2025 Plan Coverage Documents

Review these plan documents for a detailed explanation of coverage. Contact the plan administrator with coverage questions.

Documents will be posted as they become available from the plans.

Health care program

• STRS Ohio Health Care Program Guide
• Dental and Vision Plans

Medical

All enrollees

• Aetna Member Notice

Aetna Medicare Plan

All enrollees

• Access2Care Transportation Benefit

PPO enrollees

• Annual Notice of Changes (Medicare Parts A & B)
• Schedule of Cost Sharing & Evidence of Coverage (Medicare Parts A & B)

• Annual Notice of Changes (Medicare Part B-Only)
• Schedule of Cost Sharing & Evidence of Coverage (Medicare Part B-Only)

ESA PPO enrollees

• Annual Notice of Changes (Medicare Parts A & B)
• Schedule of Cost Sharing & Evidence of Coverage (Medicare Parts A & B)

• Annual Notice of Changes (Medicare Part B-Only)
• Schedule of Cost Sharing & Evidence of Coverage (Medicare Part B-Only)

Aetna Basic Plan

• PPO Summary of Benefits and Coverage
• Indemnity Summary of Benefits and Coverage
• Transform Oncology Program

Aetna Basic Health Care Assistance Plan (HCAP)

• PPO Summary of Benefits and Coverage
• Indemnity Summary of Benefits and Coverage

Prescription

All enrollees

• Mail Service Order Form

SilverScript (Medicare enrollees)

• Notice of Medicare Part D Creditable Coverage

CVS Caremark (non-Medicare enrollees)

• Prescription Medication Plan Description

Dental and vision

Delta Dental

• Special Health Care Needs Benefit

Vision Service Plan (VSP)

• Evidence of Coverage
• Special Offers on Glasses, Contacts, LASIK & More