When you enroll in medical coverage, you also automatically gain prescription drug, behavioral health and Take Charge! Live Well! benefits.

The state contracts with Aetna, Anthem and Medical Mutual of Ohio to serve as third-party administrators for the Ohio Med PPO (Preferred Provider Organization) plan. Aetna, Anthem and Medical Mutual of Ohio each serve specific regions of Ohio based upon home ZIP codes. Your plan administrator is determined by the first three digits of your home ZIP code. If your home ZIP code is outside of Ohio, you will be enrolled in Anthem. 

ZIP Code Chart

The Ohio Med PPO plan does not contain pre-existing condition exclusions. Therefore, coverage is available to you and your eligible dependents regardless of current health or health history. 

Medical coverage begins on the first day of the month following the month of your date of hire. If you do not enroll within this time frame, you must wait until the annual open enrollment period, or until you or an eligible dependent experience a change in status/qualifying event. In the occurrence of a qualifying life event, you have 31 days to add or remove yourself or your dependents to or from coverage.

Summary of Medical Benefits

Helpful medical links:

Medical Coverage, Cost and Enrollment

Eligibility Requirements

OptumRx provides prescription drug benefits for all State of Ohio employees who are enrolled in the Ohio Med PPO plan.

OptumRx.com, is a private, secure website designed just for you. All of your pharmacy plan information is available 24/7 and kept up-to-date.

Click here for information about the Specialty Drug List and a list of drugs not covered. 

HELP AVAILABLE 24/7

Specialized mental health and chemical dependency services are provided under a single program available to all employees and dependents enrolled in the state’s medical plan. This program, administered by Optum Behavioral Solutions, provides 24-hours-a-day, seven-days-a-week phone assessment and referral services for a variety of behavioral health issues, such as:

• Anger management;
• Anxiety;
• Compulsive disorders;
• Depression;
• Grief and loss;
• Marital and family and relational issues;
• Mental disorders;
• Physical abuse;
• Stress; and
• Substance use disorders.

In addition, habilitative services are available to members with a medical diagnosis of Autism Spectrum Disorder.

Copayments, deductibles and coinsurance are shared and combined with your medical plan. If you receive mental health services prior to meeting your medical plan deductible, you may need to pay for these services up to the deductible amount before your plan starts paying. This does not apply to routine office visits for which you pay only an office visit copayment.

BENEFITS

All enrolled employees and their families have access to both in-network and out-of-network behavioral health benefits. However, you will pay more if you do not use a network of participating providers and facilities. See the chart for more information.

Click here for more information on Behavioral Health Benefits.

 All full- and part-time permanent employees are eligible for dental and vision insurance after one year of continuous service. 

UNION-REPRESENTED EMPLOYEES

Union-represented employees receive dental, vision, life and legal plan benefits through Union Benefits Trust (UBT). For more information about these benefits, visit benefitstrust.org.

EXEMPT EMPLOYEES

The state pays the cost for exempt employees and their eligible dependents to participate in the dental and vision plans. 

An enrollment packet will be mailed to you prior to your one-year anniversary. Coverage will be effective the first day of your 13th month of state service, as long as you submit your completed enrollment form at least 31 days before your anniversary date. You may enroll in dental and vision coverage up to 31 days after your anniversary date. If you do not enroll within 31 days of your anniversary date, you must wait until the next open enrollment period to obtain dental and/or vision care coverage.

Delta Dental Plan

Dental coverage is offered to eligible exempt employees and their dependents through the Delta Dental PPO plan, offered through Delta Dental of Ohio. You can go to any licensed dentist of your choice and receive benefits, but you typically will pay less when you go to an in-network dentist. Your out-of-pocket expenses will vary depending on the participation status of your dentist. Your out-of-pocket costs are likely to be lower if you go to a dentist who participates in one of the Delta Dental networks. For most covered services, Delta Dental pays a higher percentage if you go to a dentist in its PPO network over its Premier network. Delta pays the least for out-of-network dentists.

Click here for more information on dental benefits.
 

