Medical PPO Assist

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	$31,900
2	$43,100
3	$54,300
4	$65,500
5	$76,700
6	$87,900
7	$99,100
8	$110,300

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?

Ask ALEX

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

UCR = Usual, customary, and reasonable, INN = In-network, OON = Out-of-network

* 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

*48-63 scheduled hours per pay period - Per-Pay Amounts

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