MEDICAL MUTUAL OF OHIO
The Guardians offer three medical PPO health plans and a NEW High-Deductible Health Plan for you and your eligible dependents. Each is structured a little differently and are available based on your employee status. Please review which plans are available to you. All of our programs are offered through Medical Mutual of Ohio and utilize the SuperMed PPO Network.
Network – SuperMed PPO
Broad network with access to nearly every healthcare professional in Ohio and 99% of the hospitals
Kentucky: Boone, Campbell and Kenton Counties
· National network through a collaboration with AXA, a global healthcare company
· Access to the Cigna Network for members residing or travelling outside of the SuperMed service area
· Member ID card indicates where to get care and how providers can submit claims for payment
· No referrals required
You have choices when looking for an in-network doctor or hospital before and after you enroll
· 24/7 digital access
o Download our mobile app on your smart phone or visit MedMutual.com
· Call our friendly and helpful Customer Care team for assistance at 1-800-362-5200
o Mon. – Thurs. – 7:30 a.m. to 7:30 p.m. (EST)
o Fri. – 7:30 a.m. to 6:00 p.m. (EST)
o Sat. – 9:00 a.m. to 1:00 p.m. (EST)
PPO MEDICAL PLANS
Our medical plans allows you to visit any physician or healthcare provider you wish without first requiring a referral from a primary care physician. No matter which healthcare provider you choose, in-network healthcare services will be covered at a higher benefit level than out-of-network services. It’s important to check if your provider accepts your health plan so you receive the highest level of benefit coverage.
For a list of in-network doctors, click here Medical Mutual of Ohio – Select Type Of Care And Year (medmutual.com).
Prescriptions are covered at a copay. In-network pharmacies will be covered at a higher level of benefit than out-of-network pharmacies. Please refer to your ID card for your network of pharmacies.
You are also eligible to contribute to the Medical Flexible Spending Account (FSA) that provides tax advantages and can be used to cover the costs of your deductible and copays.
Resources
Resource information is subject to carrier updates
Grandfathered Plan
This plan is only available to full-time team members currently enrolled on the plan and includes dental & vision.
In-Network |
Out-of-Network |
|
| Plan Design | ||
| Deductible | $400 / $800 | $800 / $1,600 |
| Maximum Out-of-Pocket | $1,000 / $2,000 | $2,000 / $3,500 |
| Primary Care Visits | $10 Copayment | 30% after deductible |
| Preventive Care |
$10 Copayment | 30% after deductible |
| Specialist Visits | $10 Copayment | 30% after deductible |
| Emergency Room | $50 Copayment + 10% | $50 Copayment + 10% |
| Urgent Care | $10 Copayment | 30% after deductible |
| Rx Retail Copays | ||
| Generic | 20% after deductible | Not covered |
| Preferred Brand | 20% (no generic manufactured) | |
| Non-Preferred Brand | 20% of generic cost plus the difference between brand and generic |
|
| Rx Mail Order | ||
| Generic | 20% after deductible | Not covered |
| Preferred Brand | 20% (no generic manufactured) | |
| Non-Preferred Brand | 20% of generic cost plus the difference between brand and generic | |
Per Plan Rates
| Coverage | Per Pay Contribution (3-in-1) | Per Pay Contribution (3-in-1) |
| Non-Tobacco Use | Tobacco Use | |
| Employee | $160.28 | $190.28 |
| 2-Person | $178.10 | $208.10 |
| Family | $208.62 | $238.62 |
Option 2
ACA COMPLIANT PLAN. AVAILABLE TO ALL FULL-TIME TEAM MEMBERS AND INCLUDES DENTAL & VISION.
In-Network |
Out-of-Network |
|
| Plan Design | ||
| Deductible | $600 / $1,200 | $2,000 / $4,000 |
| Coinsurance Limit | $1,250 / $2,500 | $2,500 / $5,000 |
| Maximum Out-of-Pocket | $6,600 / $13,200 | Unlimited / Unlimited |
| Primary Care Visits | No Charge | 40% after deductible |
| Preventive Care |
$15 Copayment | 40% after deductible |
| Specialist Visits | $15 Copayment | 40% after deductible |
| Emergency Room | $200 Copayment + 20% | $200 Copayment + 20% |
| Urgent Care | $15 Copayment | 40% after deductible |
| Rx Retail Copays | ||
| Generic | 20% after deductible | Not covered |
| Preferred Brand | 20% (no generic manufactured) | |
| Non-Preferred Brand | 20% of generic cost plus the difference between brand and generic |
|
| Rx Mail Order | ||
| Generic | 20% after deductible | Not covered |
| Preferred Brand | 20% (no generic manufactured) | |
| Non-Preferred Brand | 20% of generic cost plus the difference between brand and generic | |
Per Plan Rates
| Coverage | Per Pay Contribution (3-in-1) | Per Pay Contribution (3-in-1) |
| Non-Tobacco Use | Tobacco Use | |
| Employee | $119.57 | $147.26 |
| 2-Person | $137.39 | $165.08 |
| Family | $167.93 | $195.62 |
Plan B – Medical and Rx Only (no dental or vision)
This plan is medical only. Dental & vision must be purchased separately.
