Information provided below regards Medical benefits effective July 1, 2013.

Click here to see Medical information in effect prior to July 1, 2013.

The State of Ohio provides you with quality, affordable and competitive medical benefits as a part of your total compensation package.

Each state employee who chooses medical coverage will be enrolled in the Ohio Med PPO plan. The plan is managed by two third-party administrators (TPAs), Medical Mutual of Ohio (MMO) and UnitedHealthcare (UHC). Each TPA serves specific regions in Ohio based upon home ZIP codes. The administrator you are assigned is based on the first three digits of your home ZIP code. Click the image below to enlarge.



Click the links below to access the information you need quickly.

Costs of Coverage
What's Covered?
Enrollment
TPA Information
Health Management Program Take Charge! Live Well!
Coordination of Benefits

myBenefits through myOhio.gov
Summary of Benefits and Coverage

Costs of Coverage (Click to enlarge the image)

Out-of-Pocket Costs

Full-time vs. Part-Time
Full-time employees pay 15 percent of the rate established by the state.

The percentage that part-time employees pay toward their premium is based on the average hours in active pay status. Average hours in active pay status shall be calculated semi-annually on the basis of 13 pay periods, which start with the pay period that includes January 1 or July 1, respectively.

  What's Covered?

The list above is not all-inclusive.  Please refer to the plan documents for more details.

Enrollment

Enrolling at Hire
You can enroll by using myOhio.gov and clicking on myBenefits or by submitting a completed Benefit Enrollment/Change Form (ADM 4717) for medical coverage to your agency within 31 days of your date of hire. If you do not enroll within this time frame, you must wait until the next open enrollment period or until you experience a change in status/qualifying event. Documentation will be required for enrolling dependents. For information, visit  das.ohio.gov/EligibilityRequirements.

Medical coverage begins on the first day of the month following the month of your date of hire, regardless of when your start date falls and regardless of when your 31-day deadline falls.

Enrolling/Making Changes During Open Enrollment
You may enroll or add/drop dependents during the open enrollment period. You can enroll by by using myOhio.gov and accessing myBenefits or by submitting a completedBenefit Enrollment/Change Form (ADM 4717) for medical coverage to your agency during the open enrollment period. Coverage becomes effective on the first day of the next benefit period, which begins July 1). Documentation will be required for adding dependents. For information about dependent eligibility requirements, visit das.ohio.gov/EligibilityRequirements.

Enrolling/Making Changes Due to A Change in Status/Qualifying Event
Under normal circumstances, you cannot change or drop your coverage until open enrollment unless you experience a change in status/qualifying event. Click here for more information. You can enroll by using myOhio.gov and accessing Self-Service or by submitting a completed State of Ohio Benefit Enrollment/Change Form (ADM 4717) for
medical coverage to your agency within 31 days of the event. Documentation will be required for any changes. For information about dependent eligibility requirements, visit das.ohio.gov/EligibilityRequirements.


Third-Party Administrator (TPA) Information

Below are links to the websites, addresses, phone numbers and plan descriptions for the two TPAs. The plan description is a detailed explanation of your benefits. If you have questions about this information, please contact your TPA at the phone number below -- be sure to identify yourself as a State of Ohio enrollee.

Medical Mutual of Ohio (MMO)
Medical Mutual July 1, 2013 Plan Description Coming Soon
Medical Mutual July 1, 2012 Plan Description
Group Number: 228000
PO Box 6018
Cleveland, OH 44124
1-800-822-1152
Medical Mutual’s website

UnitedHealthcare (UHC)
United Healthcare July 1, 2013 Plan Description Coming Soon
UnitedHealthcare July 1, 2012 Plan Description
Group Number: 702097
9200 Worthington Rd.
Westerville, OH 43082
1-877-440-5977
UnitedHealthcare's website

Health Management, Prescription Drug and Behavioral Health Programs
When you enroll in the medical plan, you also will be enrolled in the Take Charge! Live Well! program, the prescription drug program and the behavioral health program.

Click here to learn more about the Take Charge! Live Well! program, including how to receive your incentive for participating.

Click here to learn more about the Prescription Drug program.

Click here to learn more about the Behavioral Health program.


Claims Process
In-Network Providers
If you receive services from a network provider, the provider will submit claims for you. Network providers file claims directly with your third-party administrator (TPA) and then the TPA sends payments directly to the providers.

To ensure fast claim filing, you may wish to contact your TPA to determine if the medical service is covered. Show your identification card to the provider and determine if the provider is in the Ohio Med PPO network. Remember, not all services are covered by the Ohio Med PPO plan. Ineligible expenses are your responsibility.

Non-Network Providers
You may be responsible for filing claims for services received by non-network providers. You also may be responsible for filing claims for services for which you have paid directly.

Use a separate claim form for each person for whom you are filing a claim. Submit the original bills with the claim form and be sure to keep copies for your records. Add your identification number to each bill to speed processing.

Payments for eligible services received at non-network or non-participating providers will be made to you  by check. You must then pay the provider.

Explanation of Benefits
After the claim is paid, your TPA will send you an Explanation of Benefits (EOB) which describes the benefits received, lists the payments to the provider and identifies expenses, if any, for which you are responsible. However, do not make payment to providers based on the EOB information. Make payment based on a bill you receive from your provider.

Claims Appeals
Keep copies of all your bills, claims and correspondence. In some cases, a claim may be denied by your TPA. You have the right to appeal that decision. If you wish to appeal a denied or reduced claim, there are some specific steps to take. Refer to your TPA plan description for details on appealing claims.

Coordination of Benefits (COB)
You and your family members may have coverage under more than one medical plan. The medical plans include a coordination of benefits (COB) provision to eliminate duplication of payment for services. However, there is no COB for prescription medications.

Please refer to your plan description for more details on COB.

Summary of Benefits and Coverage
A requirement of the Affordable Care Act, the Summary of Benefits and Coverage document is a concise four-page document that details simple and consistent information about health plan benefits and coverage.