offers a $45.50 monthly reimbursement to help eligible benefit recipients pay for Medicare Part B premiums.

To receive this reimbursement, you must:

• Be enrolled in Medicare Part B
• Be enrolled in SERS’ health care coverage

This reimbursement is available only to eligible benefit recipients. Spouses and children are not eligible.

You are not eligible for the reimbursement if your Medicare Part B premium is paid by another source, including the Medicare Premium Assistance Program or Medicaid.

Reimbursement begins after SERS receives proof of Medicare Part B enrollment and is not retroactive.

SERS offers optional dental and vision coverage through Delta Dental of Ohio and VSP Vision Care.

To enroll in dental and/or vision coverage, you must have at least 10 years of qualified service credit. You must enroll in dental/vision coverage to enroll your spouse and/or children.

The 2026-2027 enrollment period ends December 31, 2027, regardless of your effective date of coverage. Once enrolled, you must remain enrolled through December 31, 2027, and pay the monthly premiums.

When You Can Enroll

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

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

2026/2027 Dental Premiums

*A dependent can be a spouse or a child

2026/2027 Vision Premiums

*A dependent can be a spouse or a child

When comparing plans, look beyond the monthly premium. Your total cost includes:

• Deductible — The amount you must pay for covered health care services before your insurance begins to pay, aside from free preventive services.
• Copays and coinsurance — The amounts you pay when you receive medical services after meeting your deductible.
• Out-of-pocket maximum — The most you will pay for covered services in a calendar year. Once you reach this limit, the plan pays 100% of covered costs for the rest of the year.

For a full explanation of these terms and how they apply to SERS’ plans, review the Member Health Care Guide.

Each health plan has a network of doctors, hospitals, and specialists.

Before enrolling, confirm that your preferred providers participate in the plan. Using out-of-network providers may result in higher costs or services not being covered, depending on the plan.

You can search provider networks using the links below:

• Provider Search for Aetna Medicare Plan (PPO)
• Provider Search for Aetna Choice POS II
• Provider Search for AultCare PPO

Prescription drug coverage varies by plan.

Before enrolling, review each plan’s list of covered prescription drugs to understand:

• Whether your prescriptions are covered
• Whether generic or brand-name drugs are included
• How much you can expect to pay at the pharmacy

Helpful tools include:

• Will My Prescription Drugs Be Covered?
• Prescription Medication Cost Estimate