Medical PPO
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 provide comprehensive coverage.
The OhioHealthy PPO has:
- Higher premiums than the OhioHealthy HDHP+HSA
- A lower deductible than the OhioHealthy HDHP+HSA (which means the plan pays benefits sooner)
- Predetermined amounts (copays) to pay for doctors’ office visits, urgent care and certain prescriptions — even if you have not met your deductible (copays do not count toward your deductible, but do count toward your out-of-pocket maximum)
By choosing in-network providers or specialists, you’ll keep more dollars in your pocket.
OhioHealthy PPO coverage
Annual deductible (maximum of single deductible per person)
| In-network | Out-of-network |
|---|---|
| $500 for associate only $750 for associate + 1 $1,000 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
| In-network | Out-of-network |
|---|---|
| $2,500 for associate only $3,750 for associate + 1 $5,000 for associate + 2 or more | Unlimited |
Preventive care
| In-network | Out-of-network |
|---|---|
| 0% (plan pays 100%) | 50% of UCR after deductible |
Other medical
| In-network | Out-of-network |
|---|---|
| 20% after deductible | 50% of UCR after deductible |
Primary Care Physicians
| In-network | Out-of-network |
|---|---|
| $20 copay | 50% of UCR after deductible |
Specialty Care Physicians
| In-network | Out-of-network |
|---|---|
| $50 copay | 50% of UCR after deductible |
Clinically Integrated Network Specialty Care Physicians
| In-network | Out-of-network |
|---|---|
| $25 copay | Not applicable |
Telemedicine (MDLIVE)
| In-network | Out-of-network |
|---|---|
| $10 copay | Not applicable |
Urgent care
| In-network | Out-of-network |
|---|---|
| $40 copay | 50% of UCR after deductible |
ER
| In-network | Out-of-network |
|---|---|
| $200 copay + in-network deductible & coinsurance (cost you pay after you meet the deductible) | |
Chiropractic (maximum 20 visits)
| In-network | Out-of-network |
|---|---|
| 50% | 50% of UCR after deductible |
Infertility (lifetime maximum $10,000)
| In-network | Out-of-network |
|---|---|
| 20% after deductible | 50% of UCR after deductible |
Prescription Medications - Tier 1, 30-day supply
| In-network | Out-of-network |
|---|---|
| $5 copay (no deductible) | Pay difference INN vs. OON |
Prescription Medications - Tier 1, mail order/90-day supply
| In-network | Out-of-network |
|---|---|
| $12.50 copay (no deductible) | Not covered |
Prescription Medications - Tier 2
| In-network | Out-of-network |
|---|---|
| 20% (no deductible) | Pay difference INN vs. OON |
Prescription Medications - Tier 3
| In-network | Out-of-network |
|---|---|
| 30% (no deductible) | Pay difference INN vs. OON |
Prescription Medications - Specialty Rx
| In-network | Out-of-network |
|---|---|
| 20% (no deductible) — maximum copay $500 | Not covered |
Prescription Medications - Diabetes and Asthma Rx
| In-network | Out-of-network |
|---|---|
| 0% (if in program) | Pay difference INN vs. OON |
Prescription Medications - Infertility Rx
| In-network | Out-of-network |
|---|---|
| 40% (no deductible) — annual maximum $2,000 | Not covered |
Prescription Medications - Mandatory generic
| In-network | Out-of-network |
|---|---|
| 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 (26 pay periods per year) | ||||
|---|---|---|---|---|
| Full-time rates | Part-time rates* | |||
| Coverage type | No discounts earned | All discounts earned | No discounts earned | All discounts earned |
| Associate only | $98 | $53 | $111 | $66 |
| Associate + spouse | $222 | $132 | $248 | $158 |
| Associate + child | $166 | $121 | $192 | $147 |
| Associate + children | $196 | $151 | $228 | $183 |
| Family | $252 | $162 | $284 | $194 |
*48–63 scheduled hours per pay period — Per-Pay Amounts
In 2020, 27% of associates chose the OhioHealthy PPO
How to make the most of this benefit
- Need care? Consult your Primary Care Physician first
- Physician not available? Call the 24/7 Nurse Advice Line at 1 (844) 834.4375 to get free private advice from a nurse
- Can't see your usual physician? Contact MDLIVE for a virtual visit, where doctors can diagnose your symptoms, prescribe medications and send prescriptions to your pharmacy of choice - great if you’re away from home
- Use urgent care instead of the emergency room for non-emergencies — but always go to the emergency room if it is an emergency and be sure to follow-up with your physician if you have questions or need further care
- Visit ohiohealthyplans.com/ohiohealth to find in-network providers and facilities, and estimate the costs with the treatment cost calculator
- You’ll pay less for certain services from OhioHealth providers, including lower out-of-pocket costs for visits to one of the plan's preferred specialists in the OhioHealth Clinically Integrated Network
- A wide range of preventive care services are available at no cost to you, including annual physical exams, vaccines and tobacco cessation benefits — download the Preventive Care Summary below
- Combine this benefit with a Healthcare Flexible Spending Account to get eligible out-of-pocket expenses reimbursed
- Combine this benefit with Critical Illness Insurance, Accident Ca$hback℠ Insurance or Hospital Indemnity Insurance to help cover out-of-pocket expenses without using your Healthcare Flexible Spending Account
- Got an existing Health Savings Account (HSA)? You cannot contribute to an HSA while a member of the OhioHealthy PPO, but you can use dollars in an existing HSA contributed to in previous years 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) — read more under Enrollment
For medical plan questions
Call 1 (844) 200.6449 (Monday - Friday, 8 a.m. - 6 p.m. EST)
Download the on-site OhioHealthy representative schedule below for in-person help