Questions about COVID-19?
Visit coronavirus.ohio.gov or call 1-833-4-ASK-ODH for answers.

 

 

Medical


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


Medical Third-Party Administrators

Anthem and Medical Mutual of Ohio are the medical third-party administrators for the State of Ohio medical plan -- including the Ohio Med PPO (preferred provider organization) and the Ohio Med HDHP (high deductible health plan).

Finding your doctor is as easy as 1-2-3

Whether you are looking for your doctor or checking if a provider (doctor, hospital, urgent care, etc.) is in your network, follow these steps:
Go to das.ohio.gov/medicalTPA:
1. Identify your medical third-party administrator (Anthem or Medical Mutual) by locating the first three digits of your home ZIP code on the chart.
2. Click the provider guide link for your medical third-party administrator.
3. Follow the instructions to access the provider information you need.

About Medical Coverage

Medical Coverage

Medical Contributions

To download the Ohio Med PPO and/or Ohio Med HDHP options in a pdf file, click the link(s) below each chart. 

OHIO MED PPO CONTRIBUTIONS
FULL-TIME EMPLOYEE CONTRIBUTIONS

BIWEEKLY PAID EMPLOYEE CONTRIBUTIONS1
15% TIER

FULL-TIME PERMANENT
PART-TIME PERMANENT (30 OR MORE HOURS A WEEK)
PART-TIME TEMPORARY (30 OR MORE HOURS A WEEK)

MONTHLY PAID EMPLOYEE CONTRIBUTIONS1
15% TIER

FULL-TIME EMPLOYEES

  Employee Share State Share Total Employee Share State Share  Total
Single $53.34 $301.17 $354.51 $115.57 $652.54 $768.11
Family Minus Spouse $146.08 $826.69 $972.77 $316.49 $1,791.13 $2,107.62
Family Plus Spouse2 $155.31 $826.69 $982.00 $336.49 $1,791.13 $2,127.62
PART-TIME EMPLOYEE CONTRIBUTIONS

BIWEEKLY PAID EMPLOYEE CONTRIBUTIONS1
50% TIER

PART-TIME PERMANENT
(20.00 - 29.99 HOURS A WEEK)

BIWEEKLY PAID EMPLOYEE CONTRIBUTIONS1
100% TIER

PART-TIME PERMANENT EMPLOYEES
(UP TO 19.99 HOURS A WEEK)

  Employee Share State Share Total Employee Share State Share Total
Single $177.25 $177.26 $354.51 $354.51 $0.00 $354.51
Family Minus Spouse $486.38 $486.39 $972.77 $972.77 $0.00 $972.77
Family Plus Spouse2 $495.61 $486.39 $982.00 $982.00 $0.00 $982.00

1 These rates represent the total amount that will be contributed from your paycheck.
2 Family Plus Spouse rates above include a charge of $20 per month to cover a spouse. For those who receive paychecks biweekly, the Family Plus Spouse rates above include a charge of $9.23 per pay to cover a spouse.



 

OHIO MED HDHP CONTRIBUTIONS
FULL-TIME EMPLOYEE CONTRIBUTIONS

BIWEEKLY PAID EMPLOYEE CONTRIBUTIONS1
10% TIER

FULL-TIME PERMANENT
PART-TIME PERMANENT (30 OR MORE HOURS A WEEK)
PART-TIME TEMPORARY (30 OR MORE HOURS A WEEK)

MONTHLY PAID EMPLOYEE CONTRIBUTIONS1
10% TIER

FULL-TIME EMPLOYEES

  Employee Share State Share Total Employee Share State Share  Total
Single $35.75 $319.92 $355.67 $77.46 $693.16 $770.62
Single Plus Spouse $80.15 719.53 $799.68 $173.66 $1,558.98 1,732.64
Family Minus Spouse $62.39 $559.69 $622.08 $135.18 $1,212.65 $1,347.83
Family Plus Spouse $106.79 $959.29 $1,066.08 $231.38 $2,078.47 $2,309.85
PART-TIME EMPLOYEE CONTRIBUTIONS