 EyeMed Vision Care Plan

Vision coverage is offered to eligible exempt employees and their dependents through EyeMed Vision Care. The Insight network encompasses a large number of providers. Employees and their family members who choose to receive services outside of the vision plan network may be subject to a reduction in benefits.

Click here for more information on vision benefits.
 

BASIC LIFE INSURANCE

Eligible exempt and union-represented employees are entitled to basic life insurance coverage after completing one full year of continuous state service. Enrollment is automatic. This benefit – equal to your annual earnings rounded to the next highest $1,000 – is provided at no cost to you.

SUPPLEMENTAL LIFE INSURANCE

Eligible exempt and union-represented employees have the option of purchasing supplemental life insurance coverage on their date of hire, and have 90 days to enroll. You also may enroll during open enrollment. You may purchase coverage for yourself, your spouse and eligible dependent children younger than age 26. The cost of coverage is at your expense, and you must enroll directly with the carrier. 

Exempt employees receive basic and supplemental life insurance benefits through Minnesota Life Insurance. For more information about these benefits, click here.

Union-represented employees receive basic and supplemental life insurance benefits through Union Benefits Trust. For more information about these benefits, visit: benefitstrust.org  

As a State of Ohio employee, you are eligible to apply for disability leave benefits. These benefits provide financial and medical assistance to you and your family in the event that you are unable to perform the duties of your position due to a non-work-related disabling illness, injury or condition for a period of more than 14* consecutive calendar days. 

* Employees of the Auditor of State, Ohio Attorney General, Secretary of State and Treasurer of State subject to a collective bargaining agreement should refer to the applicable contract.

Those who may be eligible for disability benefits include:

• Full-time permanent employees who have completed one year of continuous state service immediately prior to the date of the disability; and
• Part-time permanent employees who have completed one year of continuous state service, and who have worked 1,500 or more hours in the 12 calendar months preceding the disability.
  

Conditions Covered

The following disabling illnesses, injuries or conditions may be considered for disability leave benefits:

• Non-work-related injury or illness;
• Mental health conditions; and
• Substance abuse conditions (An employee must be receiving ongoing treatment, which prevents the employee from working.)     
  

Click here for more information about the disability leave program.

Workers’ compensation is a ‘no-fault’ system that compensates employees for work-related injuries or illnesses.    

If you sustain a workplace injury, it is imperative that you:

• Obtain medical care promptly;
• Follow your agency’s policy on reporting accidents and injuries; and
• Complete an Accident or Illness Report.

Employer-provided benefits for Workers’ Compensation claims include:

·         Salary Continuation

This benefit is available to permanent full-time or part-time employees*. 

*The Offices of the Auditor of State, Attorney General and Secretary of State do not participate in salary continuation.  In addition, employees covered by the Ohio State Troopers Association (OSTA) collective bargaining agreement are not eligible for salary continuation. 

·         Occupational Injury Leave (OIL)

This benefit is available to employees who are injured in the line of duty as a result of a bodily injury sustained by an inmate, client, patient, resident, youth or student, and is limited to specific agencies.

Benefits are limited to a maximum number of hours determined by your bargaining unit. Non-bargaining unit employees have a maximum of 960 hours.

For detailed information about workers’ compensation eligibility requirements, application and decision processes, click here.

State employees observe 10 paid holidays each year. Holidays falling on Sunday are observed on the following Monday. Holidays falling on Saturday are observed on the preceding Friday. If your scheduled work week is other than Monday through Friday, you still will be entitled to up to eight hours of holiday pay. Part-time permanent employees receive holiday pay for a portion of any holiday that they are normally scheduled to work. 

STATE HOLIDAYS

 Vacation leave is accrued each pay period. See here for chart of accrual rates and maximum accumulation allowed.

Exempt and bargaining unit employees accrue personal leave each year. The amount of leave and accrual varies. See here for chart of accrual rates and maximum accumulation allowed. 

Exempt and bargaining unit employees accumulate sick leave each pay period. Exempt employees and bargaining unit employees, except employees represented by SEIU District 1199, accumulate 3.1 hours per pay period, for a total of 80 hours per year. Employees in SEIU District 1199 accumulate 2.77 hours per pay period, for a total of 72 hours per year.

