Medical Overview
Medical plan basics
Our medical plan, administered by OhioHealthy, allows you to access quality healthcare and provide comprehensive coverage.
Whichever plan option you choose, by choosing in-network providers or specialists, you’ll keep more dollars in your pocket.
This page provides an overview of our medical plan options, before directing you to in-depth information about each one.
Our Medical plan options at a glance
All three of our medical plan options allow you to access comprehensive healthcare from medical experts in central Ohio and across the United States, including preventive care, physician, hospital, emergency room, lab, radiology, prescription drugs, mental health and substance abuse benefits.
Review the plans below to choose what’s best for you.
OhioHealthy HDHP+HSA
For those who want lower premiums and a higher deductible than the OhioHealthy PPO (which you must meet before this plan pays any benefits), and access to a special tax-advantaged savings account with matching contributions from OhioHealth.
OhioHealthy PPO
For those who want higher premiums but a lower deductible (which means the plan pays benefits sooner) than the OhioHealthy HDHP+HSA, and predetermined amounts (copays) to pay for doctors’ office visits, urgent care and certain prescriptions.
OhioHealthy PPO Assist
For those with a lower household income (specific criteria apply), with lower premiums and healthcare costs.
Compare the plans
| Features | OhioHealthy HDHP+HSA | OhioHealthy PPO | OhioHealthy PPO Assist |
|---|---|---|---|
| Comprehensive coverage | Access comprehensive healthcare from medical experts in central Ohio and across the United States, including preventive care, physician, hospital, emergency room, lab, radiology, prescription drugs, mental health and substance abuse benefits | ||
| Lower premiums |  |
– | |
| Lower annual deductible | – | |
|
| Out-of-pocket maximum to limit your healthcare expenses | |
|
|
| Pay out of pocket until you meet your deductible | |
– | – |
| Pay a copay, even if you have not met your deductible | – | |
|
| Contribute to a Health Savings Account (HSA), with matching contributions from OhioHealth | (No “use it or lose it” rule) |
– | – |
| Prescription coverage | |
|
|
| 100% preventive care coverage | |
|
|
| Pay less when you use in-network providers or specialists | |
|
|
| Access to telehealth doctors (Teladoc Health) | |
|
|
| Access to 24/7 Nurse Advice Line | |
|
|
If you are enrolled or planning to enroll in Medicare, read this flyer before enrolling in one of our medical plan options.
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 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 (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.
Let ALEX help you choose a medical plan
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.
Looking for support for Gender Dysphoria?
Our medical plan provides coverage for the treatment of Gender Dysphoria, including psychotherapy, hormone therapy and surgery. Full details are available in your plan’s Summary Plan Description.