Laura Ecklar's response to Shirlee Zerkel re: 2007 Healthcare additional info: Higher co-pays, higher out-of-pockets
Laura Ecklar to Shirlee Zerkel, September 18, 2006
Dr. Asbury asked that I respond to your e-mail to him, inquiring about the deductible and copayment changes for 2007. This information was included in the Special Edition of the STRS Ohio Health Care Program News that you referred to, as well as the June Board News. However, in case you no longer have these documents available, I am happy to provide this information below.
Changes to the prescription drug coverage available from Caremark through the Aetna and Medical Mutual Plus and Basic plans and the Paramount plans:
Tier 2 copayment will increase to $30 from $25 at retail.
For 2007, the retail copayments for up to a 30-day prescription will be as follows:
Tier 1 (generic): $10
Tier 2 (select brand-name): $30
Tier 3 (other brand-name): $50
Mail-service copayments will increase for all tiers, from the current levels of $20/$50/$100 to $25/$75/$125.
For 2007, the mail-service copayments for up to a 90-day prescription will be as follows:
Tier 1 (generic): $25
Tier 2 (select brand-name): $75
Tier 3 (other brand-name): $125
The annual out-of-pocket maximum for the Plus plans and the Paramount plans increased to $2,000 from $1,500.
Once an enrollee has paid a total of $2,000 out of pocket in retail and mail-service copayments, that individual will pay nothing for covered drugs for the remainder of the year.
Change to the Basic plans offered through Aetna and Medical Mutual
The Basic Plan will cover preventive services, such as an annual physical, mammogram and colorectal cancer screening at 100% in 2007 (no deductibles or coinsurance costs will apply). Also, the prescription drug maximum annual benefit for the Basic Plan will increase to $5,000 from $3,100 per enrollee. Once STRS Ohio has paid $5,000 in retail and mail-service prescription drug costs for Tier 2 and Tier 3 drugs for an enrollee, that enrollee pays 100% of the full cost of Tier 2 and Tier 3 drugs for the remainder of the year. The enrollee continues to pay only the copayment for Tier 1 drugs. Tier 1 drugs are not subject to maximum benefit.
Changes to the Plus and Basic plans
The annual amount for outpatient alcoholism treatment will be increased to $1,000 from $550.
Coverage for nutritional counseling will be expanded to single conditions that can be impacted by changes in diet. These conditions include diabetes, hypertension, kidney disease and obesity.
There are no changes in medical or prescription drug coverage for the Kaiser and AultCare plans offered through STRS Ohio, and no changes to the Paramount plans except those noted above.
I hope this information is useful to you. If you need anything else, please don’t hesitate to contact us. Thanks!
Changes to the prescription drug coverage available from Caremark through the Aetna and Medical Mutual Plus and Basic plans and the Paramount plans:
Tier 2 copayment will increase to $30 from $25 at retail.
For 2007, the retail copayments for up to a 30-day prescription will be as follows:
Tier 1 (generic): $10
Tier 2 (select brand-name): $30
Tier 3 (other brand-name): $50
Mail-service copayments will increase for all tiers, from the current levels of $20/$50/$100 to $25/$75/$125.
For 2007, the mail-service copayments for up to a 90-day prescription will be as follows:
Tier 1 (generic): $25
Tier 2 (select brand-name): $75
Tier 3 (other brand-name): $125
The annual out-of-pocket maximum for the Plus plans and the Paramount plans increased to $2,000 from $1,500.
Once an enrollee has paid a total of $2,000 out of pocket in retail and mail-service copayments, that individual will pay nothing for covered drugs for the remainder of the year.
Change to the Basic plans offered through Aetna and Medical Mutual
The Basic Plan will cover preventive services, such as an annual physical, mammogram and colorectal cancer screening at 100% in 2007 (no deductibles or coinsurance costs will apply). Also, the prescription drug maximum annual benefit for the Basic Plan will increase to $5,000 from $3,100 per enrollee. Once STRS Ohio has paid $5,000 in retail and mail-service prescription drug costs for Tier 2 and Tier 3 drugs for an enrollee, that enrollee pays 100% of the full cost of Tier 2 and Tier 3 drugs for the remainder of the year. The enrollee continues to pay only the copayment for Tier 1 drugs. Tier 1 drugs are not subject to maximum benefit.
Changes to the Plus and Basic plans
The annual amount for outpatient alcoholism treatment will be increased to $1,000 from $550.
Coverage for nutritional counseling will be expanded to single conditions that can be impacted by changes in diet. These conditions include diabetes, hypertension, kidney disease and obesity.
There are no changes in medical or prescription drug coverage for the Kaiser and AultCare plans offered through STRS Ohio, and no changes to the Paramount plans except those noted above.
I hope this information is useful to you. If you need anything else, please don’t hesitate to contact us. Thanks!
The deductible of $500 per person and the 20% copayment on hospitalization is still in effect for the Plus Plan for 2007. Also, the $1,500 deductible and 20% copayment on hospitalization for the Basic Plan is still in effect for 2007. The only changes for 2007 are the ones I described in my earlier e-mail. Please do not hesitate to contact us if you have further questions. Thanks!
posted by Kathie Bracy at 1:01 PM
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