Medical HDHP

Understanding the OhioHealthy HDHP

Our medical plan, administered by OhioHealthy, allows you to access quality healthcare and provides comprehensive coverage.

The OhioHealthy HDHP has:

  • Lower premiums than the OhioHealthy PPO
  • A higher deductible than the OhioHealthy PPO (which you must meet before this plan pays any benefits)
  • Access to a special tax-advantaged savings account with matching contributions from OhioHealth – a Health Savings Account (HSA)

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 $2,000 $3,000 $4,500
Associate + 1 dependent $3,000 $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 $4,500 $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 (Teladoc) 10% after deductible 30% 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 10% after deductible 10% after deductible 10% + the difference between Allowed Amount and Negotiated Charge
Specialty Rx 10% after deductible 10% after deductible Not covered
Diabetes & Asthma Rx 0% after deductible, if in Management Program; 10% if not in program 10% after deductible 10% + the difference between Allowed Amount and Negotiated Charge

Three-tier provider & facility network

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 (888) 841.5670.

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 (PHCS Practitioner and Ancillary network and all facilities).

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.

Watch a short video on the three-tier provider & facility network structure.

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 HealthEquity. Very simply, save dollars to pay for future out-of-pocket healthcare expenses, with help from OhioHealth, and reduce your taxable income.

Learn More

How much does this benefit cost?

Full-time rates

  2023 Associate cost per pay period 2024 Associate cost per pay period
Coverage type No discounts earned All discounts earned No discounts earned All discounts earned

Associate only

$77

$47

$72

$37

Associate + spouse

$218

$188

$213

$178

Associate + child

$136

$106

$131

$96

Associate + children

$154

$124

$149

$114

Family

$235

$205

$230

$195

Part-time rates*

  2023 Associate cost per pay period 2024 Associate cost per pay period
Coverage type No discounts earned All discounts earned No discounts earned All discounts earned

Associate only

$92

$62

$87

$52

Associate + spouse

$245

$215

$240

$205

Associate + child

$164

$134

$159

$124

Associate + children

$188

$158

$183

$148

Family

$268

$238

$263

$228

*48-63 scheduled hours per pay period

Working spouse surcharge

There is a premium surcharge of $70 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 short video on the working 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 Teladoc Health 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.
  • Need to cover a large healthcare expense? You can get early access to both your own and OhioHealth’s contributions to your HSA using Balance Booster – download the Balance Booster User Guide.
  • 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 InsuranceAccident Ca$hback℠ 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.