BIWEEKLY PAID EMPLOYEE CONTRIBUTIONS1
50% TIER

PART-TIME PERMANENT
(20.00 - 29.99 HOURS A WEEK)

BIWEEKLY PAID EMPLOYEE CONTRIBUTIONS1
100% TIER

PART-TIME PERMANENT EMPLOYEES
(UP TO 19.99 HOURS A WEEK)

  Employee Share State Share Total Employee Share State Share Total
Single $177.83 $177.84 $355.67 $355.67 $0.00 $355.67
Single Plus Spouse $399.84 $399.84 $799.68 $799.67 $0.00 $799.68
Family Minus Spouse $311.04 $311.04 $622.08 $622.08 $0.00 $622.08
Family Plus Spouse $533.04 $533.04 $1,066.08 $1,066.08 $0.00 $1,066.08
1 These rates represent the total amount that will be contributed from your paycheck.


 

What is Covered

• Allergy testing and treatment;
• Ambulance service;
• Breastfeeding support, supplies and counseling;
• Chiropractic services;
Diabetes Management Program;
• Dietitian services;
• Durable medical equipment;
• Emergency room;
• Hearing loss;
• Home health care;
• Hospice services;
• Immunizations;
• Infertility testing;
• Inpatient and outpatient services;
• Maternity - Delivery;
• Maternity - Prenatal care;
• Mental health and substance abuse;
• Physical, occupational and speech Therapy (Includes coverage for Autism Spectrum Disorder);
• Prescription medications;
• Preventive care;
• Prostheses;
• Radiological services;
• Skilled nursing facility;
• Urgent care; and
• Well child care.

This list is not all-inclusive. Refer to the plan documents for further details.

Comparing the Ohio Med PPO and Ohio Med HDHP Plans

ONE MEDICAL PLAN*: OHIO MED
TWO PLAN DESIGNS: OHIO MED PPO AND OHIO MED HDHP

What is covered in each plan design is similar. What is different is how the plan is administered as well as costs.

What is a Preferred Provider Organization?
A Preferred Provider Organization (PPO) is a medical plan that offers benefits at both in-network and out-of-network levels with set copay amounts for certain services. When you enroll in the Ohio Med PPO, you may visit any doctor and receive benefits. However, the coverage amount is greater when you use in-network providers.

What is a High Deductible Health Plan?
A High Deductible Health Plan (HDHP) is a medical plan that offers benefits at both in-network and out-of-network levels with a higher deductible and out-of-pocket maximum than the PPO plan. The contribution is usually lower, but you pay more health care costs before the medical third-party administrator starts to pay its share. The HDHP comes with a Health Savings Account (HSA), which allows you to pay for certain medical expenses with money free from federal taxes. 

Employees enrolled in the Limited Purpose FSA can still enroll in the Ohio Med HDHP.
Exclusions from the HDHP: If you or your spouse are currently enrolled in a Flexible Spending Account – Health Care Spending Account for calendar year 2020, neither of you are eligible to enroll in the Ohio Med HDHP. This also applies if you have a carryover balance as of Dec. 31. You also cannot enroll in the HDHP if you are currently enrolled in Medicare or Tricare. You may enroll or remain enrolled in the Ohio Med PPO.

Ohio Med PPO Ohio Med HDHP
• This plan is a Preferred Provider Organization (PPO)
• Has a higher employee contribution, but a lower deductible
• Copay amounts are set for medical services such as a visit to the doctor or hospital, and prescriptions
• Prescription costs are not combined with medical to meet your out-of-pocket maximum
• There is a separate $3,500 single or $7,000 family out-of-pocket maximum that must be met before prescription costs may be paid at 100%
• Each person covered in a family plan must meet the individual deductible or the combined family deductible, whichever occurs first, before the plan begins to pay
• The high deductible health plan (HDHP) includes a Health Savings Account (HSA) with a State contribution to your account 
• Has a lower employee contribution, but a higher deductible
• Initial expenses can be paid by you using the HSA, or you could be reimbursed after a claim has been submitted
• Neither you nor your spouse can currently be enrolled in or have a carryover balance from the previous calendar year in any Flexible Spending Account – Health Care Spending Account
• You can enroll in a Limited Purpose Flexible Spending Account
• Prescription costs are combined with medical to meet your out-of-pocket maximum
• If you are in a family plan, the plan will begin to pay only after the entire family deductible has been met

 

Which Plan is Best for You and Your Family?

