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2006-2007
BENEFITS
COMPARISON
CHART

*Plan pays 100 percent of eligible expenses after you reach the out-of-pocket maximum.
**Please note the only plan with an out-of-network benefit is Ohio Med.

Some Helpful Terms to Know

Balance Billing - Non-network providers may not accept the Ohio Med PPO’s benefit allowance as payment in full. They can bill you the difference between their charge and Ohio Med’s benefit allowance in addition to any coinsurance for which you may be responsible.

Coinsurance - The percentage of the cost of a service that you will be billed. In the Ohio Med PPO, the percentage of coinsurance you must pay depends on whether you use network (20 percent) or non-network (40 percent) providers.

Copayment or Copay - A set dollar amount you pay before you receive certain services or products, such as office visits or drugs.

CAD - Coronary Artery Disease

CHF - Congestive Heart Failure
 
  COPD - Chronic Obstructive Pulmonary Disease.

Deductible - The amount you must pay out of your own pocket for services in the Ohio Med PPO plan each year before the plan begins paying benefits. Office visits and drug benefits are covered before the deductible is met upon payment of the applicable copay and those copays do not go toward satisfying the deductible.

Formulary - A preferred drug list from which a physician may prescribe. See page 11.

Health Management Program - A program for a specific disease designed to help those with the disease to better cope. Also “disease management.”

  Out-of-Pocket Maximum - The total amount you must pay out of your own pocket — including copayments, coinsurance and deductibles — for covered services before your plan starts to pay 100 percent of covered medical expenses during the rest of the plan year except for set-dollar amount copays.

PUD - Peptic Ulcer Disease

 

 

 

 

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