Medical PPO

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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