Medical PPO
Need help choosing a medical plan option?
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