In-Network |
Out-of-Network |
|
| Plan Design | ||
| Deductible | $1,000 / $2,000 | $2,000 / $4,000 |
| Maximum Out-of-Pocket | $6,350 / $12,700 | Unlimited / Unlimited |
| Primary Care Visits | 30% after deductible | 50% after deductible |
| Preventive Care |
No Charge | 50% after deductible |
| Specialist Visits | 30% after deductible | 50% after deductible |
| Emergency Room | $200 Copayment + 30% | $200 Copayment + 30% |
| Urgent Care | 30% after deductible | 50% after deductible |
| Rx Retail Copays | ||
| Generic | 30% after deductible | Not covered |
| Preferred Brand | 30% (no generic manufactured) | |
| Non-Preferred Brand | 30% of generic cost plus the difference between brand and generic |
|
| Rx Mail Order | ||
| Generic | 30% after deductible | Not covered |
| Preferred Brand | 30% (no generic manufactured) | |
| Non-Preferred Brand | 30% of generic cost plus the difference between brand and generic | |
Per Plan Rates
| Coverage | Per Pay Contribution | Per Pay Contribution |
| Non-Tobacco Use | Tobacco Use | |
| Employee | $81.42 | $106.80 |
| 2-Person | $99.23 | $124.61 |
| Family | $109.42 | $134.78 |
High-Deductible Health Plan (HDHP)
A High-Deductible Health Plan (HDHP) is a health insurance plan that has a lower monthly premium but a higher deductible. With an HDHP, you’ll see less money taken out of your paycheck, but you’ll pay more out of pocket when you need medical care—especially before your insurance coverage kicks in. Unlike a Preferred Provider Organization (PPO) plan, you generally won’t have flat copays for doctor visits or prescriptions; instead, you pay the full cost of care until you meet your deductible. However, an HDHP can be paired with an HSA, which allows you to set aside money for qualified medical expenses on a pre-tax basis.
Health Savings Accounts (HSA)
A Health Savings Account (HSA) is a special savings account you can use to pay for health care costs. You don’t pay federal income tax on the money you deposit, and when you use your HSA to pay for qualified medical expenses, you don’t pay tax on those withdrawals either. To open an HSA, you must be enrolled in a High-Deductible Health Plan (HDHP). For more information, please visit the HSA page.
This plan is available to all benefits eligible team members and includes dental & vision.
In-Network |
Out-of-Network |
|
| Plan Design | ||
| Deductible | $3,500 individual / $7,000 family | $7,000 individual / $14,000 family |
| Maximum Out-of-Pocket | $3,500 individual / $7,000 family | unlimited individual / unlimited family |
| Coinsurance |
0% after Deductible | 40% after Deductible |
| Primary Care Visits | 0% after Deductible | 40% after Deductible |
| Preventive Care |
No Charge | 40% after Deductible |
| Specialist Visits | 0% after Deductible | 40% after Deductible |
| Inpatient Visit |
0% after Deductible | 40% after Deductible |
| Outpatient Services | 0% after Deductible | 40% after Deductible |
| Emergency Room | 0% after Deductible | 0% after Deductible |
| Urgent Care | 0% after Deductible | 40% after Deductible |
| Rx Retail Copays | ||
| Generic | 0% after Deductible | 40% after Deductible |
| Preferred Brand | 0% after Deductible | 40% after Deductible |
| Non-Preferred Brand | 0% after Deductible | 40% after Deductible |
| Specialty |
0% after Deductible | 40% after Deductible |
| Rx Mail Order | ||
| Generic | 0% after Deductible | Not Covered |
| Preferred Brand | 0% after Deductible | Not Covered |
| Non-Preferred Brand | 0% after Deductible | Not Covered |
| Specialty |
0% after Deductible | Not Covered |
Per Plan Rates
| Coverage | Per Pay Contribution (3-in-1) | Per Pay Contribution (3-in-1) |
| Non-Tobacco Use | Tobacco Use | |
| Employee | $58.16 | $81.24 |
| 2-Person | $70.88 | $93.96 |
| Family | $78.14 | $101.22 |