Ohio Med PPO could be the best option if you: Ohio Med HDHP could be the best option if you:
• Prefer to know in advance the cost of your copayments, including doctor visits, prescriptions, hospital stays, and medical services
• Anticipate a high-cost medical expense, such as surgery
• Have a chronic condition or a need for frequent doctor visits
• Take a high-cost specialty drug or take multiple prescriptions
• Prefer to actively manage your health care spending by regularly comparing costs and saving for future medical expenses
• Rarely need doctor visits
• Have the ability to pay, up front, the full deductible and out-of-pocket costs for medical expenses at the time that you incur these costs
• Are able to contribute to your Health Savings Account and prefer to save for future medical expenses including expenses after you retire

 

IMPORTANT POINTS ABOUT THE HDHP 
The deductible must be reached first before the plan pays toward any of your medical, pharmacy, or behavioral health costs. If you have family coverage, the plan will begin to pay only after the entire family deductible has been met. This is especially important to understand if a major medical expense or a high-cost specialty drug needs to be covered within the first few days, weeks, or months of the Ohio Med HDHP plan taking effect. 

For example, if your medical coverage would begin on August 1 and an accident would occur on August 4, you should ensure that you can pay the full out-of-pocket cost (including the deductible) for the plan option that you selected: either single coverage at $3,500 or family coverage at $7,000. After you meet your deductible, the plan would cover expenses at 80%. After the full amount of the out-of-pocket maximum is paid, the plan would cover expenses at 100%.

Specialty drugs could have a high cost (even into the thousands of dollars). If you or a dependent already are taking, or could be taking, a specialty drug, use a cost comparison tool at optumbank.com/myohiohsa to determine which is the best medical plan for you. Your deductible is used to pay for the specialty drug before the plan will pay. 

Enrollment in the HDHP is online only. Because the federal guideline for the HSA requires a personal bank account (provided by Optum Bank) managed by you, and because contributions to the HSA are determined by you, enrollment in the Ohio Med HDHP only can be completed online through myOhio.gov

For eligibility details, visit das.ohio.gov/eligibilityrequirements.

HOW HDHP CLAIMS ARE PAID
Doctor’s Visit You go to the doctor.
Medical Claim The doctor sends a claim to your medical third-party administrator with a list of services you received. The claim is reviewed and processed based on your plan benefits.
Plan Pays Your medical third-party administrator lets the doctor know how much is being paid for covered medical services and how much, if anything, you have to pay.
Explanation
of Benefits
Your medical third-party administrator sends an explanation of benefits to you. It’s not a bill; it’s a summary of how the claim was processed and what, if anything, you owe the doctor.
Medical Bill If you owe the doctor any money, the doctor will bill you for it and you can pay the doctor directly.
HSA You can use any available funds in your HSA to pay the doctor if you have money in your HSA.

 

About the Health Savings Account

SAVE SMART WITH A HEALTH SAVINGS ACCOUNT

The Health Savings Account (HSA) is an account that is funded by employer and employee contributions on a pre-tax basis to help pay for eligible medical expenses, including deductibles and coinsurance. The HSA is only available as part of the Ohio Med HDHP option and automatically comes with the HDHP; the two cannot be separated. 

An HSA is set up online through Optum Bank (optumbank.com), similar to a bank account at a brick and mortar bank. An HSA is your personal bank account and allows you to manage your funds. 