Full-time permanent employees are entitled to three days of bereavement leave with pay upon the death of a member of their immediate family.

“Immediate family” is defined as your spouse, parents, children, grandparents, siblings, grandchildren, brothers-in-law, sisters-in-law, mother-in-law, father-in-law, or a legal guardian or other person who stands in the place of the parent.*

*Bargaining unit employees should refer to collective bargaining agreement for definition of immediate family.

Eligible employees may take up to 12 weeks of unpaid leave per rolling 12 month period for absences due to their own health condition, certain family members’ qualifying health condition, caring for a child after birth or placement for adoption or foster care, or a qualifying exigency related to military service. In addition, eligible employees may take up to 26 weeks of unpaid leave in a single 12-month period to care for a covered service member or covered veteran on a per-injury, per-illness basis. 

Family and medical leave is unpaid. However, you must exhaust accrued paid leave (e.g., sick, vacation and personal) prior to using unpaid leave. Additionally, some employees may be required to exhaust compensatory time prior to using unpaid leave. Your agency’s policy may specify the order in which leave must be used. 

To be eligible, you must:

• Have been employed by the state for at least 12 months; and
• Have been in active work status for at least 1,250 hours during the 12 months immediately preceding the date on which the requested leave begins.

The full policy is available here.

Credit Union of Ohio 

All state employees can join this credit union. For more information, call 614-487-6650 or 800-443-5698 or visit cuofohio.org.

Bridge Credit Union

State employees of the following state agencies can join the Bridge Credit Union: Ohio Departments of Administrative Services, Budget and Management, Public Safety, Transportation and Youth Services. For more information, visit bridgecu.org.

All permanent full-time and part-time employees are eligible to save for college through payroll deduction to the CollegeAdvantage Direct 529 Savings Plan, Ohio's 529 Plan. Employees can set up payroll deduction in their CollegeAdvantage Direct Plan account and their employee self-service payroll management system. Invest as little as $25 per pay to pre-save for future college expenses. The funds are managed by leading investment firms and are exempt from federal and state taxes when used for eligible higher education expenses. Contributions up to $4,000 per year per beneficiary can be deducted from your State of Ohio income tax. For more information, visit CollegeAdvantage.com, or call 1-800-AFFORD-IT (233-6734).

The State of Ohio offers the Child Care Voucher Program (CCVP) to eligible full-time and part-time permanent employees. 

This program applies to employees who have an annual federal adjusted gross income of less than $35,000 ($40,000 for employees of the Attorney General's Office), and who incur work-related child care expenses for dependents younger than age 13.

The Child Care Voucher Program provides cash grants once a year for work-related child care expenses. The amount you receive depends on:

• Your family adjusted gross income;
• Your hours and pay periods worked;
• Your number of dependents; and
• The grant amount allowed in your collective bargaining agreement.

For more about the Child Care Voucher Program, click here. 

Full and part-time permanent employees are eligible to participate in the Commuter Choice Parking and Transit Program. The program allows pre-tax payment of eligible parking and transit expenses associated with commuting to work. No federal, state, school district or Medicare taxes are withheld from eligible commuting expenses. Therefore, you save money each month you participate in the program.

The Commuter Choice Program is managed by a third-party administrator, WageWorks.  A monthly administrative fee of $4.60 is assessed on an after- tax basis.

The Commuter Choice program covers two types of commuting expenses:

• Transportation expenses, which include qualified fares for riding buses, trains, subways, ferries and other types of mass transportation or van pools.  When you enroll in the Commuter Choice transit benefit, your fare pass is delivered directly to your home address; and
• Parking expenses, which include the cost of parking at or near your place of work, or at or near a place from which you commute to work by mass transit, such as a park-and-ride lot. When you enroll in the Commuter Choice parking benefit, WageWorks pays your parking service directly.

