You've enrolled for benefits, but how do you make the most of them?
You'll find tips under 'How to make the most of this benefit' for each of the benefits shown on this website.
This page provides some extra tips on how to be a smart healthcare consumer - from earning discounts to paying for healthcare!
Earn medical plan discounts
Associates and spouses each have the opportunity to earn OhioHealthy Medical Plan discounts up to $1,170 annually for associate and $2,340 for associate + spouse. The discounts are earned for meeting or taking steps to achieve healthy biometric measures (blood pressure and body mass index).
New associates and their covered spouses hired in 2021 will receive the 2021 discounts automatically. There is no action needed for the first year to earn these discounts.
ALL ASSOCIATES. CHECK YOUR DISCOUNTS
You should log in to Workday to view your discounts in the Pay application to make sure they are correct. Any request for corrections for 2021 discounts must be reported to the HR Resource Center no later than January 8, 2022 to ensure these discounts are properly reported on your Form W-2. Corrections cannot be adjusted after this date.
If you have questions, contact the HR Resource Center at (614) 533.8888 or email HRRC@ohiohealth.com.
Be a smart healthcare consumer
There are things you can do to maximize your healthcare coverage and minimize your out-of-pocket expenses when you need healthcare.
- Know the difference between in-network and out-of-network care to help save on health care expenses. When you use providers that are in-network for medical, dental and vision care, you maximize your plan coverage and pay less.
- Medical plan: The OhioHealthy provider network includes:
- OhioHealthy Preferred
- OhioHealth Clinically Integrated Network for specialists
- OhioHealthy PHCS/Multiplan Network - A national "wrap" network that extends beyond the central Ohio area if associates or dependents live outside of the network area.
- To find a provider, visit ohiohealthyplans.com/ohiohealth
- Prescription Medications: Coverage through the Formulary List/Prescription Drug List (PDL) - find the list and locate in-network pharmacies at OptumRx.com
- Dental: In-network coverage through the Delta Dental Network - find a provider at DeltaDentalOH.com
- Vision: In-network coverage through the VSP Choice Network - find a provider at www.vsp.com
- Medical plan: The OhioHealthy provider network includes:
- Speak to a Nurse for free, 24/7When illnesses or injuries occur after hours or when the physician’s office is closed, OhioHealthy members have the After Hours Nurse Advice Line. Calling the Nurse Advice Line puts you in contact with a professional nurse who can assess your medical situation, advise you as to where to seek care, and if possible, suggest self-care options until you can see your physician. In any life-threatening emergency situation, always go to the closest emergency room or call 911. Call the 24/7 Nurse Advice Line at 1 (844) 834.4375.
- Start with your Primary Care Provider (PCP)Primary care providers, both doctors and nurse practitioners, can take care of your regular medical needs, like annual physicals, health screenings, prescriptions, vaccines, treatments for minor illnesses and injuries, and referrals for specialized care. Your PCP can also help you identify and meet your health goals and help you prevent serious, long-term health conditions. Building a relationship with a consistent provider can help you get care more quickly, better manage your health goals and prevent future illness.
- Talk with a provider virtually with MDLIVEMDLIVE®, an affordable option for talking with a doctor any time, using your computer, smartphone or tablet for a non-emergency, virtual visit. Board-certified doctors can diagnose your symptoms, prescribe medications and send prescriptions to your pharmacy of choice — great if you’re away from home.
Visit ohiohealthyplans.com/ohiohealth and sign in to enroll in MDLIVE or log in to use the service from your computer or smartphone. If you don't have easy online access, you can call 1 (888) 912.1987 and access the MDLIVE service by phone. There is no cost for MDLIVE through June 30, 2021.
- Shop around and compare costsShopping around can help you get the best price for healthcare services.