  • HSA funds are yours to keep 
  • There is no “use it or lose it” rule at the end of the year 
  • HSA funds stay with you even if you change jobs, leave employment with the State of Ohio, or retire 
  • After reaching an investment threshold of $2,100, you can:
    • Invest in the mutual funds offered from Optum Bank 
    • Move investments from various funds
    • Transfer money between your HSA and your investment account 

Through Optum Bank, optumbank.com, employees enrolled in the Ohio Med HDHP will be able to access their HSA as well as utilize the following:

  • HSA Calculators 
  • A Health Savings Checkup tool 
  • A health account comparison tool 
  • Videos and webinars 

HSA Employee Contribution
From Jan. 1, through Dec. 31, 2020, the HSA contribution limit for individual coverage is $3,550, and the limit for family coverage is $7,100.If you are 55 years of age or older, you may make a catch-up contribution of $1,000. When enrolled in the HDHP, your monthly premium will be lower. You can use these savings to contribute to the HSA.

HSA Employer Contribution
To help get your HSA started, the State of Ohio will make contributions to your HSA if you select the Ohio Med HDHP option. The employer contribution is prorated for new hires. If you are eligible for, and enroll in, the Ohio Med HDHP option, you will receive the employer contribution for each year you are enrolled. The employer contribution counts toward your annual maximum. For new hires, the first contribution may be prorated based on the date of hire.

HSA EMPLOYER CONTRIBUTION SCHEDULE
2020-21 Plan Year Single/Family
July 2020 $500/$1,000 (Prorated for new hires)
January 2021 $500/$1,000 (Prorated for new hires)

 

3 Ways to Receive Tax Savings
Typically, you: 

  • Won’t pay tax on money deposited in the HSA (although the IRS limits how much can be contributed each year)
  • Won’t pay tax on qualified medical expenses, including dental and vision expenses 
  • Grow your savings tax-free, which can be used for expenses now or in retirement

Easy Access to Your Account
Through the Optum Bank mobile app or website, you can: 

  • Track balances and transactions 
  • Make an HSA contribution 
  • Capture and submit receipts 
  • Learn how to maximize your HSA 

For more information, go to optumbank.com/myohiohsa.

In-Network and Out-of-Network Costs

Telehealth Services

Telehealth Services

Get the Medical Treatment and Advice You Need Quicker for Minimal Cost

Don’t have time to go to the doctor? Bring the doctor to you with LiveHealth Online.

Visit with a doctor 24/7 using the new telehealth services.

Feeling under the weather? Don’t want to fight traffic to get to the doctor? Searching for care after hours? Without leaving your home, LiveHealth Online allows you to:

  • Visit with a doctor through live video chat 24/7
  • Select your choice of U.S. board-certified doctors from among those available at the time of service

Chat with a board-certified doctor. The doctor can assess your condition, recommend a treatment plan, and even prescribe basic medications (not narcotics or controlled substances) for pickup at a nearby pharmacy.

Visit with a licensed therapist or board-certified psychiatrist. When stress, anxiety, or depression occurs, talking with a therapist online may be the most convenient solution. In most cases, an appointment can be made to talk with a therapist in four days or less.

Save time and money. Download the free LiveHealth Online app on your mobile device to get the care you need by chatting with a doctor online for the following conditions and more:

  • Flu
  • Allergies
  • Headache
  • Cold and fever
  • Sore throat
  • Tooth pain
  • Minor rash
  • Skin infection
  • Pink eye

With just a $10 copay for the Ohio Med PPO or $59 for the Ohio Med HDHP, LiveHealth Online costs much less than a trip to an emergency room, an urgent care center, or even a walk-in clinic. Prices vary for behavioral health visits for Ohio Med HDHP members. ($80 for a therapist, $95 for a psychologist, $175 for an initial visit with a psychiatrist and $75 for follow-up visits).

