Medical PPO

The details below reflect 2022 medical plan information for deductibles, out-of-pocket maximums, coinsurance/copays and premiums.

Click here for 2023 plan information

Need help choosing a medical plan option?

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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

In-network Out-of-network
Annual deductible (maximum of single deductible per person) $700 for associate only
$1,150 for associate + 1
$1,600 for associate + 2 or more
$3,000 for associate only
$4,500 for associate + 1
$5,600 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 $2,700 for associate only
$4,150 for associate + 1
$5,600 for associate + 2 or more
Unlimited
Preventive care 0% (plan pays 100%) 50% of UCR after deductible
Other medical 20% after deductible 50% of UCR after deductible
Primary Care Physicians $20 copay 50% of UCR after deductible
Specialty Care Physicians $50 copay 50% of UCR after deductible
Clinically Integrated Network Specialty Care Physicians $25 copay Not applicable
Telemedicine (Teladoc Health) $10 copay Not applicable
Urgent care $40 copay 50% of UCR after deductible
ER $200 copay + in-network deductible & coinsurance (cost you pay after you meet the deductible)
Chiropractic (maximum 20 visits) 50% 50% of UCR after deductible
Infertility (lifetime maximum $10,000) 20% after deductible 50% of UCR after deductible
Prescription Medications - Tier 1: 30-day supply $5 copay (no deductible) Pay difference INN vs. OON
Prescription Medications - Tier 1: mail order/90-day supply $12.50 copay (no deductible) Not covered
Prescription Medications - Tier 2 20% (no deductible) Pay difference INN vs. OON
Prescription Medications - Tier 3 30% (no deductible) Pay difference INN vs. OON
Prescription Medications - Specialty Rx 20% (no deductible) — maximum copay $500 Not covered
Prescription Medications - Diabetes and Asthma Rx 0% (if in program*) Pay difference INN vs. OON
Prescription Medications - Infertility Rx 40% (no deductible) — annual maximum $2,000 Not covered
Prescription Medications - 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 $102 $57 $116 $71
Associate + spouse $252 $162 $278 $188
Associate + child $174 $129 $201 $156
Associate + children $205 $160 $239 $194
Family $282 $192 $314 $224

*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, 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 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 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