- Medical plan: Log in at ohiohealthyplans.com/ohiohealth to use the Treatment Cost Calculator to estimate and compare costs for common procedures and services
- Prescription Medications: Visit OptumRx.com to research prices
- Dental: Use the Dental Care Cost Estimator at DeltaDentalOH.com or request a pre-treatment estimate to find out costs before going ahead with treatments
- Set up a Get preventive care routine.It may seem odd to visit the doctor when you’re healthy, but this is actually the best time to maintain your health and catch any potential issues early. A primary care provider offers a wide range of preventative wellness, screening and healthcare services, including annual physicals, annual mammogram and childhood immunizations.Talk to your primary care physician about setting up a preventive care routine for you and your family that is tailored to your specific health needs.Download the Preventive Care Summary below for more information. You can take this document to your annual routine preventive physical exam with your provider so that you can discuss what’s covered by your plan and what's not.
- Get support for your physical, emotional, spiritual, social and financial health with our many well-being programs. Maintain and improve your well-being and earn cash rewards too!
- Call or meet with a member advocate.Dedicated, local member advocates offer concierge-like service to answer questions and solve more complex issues and challenges.
- Download the on-site OhioHealthy representative schedule below for in-person help. Note that the visits will be virtual until we are able to resume an on-site presence.
Paying for medical care
You play an active role in managing your healthcare dollars in our medical plan. Here’s how to pay your share of healthcare claims:
- Visit your healthcare provider (including the Associate Health Clinic) and show your OhioHealthy insurance card — read our tips above on how to 'Be a smart healthcare consumer' when choosing healthcare and providers
- OhioHealthy will process the claim, apply the network discounts, and track your claims toward your deductible and out-of-pocket maximum
- OhioHealthy will send you an Explanation of Benefits (EOB) reflecting the negotiated rates and the appropriate charges based on your healthcare expenses for the year (this is not a bill) — keep track of your EOBs, which IRS may request if you are ever subject to a tax audit; electronic copies are available on the OhioHealthy website
Your healthcare provider will send you a bill for your share of the charges
- If you have not yet met your deductible, you are responsible for 100% of the charges
- If you have met your deductible, you’ll only pay 20% of the discounted in-network charges (or 50% of the non-discounted out-of-network charges)
- If you've met your annual out-of-pocket maximum, the plan will cover in-network charges in full
- In-network preventive care is fully covered by the plan as long as the services are billed as preventive care
- You choose how to pay, using cash/personal funds or a Health Savings Account (HSA)/Healthcare Flexible Spending Account (Healthcare FSA), if enrolled — keep track of your expenses from an HSA/FSA for tax purposes
Glossary of healthcare terms
Below you will find an explanation of common healthcare terms. For a more extensive glossary, visit https://www.healthcare.gov/glossary/.
|Coinsurance||The cost that you pay for a covered healthcare service after you meet your deductible and before you reach the annual out-of-pocket maximum.|
|Copay||Predetermined amounts that you pay for doctors’ office visits, urgent care and certain prescriptions — even if you have not met your deductible (copays do not count toward your deductible, but do count toward your out-of-pocket maximum).|
|Deductible||The dollar amount you must pay toward medical expenses and prescriptions before OhioHealth will pay any expenses.|
|Formulary/Prescription Drug List (PDL)||A list of medications covered by our medical plan, organized into tiers — the higher the tier, the higher the cost of the medication|
|In-network||Providers/facilities that are part of the plan’s network of providers and offer services at negotiated rates. The plan pays a greater share of the cost for in-network health providers than for providers who are out-of-network.|
|Out-of-network||Providers/facilities that are not a part of the plan’s network of providers. You will pay more out of pocket to use out-of-network providers than for in-network providers.|
|Out-of-pocket maximum||The maximum amount you will pay for in-network medical and prescription medication expenses in a plan year. You won’t pay any in-network expenses for the rest of the year if you reach this; OhioHealth will pay 100% of the cost.|
|Premiums||The cost to participate in our medical plan, which is paid for by both OhioHealth and the participant. Premiums vary by plan option and coverage level.|