Premiums

The premium you pay for SERS’ health care coverage includes medical and prescription drug coverage.

Premiums are based on:

  • Years of qualified service credit
  • Eligibility for a premium subsidy
  • Health care plan selected

If you enroll in dental and/or vision coverage, you will be charged additional premiums.

SERS automatically deducts the premiums for you and any dependents from your monthly payment.

If your payment is not enough to cover your premiums, SERS will bill you for the remaining balance each month. The billed amount can be automatically deducted from your bank account. If you are interested in having your premiums automatically deducted, you must complete a Health Care Automatic Payment Authorization Agreement.

If monthly premiums are not paid, your coverage will be cancelled.


Premium Subsidy

SERS helps reduce health care premiums by providing a subsidy to those who qualify.

To receive 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

Spouse premiums are based on the qualified service credit of the service retiree, disability recipient, or member.


Non-Medicare Plans and Premiums

Plan

Service Area

Premiums

Medical Plan Coverage

Prescription Drug Coverage

Preventive Screenings

Aetna Choice POS II

United States

Non-Medicare Premiums

Aetna Choice POS II Summary of Benefits and Coverage

Express Scripts Guide

2018 Express Scripts Non-Medicare Formulary

2019 Express Scripts Non-Medicare Formulary

Non-Medicare Preventive Screenings

AultCare PPO

In Ohio: Ashland, Belmont, Carroll, Columbiana, Coshocton, Guernsey, Harrison, Holmes, Jefferson, Knox, Mahoning, Medina, Portage, Richland, Stark, Summit, Tuscarawas, and Wayne counties.

Non-Medicare Premiums

AultCare Summary of Benefits and Coverage

AultCare

Non-Medicare Preventive Screenings

SERS Marketplace Wraparound Plan

SERS offers the Marketplace Wraparound Plan, which works in combination with the Health Insurance Marketplace.

You first select a Marketplace plan with the help of a counselor from our plan administrator, HealthSCOPE Benefits. The counselor will help you review the Marketplace plans that are best for you, and assist you in signing up for a plan. The counselor also will tell you whether you are eligible for a federal subsidy to help you pay your Marketplace premium.

The SERS Marketplace Wraparound Plan provides additional benefits to help pay for deductibles, co-pays, and other costs. There is no additional premium for the SERS Wraparound Plan.

To receive the SERS Marketplace Wraparound benefits, you MUST complete the Health Insurance Marketplace enrollment process through HealthSCOPE Benefits.

You are eligible for the Marketplace Wraparound Plan when you are eligible for SERS’ health care coverage. However, this option is NOT available when you:

  • Waive SERS coverage
  • Are eligible for Medicare
  • Are enrolled in Medicaid, or
  • Have a family member enrolled in a SERS Medicare Advantage Plan

For more information on the Marketplace Wraparound Plan, review the SERS Marketplace Wraparound Plan brochure and Summary of Benefits.


Medicare Plans and Premiums

Plan

Service Area

Premiums

Medical Plan Coverage

Prescription Drug Coverage

Preventive Screenings

Aetna Medicare Plan (PPO)

United States

Medicare Premiums

Aetna Medicare PPO Plan Summary

Express Scripts Guide

2018 Express Scripts Medicare Formulary

2019 Express Scripts Medicare Formulary

Medicare Preventive Screenings

Paramount Elite Medicare Advantage

In Ohio: Fulton, Henry, Lucas, Ottawa, Williams, and Wood counties. In Michigan: Lenawee and Monroe counties.

Medicare Premiums

 

Medicare Co-Pays

Paramount Elite Medicare Advantage Plan Summary

Express Scripts Guide

2018 Express Scripts Medicare Formulary

2019 Express Scripts Medicare Formulary

Medicare Preventive Screenings

PrimeTime Health Plan

In Ohio: Carroll, Columbiana, Harrison, Holmes, Jefferson, Mahoning, Stark, Summit, Tuscarawas, and Wayne counties.

Medicare Premiums

 

Medicare Co-Pays

PrimeTime Plan Summary

PrimeTime

Medicare Preventive Screenings


Health Care Premium Discount Program

To apply for the Health Care Premium Discount Program, at least one family member must be enrolled in a SERS Medicare plan, and you must qualify based on your household size and income.

A 25% reduction in your monthly SERS health care premium for medical and prescription drugs is available if your total household income falls at or below qualifying income levels. The discount does not apply to dental and vision premiums.

To receive the discount, your total household income must be at or below the following levels:

Household Size

Qualifying Income

1

$15,175

2

$20,575

3

$25,975

4

$31,375

5

$36,775

6

$42,175

7

$47,575

8

$52,975

To apply, you must complete and sign a Health Care Premium Discount Application and return it to SERS.

Call SERS toll-free at 800-878-5853 to request an application through the mail.

New retirees can submit an application within 90 days of their retirement.