Medical HDHP + HSA

Need help choosing a medical plan option?

If you are enrolled or planning to enroll in Medicare, read the flyer available to download below before enrolling in one of our medical plan options.

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

The OhioHealthy HDHP+HSA 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.

OhioHealthy HDHP coverage

	OhioHealth Pharmacies	Participating Pharmacies	Non-Participating Pharmacies
	Tier 1 (In-Network Preferred)	Tier 2 (In-Network)	Tier 3 (Out-of-Network)
	Tier 1 Network Examples Include:	Tier 2 Network Examples Include:	Tier 3 Network 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	Fairfield Medical Center, Licking Memorial Hospital, Holzer Hospital, Genesis Hospital, and out-of-area claims (PHCS Practitioner and Ancillary network and all facilities)	Ohio State University (OSU), Mount Carmel Health System, Avita Health System, Adena Regional Medical Center, and Marietta Memorial
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
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.

To find what Tier your provider is in, go to OhioHealthyPlans.com or call the OhioHealthy Member Advocates at (888) 841.5670.

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.

How Health Savings Accounts (HSAs) work

Your HSA, your dollars
Your HSA funds stay with you, even when you leave OhioHealth or retire.

Triple tax advantages
Your contributions are not taxed, the interest you earn is not taxed, and the dollars you spend on qualified healthcare expenses (including your deductible) is not taxed.

OhioHealth helps you save
You make contributions by payroll deductions and OhioHealth will match your contributions up to a maximum based on the number of people you cover.

Invest and earn interest
You can earn interest if you choose to invest your HSA funds.

You decide how and when to spend
You decide whether to use your funds to pay for your share of your healthcare expenses (your deductible, prescription medications, and even dental or vision expenses) - or you can choose to pay another way and save your funds for the future or retirement. HealthEquity provides a Debit Card for ease of payment.

Get early access with Balance Booster
You can access both your own and OhioHealth’s contributions to your HSA early, which means your entire HSA contribution for the year can be available to you earlier in the calendar year, if you need it. Download the Balance Booster User Guide below for more information.

No “use it or lose it” rule
Any unused funds stay in your HSA so you can use them in the future. You could use your HSA like a retirement savings account just for healthcare expenses not covered by Medicare when you retire or become Medicare-eligible.

Making contributions

During annual enrollment and at any time during the year, you can start, stop or change your own HSA contributions. To change your contributions:

Log in to Workday at https://wd5.myworkday.com/ohiohealth
Click on the Benefits icon
Select 'Change-Benefits'
Select the 'HSA Change' benefit event

If you want to make a lump sum contribution, log in to the HealthEquity website or call 1 (844) 311.9730.

Health Savings Account (HSA) Employer Match

HDHP+HSA	Maximum Annual Match
Associate only	up to $250
Associate + 1	up to $375
Associate + 2 or more	up to $500

IRS HSA maximums for 2023

There are IRS-established annual maximums on the combined total of how much you and OhioHealth can contribute to your HSA:

Who is covered?	IRS maximum*
Associate only	$3,850
Associate + 1 or more	$7,750

* If you will be age 55 or older this tax year, you are eligible to contribute an additional $1,000.
Note: These maximums include OhioHealth’s matching contribution.

Previous HSAs or IRA funds

If you have another HSA from a prior employer that you would like to combine with your HealthEquity HSA or funds in an IRA you would like to roll over, log in to the HealthEquity website or call 1 (844) 311.9730.

Visit the HealthEquity website to:

Learn more about HSAs
Use calculators to see how much you can save into your HSA and on your taxes
Learn how to invest your HSA funds to earn interest
Find out what healthcare expenses you can cover with your HSA

How much does this benefit cost?

	Associate cost per pay period
	Full-time rates		Part-time rates*
Coverage type	No discounts earned	All discounts earned	No discounts earned	All discounts earned
Associate only	$77	$47	$92	$62
Associate + spouse	$218	$188	$245	$215
Associate + child	$136	$106	$164	$134
Associate + children	$154	$124	$188	$158
Family	$235	$205	$268	$238

*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.

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 Insurance, Accident 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