LiveHealth Online Registration

How to Register for LiveHealth Online

Employees enrolled in the State of Ohio medical plan have been pre-registered in LiveHealth Online. To complete your registration:

  • Beginning in the fall of 2019, employees enrolled in the State of Ohio medical plan at that time received and email from LiveHealth Online with login instructions indicating their username is their State of Ohio work email address. 
  • A second email from LiveHealth Online was sent with a temporary password.
  • Enrolled employees should log in to LiveHealth Online using your username: your State work email address, and the temporary password that was sent to you.

For videos about how LiveHealth Online works and its benefits, visit livehealthonline.com.

For life-threatening health situations, call 9-1-1 or go to an emergency room for immediate assessment and treatment.

Preventive Care Information

Free Exams and Screenings
Clinical breast exam 1/plan year
Colonoscopy Every 10 years starting at age 50
Flexible sigmoidoscopy Every 10 years starting at age 50
Glucose  1/plan year
Gynecological exam 1/plan year
Hemoglobin, hematocrit, or CBC 1/plan year
Lipid profile or total and HDL cholesterol 1/plan year
Mammogram 1 routine and 1 1 routine and 1 medically
necessary/plan year
Pre-natal office visits As needed; based on physician’s
ability to code claims separately from
other maternity-related services
Stool for occult blood 1/plan year
Urinalysis 1/plan year
Well-baby, well-child exam Various for birth to 2 years;
then annual to age 21
Well-person exam (annual physical) 1/plan year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Free Immunizations
Diphtheria, tetanus, 
pertussis (DTap)
2/4/6/15-18 months; 4-6 years
Haemophilus influenza b (Hib) 2/4/6/12-15 months
Hepatitis A (HepA) 2 doses between 1-2 years
Hepatitis B (HepB) Birth; 1-2 months; 6-18 months
Human Papillomavirus (HPV) 3 doses for 9-26 years
Influenza 1/plan year
Measles, mumps, rubella (MMR) 12-15 months, then at 4-6 years;
adults who lack immunity
Meningococcal (MCV4) 1 dose between 11-12 years
or start of high school or college
Pneumococcal 2/4/6 months; 12-15 months;
annually at age 65 and older;
high risk groups
Poliovirus (IPEV) 2 and 4 months; 6-18 months;
4-6 years
Rotavirus (Rota) 2/4/6 months
Tetanus, diphtheria, 
pertussis (Td/Tdap)
11-12 years; Td booster
every 10 years, 18 and older
Varicella (Chickenpox) 12-15 months; 4-6 years;
2 doses for susceptible adults
Zoster (shingles) 1 dose for age 19 and older;
2 doses for Shingrix

 

For more information, visit healthcare.gov/preventive-care-benefits.

Third-Party Administrator Information

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

Anthem
Anthem - Ohio Med PPO Plan Description - July 1, 2020 - June 30, 2021
Anthem - Ohio Med HDHP Plan Description - July 1, 2020 - June 30, 2021
Anthem - Ohio Med PPO Plan Description - July 1, 2019 - June 30, 2020
Anthem - Ohio Med HDHP Plan Description - July 1, 2019 - June 30, 2020
Group Number: 004007521
1-844-891-8359
Anthem's State of Ohio employee portal

Medical Mutual of Ohio (MMO)
Medical Mutual of Ohio - Ohio Med PPO Plan Description - July 1, 2020 - June 30, 2021
Medical Mutual of Ohio - Ohio Med HDHP Plan Description - July 1, 2020 - June 30, 2021
Medical Mutual of Ohio - Ohio Med PPO Plan Description - July 1, 2019 - June 30, 2020
Medical Mutual of Ohio - Ohio Med HDHP Plan Description - July 1, 2019 - June 30, 2020
Group Number: 228000
PO Box 6018
Cleveland, OH 44124
1-800-822-1152
Medical Mutual Of Ohio’s State of Ohio employee portal

Summary of Benefits and Coverage

Enrollment

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 using myOhio.gov and accessing myBenefits or by submitting a completed Benefit 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 Benefit Enrollment/Change Form (ADM 4717) 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.

