Open Enrollment

How the Health Plans Cover Services

The state contracts with six health plans throughout Ohio. Some benefits and features are mandatory for all plans, although the plans may customize the
benefit or feature.

Benefits Schedule
This chart shows how benefit features compare across the health plans.

*These amounts do not include balance-billing from non-network providers.

Core Benefits
Because you are a state employee, each of the health plans covers the following eligible and medically approved services at the same levels. It doesn’t matter which health plan you choose.

Physician Office Visits
You pay a $15 copayment when you visit the doctor.

Your plan pays benefits for eligible services you receive from providers based on your individual plan’s benefit schedule. For example, in the Ohio Med PPO, the plan pays 80 percent for procedures done in a network provider’s office. The same is true for HMOs; however, there is no annual deductible in HMO plans.

If you are in the Ohio Med PPO and use a non-network provider, your office visit payment is $30, and the plan covers 60 percent of the charges for additional eligible services you receive.

Well Child Care
All plans cover the full costs for routine, annual physical exams for children through age 6, another between 7 and 9, one at age 12 and another between ages 13 and 18. Childhood immunizations are covered in full through age 16.

Routine Physical Examinations
You pay a $15 copayment when you have a routine physical exam by a network physician. However, if you are in the Ohio Med PPO and use a non-network physician, your copayment is $30 and the maximum benefit payable is $150.

Hospice Services
All plans pay 100 percent of hospice services charges. You do not have to pay a copayment, and there are no time or dollar limitations.


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12 CORE BENFITS FOR ALL HEALTH PLANS New for June 2006 to July 2007: • Durable medical equipment, skilled nursing home and home health care benefits paid at 80 percent regardless of plan.	How the Health Plans Cover Services The state contracts with six health plans throughout Ohio. Some benefits and features are mandatory for all plans, although the plans may customize the benefit or feature. Benefits Schedule This chart shows how benefit features compare across the health plans. These amounts do not include balance-billing from non-network providers. Core Benefits* Because you are a state employee, each of the health plans covers the following eligible and medically approved services at the same levels. It doesn’t matter which health plan you choose. Physician Office Visits You pay a $15 copayment when you visit the doctor. Your plan pays benefits for eligible services you receive from providers based on your individual plan’s benefit schedule. For example, in the Ohio Med PPO, the plan pays 80 percent for procedures done in a network provider’s office. The same is true for HMOs; however, there is no annual deductible in HMO plans. If you are in the Ohio Med PPO and use a non-network provider, your office visit payment is $30, and the plan covers 60 percent of the charges for additional eligible services you receive. Well Child Care All plans cover the full costs for routine, annual physical exams for children through age 6, another between 7 and 9, one at age 12 and another between ages 13 and 18. Childhood immunizations are covered in full through age 16. Routine Physical Examinations You pay a $15 copayment when you have a routine physical exam by a network physician. However, if you are in the Ohio Med PPO and use a non-network physician, your copayment is $30 and the maximum benefit payable is $150. Hospice Services All plans pay 100 percent of hospice services charges. You do not have to pay a copayment, and there are no time or dollar limitations.