Medical HDHP
Understanding the OhioHealthy HDHP
Our medical plan, administered by OhioHealthy, allows you to access quality healthcare and provides comprehensive coverage.
By choosing in-network providers or specialists, you’ll keep more dollars in your pocket.
Need help choosing a medical plan option?
Get help with ALEX, an interactive online tool that will walk you through your benefit options and provide personal assistance in pointing out what choices make the most sense for you. Ask ALEX here.
OhioHealthy HDHP coverage
| Tier 1 (In-Network Preferred) |
Tier 2 (In-Network) |
Tier 3 (Out-of-Network) |
|
|---|---|---|---|
| Deductible | What you pay before the plan pays: | ||
| Associate only | $1,700 | $3,000 | $4,500 |
| Associate + 1 dependent |
$3,400 |
$4,500 | $6,750 |
| Associate + 2 or more dependents | $4,000 | $6,000 | $9,000 |
| Out-of-Pocket Maximum (OOPM) | The most you’ll pay out-of-pocket in a plan year: | ||
| Associate only | $3,500 | $6,500 | Unlimited |
| Associate + 1 dependent | $6,750 | $9,750 | Unlimited |
| Associate + 2 or more dependents | $9,000 | $13,000 | Unlimited |
| Covered Services | What you pay for certain services: | ||
| Preventive care | 0% (plan pays 100% day one) | 0% (plan pays 100% day one) | 50% after deductible |
| Other medical | 10% after deductible | 30% after deductible | 50% after deductible |
| Primary Care Physicians | 10% after deductible | 30% after deductible | 50% after deductible |
| Specialty Care Physicians | 10% after deductible | 30% after deductible | 50% after deductible |
| Telemedicine (Rightway) | 10% after deductible ($0 copay in 2026) |
10% after deductible | Not covered |
| Urgent care | 10% after deductible | 30% after deductible | 50% after deductible |
| ER | 10% after deductible | 10% after deductible | 10% after deductible |
| Behavioral Health & Substance Use Services | 10% after deductible | 10% after deductible | 50% after deductible |
| Outpatient Surgery at Ambulatory Surgery Center | 10% after deductible | 30% after deductible | 50% after deductible |
| Outpatient Surgery at Acute Care Hospital | 10% after deductible | 30% after deductible | 50% after deductible |
| OhioHealth Pharmacies | Participating Pharmacies | Non-Participating Pharmacies | |
|---|---|---|---|
| Prescriptions (Rx) | What you pay for prescription medications: | ||
| Tier 1 | 10% after deductible | 10% after deductible | 10% + the difference between Allowed Amount and Negotiated Charge |
| Tier 2 | 10% after deductible | 10% after deductible | 10% + the difference between Allowed Amount and Negotiated Charge |
| Tier 3 | Tier 3 medications are not covered unless approved under medical necessity/with a prior authorization. | ||
| Specialty Rx | 10% after deductible | 10% after deductible | Not covered |
| Diabetes & Asthma Rx | 0% after deductible if in Management Program; Tier cost/coinsurance applies if not in program |
Applicable Tier cost/coinsurance |
Tier Coinsurance plus the difference between the Maximum Allowable Amount and the Negotiated Charge |
The three medical plan options offered by OhioHealth and administered by OhioHealthy now have a three-tier provider and facility network structure (Tier 1, Tier 2 and Tier 3). Depending on what provider and/or facility you use, your out-of-pocket costs may be different. You’ll save the most money when using Tier 1 providers and facilities.
Download the Medical Plan Tier Overview
To find what Tier your provider is in, go to OhioHealthyPlans.com or call the OhioHealthy Member Advocates at 1 (855) 571-1378.
Tier 1 Network (in-network preferred) examples include: OhioHealth Physician Group (OPG), Clinically Integrated Network (CIN), Columbus Ohio Primary Care (COPC), Nationwide Children’s Hospital, Cleveland Clinic, and emergency services at any location.
Tier 2 Network (in-network) examples include: Fairfield Medical Center, Licking Memorial Hospital, Holzer Hospital, Genesis Hospital, and out-of-area claims (Aetna wrap network).
Tier 3 Network (out-of-network) examples include: Ohio State University (OSU), Mount Carmel Health System, Avita Health System, Adena Regional Medical Center, and Marietta Memorial.
HSA (Health Savings Account)
When you enroll in the OhioHealthy HDHP medical plan option, you get access to a special tax-advantaged savings account with matching contributions from OhioHealth – a Health Savings Account (HSA), administered by Fidelity. Very simply, save dollars to pay for future out-of-pocket healthcare expenses, with help from OhioHealth, and reduce your taxable income.
How much does this benefit cost?
Full-time rates
| 2026 Associate cost per pay period | ||
|---|---|---|
| Coverage type | No discounts earned | All discounts earned |
|
Associate only |
$85 |
$50 |
|
Associate + spouse |
$213 |
$178 |
|
Associate + child(ren) |
$162 |
$127 |
|
Family |
$289 |
$254 |
Part-time rates*
| 2026 Associate cost per pay period | ||
|---|---|---|
| Coverage type | No discounts earned | All discounts earned |
|
Associate only |
$100 |
$65 |
|
Associate + spouse |
$250 |
$215 |
|
Associate + child(ren) |
$190 |
$155 |
|
Family |
$340 |
$305 |
*48-63 scheduled hours per pay period
Working spouse surcharge
There is a premium surcharge of $50 per pay period for spouses who are working and eligible for medical coverage through a different employer. This surcharge is in addition to the premium cost for whatever plan you elect that includes a spouse: associate + spouse and family plans. This surcharge encourages those participants eligible for other group health insurance through their employer to take advantage of that coverage. Like many other employers, the working spouse premium surcharge is one way to manage ongoing healthcare costs, now and into the future.
Do you and your spouse both work for OhioHealth? If you and your spouse work for OhioHealth, then the surcharge does not apply. The surcharge is only applicable if your spouse has medical coverage options through an employer other than OhioHealth.
Watch a video about the spouse surcharge
Enrolling in Medicare?
If you are enrolled or planning to enroll in Medicare, read the special notice flier before enrolling in one of our medical plan options.
How to make the most of this benefit
- Need care? Consult your Primary Care Physician first.
- Physician not available? Call the 24/7 Nurse Advice Line at 1 (844) 834-4375 to get free private advice from a nurse.
- Can’t see your usual physician? Contact Rightway for a virtual visit, where doctors can diagnose your symptoms, prescribe medications and send prescriptions to your pharmacy of choice – great if you’re away from home.
- Use urgent care instead of the emergency room for non-emergencies – but always go to the emergency room if it is an emergency and be sure to follow-up with your physician if you have questions or need further care.
- Visit ohiohealthyplans.com to find in-network providers and facilities, and estimate the costs with the treatment cost calculator.
- You’ll pay less for certain services from OhioHealth providers, including lower out-of-pocket costs for visits to one of the plan’s preferred specialists in the OhioHealth Clinically Integrated Network.
- A wide range of preventive care services are available at no cost to you, including annual physical exams, vaccines and tobacco cessation benefits – download the Preventive Care Summary.
- Combine this benefit with a Healthcare Flexible Spending Account if you need to save more for out-of-pocket dental and vision expenses.
- Combine this benefit with Critical Illness Insurance, Accident Insurance or Hospital Indemnity Insurance to help cover out-of-pocket expenses without using your HSA.
- Add dependent coverage – your spouse and any children through the month they turn age 26 are eligible.
- Change your coverage at any time during the year if you have a relevant and qualified change in family status (e.g. you get married and want to add your spouse) – update your elections in Workday.