The 2014 IRS monthly allowable dollar limit for transit is $130; the monthly dollar limit for parking is $250. If parking and/or transit expenses exceed the IRS monthly allowable dollar limit, you may have additional dollars withheld on an after-tax basis to pay your expenses that exceed the IRS dollar limit.

For more information:

Commuter Choice Program

WageWorks

HEALTH CARE SPENDING ACCOUNT

The health care spending account (HCSA) is a tax-favored account that provides the opportunity for eligible employees to defer on a pre-tax basis up to a maximum of $2,500 into an account to pay for eligible medical expenses not paid by your health care, vision or dental plans. There is no administrative fee for participants.

To enroll in an HCSA, you must:

• Be a permanent part-time or permanent full-time employee who has successfully completed her or his initial probationary period and has sufficient pay to cover the election amount; and
• Enroll within 31 days of the hire date, if there is no probationary period; or
• Enroll within 31 days of completing probation, if there is a probationary period.

It is not necessary to be enrolled in the State of Ohio’s health benefits to participate in HCSA.  If both a husband and wife are state employees, both may participate in HCSA as separate individuals. 

The dependent care spending account (DCSA) is a tax-favored account that provides the opportunity for eligible employees to defer on a pre-tax basis up to a maximum of $5,000 (depending on tax filing status) into an account to pay for eligible child care, dependent care or eldercare expenses.

To enroll in a DCSA, you must:

• Be a permanent part-time or permanent full-time employee with sufficient pay to cover the election amount;
• Have a qualifying dependent(s); and
• Enroll within 31 days of the hire date.

Both a husband and wife, regardless if they are state employees, may participate in DCSA as separate individuals but cannot exceed the $5,000 IRS annual maximum per family.

If an employee does not enroll within the time frames noted, other opportunities to enroll are as follows: 

• During the annual Open Enrollment period; or
• Following a qualifying change in status: According to the IRS regulations governing Section 125 Cafeteria Plans, a mid-year change can be made to the employee’s HCSA and DCSA election. However, the proposed change must be consistent with the type of change experienced. Contributions and benefit changes must be an appropriate result of the change in status. The time frame for notification is within 31 days of the qualifying event. 

Click here for more detailed information about Flexible Spending Accounts.

IRS Forfeiture Rules: Federal regulations provide certain forfeiture rules. For example, at the end of the month of your employment termination, any unspent HCSA or DCSA balance will be forfeited.

Many state employees are faced with the need to care for an adult individual. To help them understand the support and resources available, a new Caregiver Resources initiative provides the details they need on the Caregiver Resources website at das.ohio.gov/caregiver, which includes information about:

• Being a caregiver;
• Leave plans;
• Scheduling options;
• Tips for the most common caregiver needs;
• Legal resources;
• Support organizations;
• Frequently asked questions about being a caregiver and more.

The Ohio Employee Assistance Program (Ohio EAP) is a confidential, professional support service designated to assist state employees and their dependents. The goal of the program is to help resolve personal and job problems. These can include marital and family conflicts, emotional problems, illness, financial difficulties, drug and alcohol problems, job stress, burnout, legal difficulties and other major life changes.

There is no cost associated with using the Ohio EAP for assistance. If a referral is made to counseling, the employee or employee’s dependent may be responsible for a co-payment. For State of Ohio employees covered by a state health plan, mental health services are covered by the behavioral health provider that the state contracts with for these services.

Employees not covered by a state health plan can still contact the Ohio EAP for assistance.

For more information about services and courses provided by the Ohio EAP, visit: ohio.gov/eap

A phone call can make all the difference. Toll-free statewide: 800-221-6EAP (6327).

Take Charge! Live Well! is the State of Ohio's 
health and wellness program available to State of Ohio employees and spouses enrolled in the State of Ohio medical plan. As a member of the plan, you can earn rewards by enhancing your wellness experience and achieving your wellness goals. State employees and spouses are each eligible to receive up to $350 in rewards. Refer to the Wellness Rewards chart on the right (click image to download the chart) and see how easy it is for you to improve your health and be rewarded for your effort for achieving activities.

For more information, visit the Take Charge! Live Well! website: ohio.gov/tclw.