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In-Network and Out-of-Network Costs

Compare the cost differences between in-network and out-of-network costs and see the advantage of using in-network health care providers. 

In-Network and Out-of-Network Costs

Annual Deductible

Ohio Med PPO

Ohio Med HDHP

$400 single, $800 family in-network

$800 single, $1,600 family out-of-network

$2,000 single/$4,000 family in-network
$4,000 single/$8,000 family out-of-network

Your Copayments
(Office Visits)

Primary care physician: $30 in-network, $50 out-of-network; Specialist: $35 in-network: $55 out-of-network.

Outpatient office visit: $30 in-network; $50 out-of-network (balance billing applies).

80% after deductible in-network
60% after deductible out-of- network

Coinsurance

Medical: You pay 20%, plan pays 80% in-network; you pay 40%, plan pays 60% out-of-network.

Behavioral Health:

Outpatient out-of-network: 60% of contracted allowable amount after copayment (balance billing applies)

Inpatient in-network: 80% after deductible

Inpatient out-of-network: 60% after deductible, $350 penalty if not preauthorized

80% after deductible in-network
60% after deductible out-of- network

Out-of-Pocket
Maximum

$2,500 single, $5,000 family in-network
$5,000 single, $10,000 family out-of- network.
This deductible is combined with behavioral health.

$3,500 single/ $7,000 family in-network
$7,000 single/ $14,000 family out-of-network

Behavioral Health

No day, annual or lifetime limits. Some benefit limits may apply.
For details, visit das.ohio.gov/BehavioralHealth, click the Summary Plan Descriptions tab and select the current summary plan.

Same as PPO

Benefit/Service

Coverage Levels

Chiropractic Care

Covered at 80% in-network; 60% out-of-network

Unlimited visits (review required after 25 visits)

80% after deductible in-network
60% after deductible out-of- network

Diagnostic, X-Ray
and Lab Services

Covered at 80% in-network

60% out-of-network

80% after deductible in-network
60% after deductible out-of- network

Durable Medical
Equipment

Covered at 80% in-network

60% out-of-network

80% after deductible in-network
60% after deductible out-of- network

Emergency Room

Covered at 80%; $150 copay, which is waived if patient is admitted as inpatient; 60% out-of-network for non-emergency

80% after deductible in-network
60% after deductible out-of- network

Immunizations

Most are covered at 100% in-network; 60% out-of-network

Same as PPO

Maternity: Delivery

Covered at 80% in-network

60% out-of-network

80% after deductible in-network
60% after deductible out-of- network

Physical, Occupational
and Speech Therapy 

 

Covered at 80% in-network; 60% out-of-network

Unlimited visits (review required after 25 visits)

Includes coverage for autism spectrum disorder

80% after deductible in-network

60% after deductible out-of- network

Preventive Exams
and Screenings

Most preventive care covered at 100% in-network; 60% out-of-network

Age restrictions may apply

Same as PPO

Urgent Care

$40 copay in-network; $60 copay out-of-network

Covered at 80% in-network; 60% out-of-network

80% after deductible in-network
60% after deductible out-of- network

Non-network services: Plan pays 60% of Ohio Med PPO and Ohio Med NN, and Ohio Med HDHP contracted allowable amount and you pay any remaining balance (subject to balance billing). 

If your out-of-network charge is greater than the contracted allowable amount, your out-of-pocket costs will be more. 

In-Network and Out-of-Network Costs