Medical HDHP + HSA
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
|Tier 1 |
|Tier 2 |
|Tier 3 |
|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 + 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 + 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|
|OhioHealth Pharmacies||Participating Pharmacies||Non-Participating Pharmacies|
|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.
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 + 1 or more||$7,750|
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 + spouse||$218||$188||$245||$215|
|Associate + child||$136||$106||$164||$134|
|Associate + children||$154||$124||$188||$158|
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
For medical plan questions
For HSA questions
Download the HealthEquity mobile app from your app store