Enrollment in Health Management Programs

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! -- the state's health and wellness program, the prescription drug program and the behavioral health program.

Click the links below to access details about these benefits programs.
Take Charge! Live Well! 
Prescription Drug
Behavioral Health

Benefits ZIP Code Zone Chart

 

3-Digit ZIP Code
 
Third-Party Administrator  Find a Provider Guide
(Doctor, Hospital, Urgent Care, etc.)

Cincinnati,
Dayton,

Springfield,
Youngstown


Southern Ohio

Out of State
 

437, 438, 439, 444, 445, 450, 451,
452, 453, 454, 455, 456, 457, 458,
all out-off-state ZIP codes



Plan/Network:
Blue Access (PPO)
Anthem Provider Guide

Akron,
Columbus,

Cleveland,
Toledo

 430, 431, 432, 433, 434, 435, 436, 440,
441, 442, 443, 446, 447, 
448, 449 



Plan/Network:
OhioMed
Medical Mutual of Ohio Provider Guide 

Part-time Permanent vs. Part-time Temporary Employee Benefits

Part-time Permanent Employees

  • Part-time permanent employees’ premium tier will be determined annually rather than semi-annually.
  • The percentage that part-time employees pay toward their premium is based on the average service hours in an active pay status. Average service hours in an active pay status shall be calculated over a 12-month period (Standard Measurement Period), which starts with the first pay period in May through the last pay period in April.
    • All part-time permanent employees working an average of 30 or more hours a week (over a 12-month period) will be eligible for the full-time deduction tier, or 15 percent.
    • All part-time permanent employees working an average of 29.99 or less hours a week (over a 12-month period) will be eligible for the 50 percent tier.
    • All part-time permanent employees working an average of 19.99 or less hours a week (over a 12-month period) will be eligible for the 100 percent tier.


Part-time Temporary Employees

  • The State of Ohio is required to offer medical care coverage only, per the ACA, to all part-time temporary employees who average at least 30 hours of service per week throughout a twelve-month measurement period (Standard Measurement Period). 
  • Part-time temporary employees are those employees typically hired as interns, intermittent employees, and external interim employees. This does not include Americorps or contingent workers.
    • Existing employees who were hired before April 5, 2014, and who averaged 30 work hours or more will be notified by DAS of their eligibility for medical coverage. Those who elect medical coverage will have coverage from July 1, 2015 through June 30, 2016, or until they terminate their service with the State of Ohio.
    • Employees who are hired with a reasonable expectation of averaging 30 hours or more per week will be eligible to enroll for coverage upon hire. Coverage is effective the first of the month following the hire date and cannot be terminated until the 12 months expires or the employee leaves state service.
    • Employees who are hired with a reasonable expectation of averaging 29 hours or less per week will be not be eligible at the time of hire and will instead be measured over a twelve-month period. The twelve-month measurement period for all newly hired part-time temporary employees is called the initial measurement period.
      • The initial measurement period begins the first full pay period after the first pay period with one or more hours of service credited.
      • After the initial measurement period, if the average service hours are 30 or more per week, the employee will be offered the opportunity to enroll the first of the month following the end of the initial measurement period. Part-time temporary employees meeting this criteria will be placed into the 15 percent tier. 

Claims

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 third-party administrator sends payments directly to the providers. 

To ensure fast claim filing, you may wish to contact your third-party administrator 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 third-party administrator 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 explanation of benefits 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 third-party administrator. 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 third-party administrator plan description for details on appealing claims.

Coordination of Benefits

You and your family members may have coverage under more than one medical plan. The medical plans include a coordination of benefits provision to eliminate duplication of payment for services. However, there is no coordination of benefits for prescription medications. Refer to your plan description for more details on the coordination of benefits.

General Contact

Ohio Department of Administrative Services
30 E. Broad St. 27th Floor
Columbus, Ohio 43215
Local: 614-466-8857 
Toll Free: 800-409-1205, option 2

Driving Directions

Benefits Administration Services Home Page