Medical PPO Assist
The details below reflect 2022 medical plan information for deductibles, out-of-pocket maximums, coinsurance/copays and premiums.
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.
The OhioHealthy PPO Assist is a special version of the OhioHealthy PPO for those with a lower household income, and it has lower premiums and healthcare costs.
You’re eligible to apply for the OhioHealthy PPO Assist if:
- You are regularly scheduled to work at least 48 hours per pay period
- Your household income is less than or equal to the following amounts (as reported on your tax return, IRS Form 1040):
| Number of people in your household: | Annual household income was less than: |
|---|---|
| 1 | $40,770 |
| 2 | $54,930 |
| 3 | $69,090 |
| 4 | $83,250 |
| 5 | $97,410 |
| 6 | $111,570 |
| 7 | $125,730 |
| 8 | $139,890 |
For instructions to apply, please visit the link below in the Downloads section. You will be required to provide your Federal IRS Form 1040 as proof of income.
Need help choosing a medical plan option?
OhioHealthy PPO Assist coverage
| In-network | Out-of-network | |
|---|---|---|
| Annual deductible (maximum of single deductible per person) | $150 for associate only $225 for associate + 1 $300 for associate + 2 or more |
$1,800 for associate only $2,800 for associate + 1 $3,600 for associate + 2 or more |
| Annual out-of-pocket maximum (maximum of single out-of-pocket maximum per person) - you won’t pay any in-network expenses for the rest of the year if you reach this | $1,000 for associate only $1,500 for associate + 1 $2,000 for associate + 2 or more |
Unlimited |
| Preventive care | 0% (plan pays 100%) | 40% of UCR after deductible |
| Other medical | 10% after deductible | 40% of UCR after deductible |
| Primary Care Physicians | $20 copay | 40% of UCR after deductible |
| Specialty Care Physicians | $50 copay | 40% of UCR after deductible |
| Clinically Integrated Network Specialty Care Physicians | $25 copay | Not applicable |
| Telemedicine (Teladoc Health) | $10 copay | Not applicable |
| Urgent care | $35 copay | 40% of UCR after deductible |
| ER | $150 copay | |
| Chiropractic (maximum 20 visits) | 40% | 40% of UCR after deductible |
| Infertility (lifetime maximum $10,000) | 10% after deductible | 40% of UCR after deductible |
| Prescription Medications | ||
| Tier 1: 30-day supply | $5 copay (no deductible) | Pay difference INN vs. OON |
| Tier 1: mail order/90-day supply | $12.50 copay (no deductible) | Not covered |
| Tier 2 | 15% (no deductible) - maximum copay $30/30 days | Pay difference INN vs. OON |
| Tier 3 | 25% (no deductible) - maximum copay $60/30 days | Pay difference INN vs. OON |
| Specialty Rx | 20% (no deductible) - maximum copay $500 | Not covered |
| Diabetes and Asthma Rx | 0% (if in program *) | Pay difference INN vs. OON |
| Infertility Rx | 40% (no deductible) - annual maximum $2,000 | Not covered |
| Mandatory generic | Yes | Not applicable |
* Read more about Prescription Medications coverage.
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 | $71 | $26 | $84 | $39 |
| Associate + spouse | $173 | $83 | $199 | $109 |
| Associate + child | $122 | $77 | $148 | $103 |
| Associate + children | $141 | $96 | $173 | $128 |
| Family | $192 | $102 | $224 | $134 |
How to make the most of this benefit
- Need care? Consult your Primary Care Physician first
- Physician not available? Call the 24/7 Nurse Advice Line at 1 (844) 834.4375 to get free private advice from a nurse
- Can’t see your usual physician? Contact Teladoc Health for a virtual visit, where doctors can diagnose your symptoms, prescribe medications and send prescriptions to your pharmacy of choice - great if you’re away from home
- Use urgent care instead of the emergency room for non-emergencies - but always go to the emergency room if it is an emergency and be sure to follow-up with your physician if you have questions or need further care
- Visit ohiohealthyplans.com/ohiohealth to find in-network providers and facilities, and estimate the costs with the treatment cost calculator
- You’ll pay less for certain services from OhioHealth providers, including lower out-of-pocket costs for visits to one of the plan’s preferred specialists in the OhioHealth Clinically Integrated Network
- A wide range of preventive care services are available at no cost to you, including annual physical exams, vaccines and tobacco cessation benefits - download the Preventive Care Summary
- Combine this benefit with a Healthcare Flexible Spending Account to get eligible out-of-pocket expenses reimbursed
- Combine this benefit with Critical Illness Insurance, Accidental Ca$hback Insurance or Hospital Indemnity Insurance to help cover out-of-pocket expenses without using your Healthcare Flexible Spending Account
- Got an existing Health Savings Account (HSA)? You cannot contribute to an HSA while a member of the OhioHealthy PPO Assist, but you can use dollars in an existing HSA to pay eligible expenses
- 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
For eligibility or application queries
Call the HR Resource Center at (614) 533.8888
Email HRRC@ohiohealth.com
For medical plan questions
The Member Advocates phone number is changing for 2022.
Before December 31, 2021, call: 1 (844) 200.6449
After January 1, 2022, call: 1 (888) 841.5670
Call 1 (844) 200.6449 (Monday - Friday, 8 a.m. - 6 p.m. EST) ohiohealthyplans.com/ohiohealth