2024 Medical
Plan Comparisons
Gold
A Preferred Provider Organization (PPO) allows you to see specialists and out-of-network doctors without a referral. Copays and coinsurance for in-network doctors are generally lower.
| 听 | UTMC - Tier 1 | In-Network - Tier 2 | Out-Of-Network - Tier 3 |
| Deductible: | $150 Employee $300 Employee +1 $300 Family |
$300 Employee $600 Employee +1 $600 Family |
$1,000 Employee $2,000 Employee +1 $2,000 Family |
| Out-of-Pocket Max: | $1,250 Employee $2,500 Employee +1 $2,500 Family |
$2,500 Employee $5,000 Employee +1 $5,000 Family |
$4,000 Employee $8,000 Employee + 1 $8,000 Family |
| Co-Insurance: | 95% | 85% | 70% |
| Office Visit: | $15 | $25 | 70% (AD) |
| Specialist Visit: | $30 | $40 | 70% (AD) |
| Emergency Room - Facility: | $200 (waived if admitted) | $200 (waived if admitted) | $200 (waived if admitted) |
| Emergency Room - Professional and Ancillary: | 95% (AD) | 85% (AD) | 85% (AD) |
| Urgent Care: | N/A | $50 | $50 |
| Preventive Services: | 100% (DW) | 100% (DW) | 70% |
| Diagnostic Services: | 95% (AD) | 85% (AD) | 70% (AD) |
| Accounts: | A Flexible Spending Account (FSA) is available with this plan to offset out-of-pocket expenses. Funds in this account are contributed to by the employee pre-tax, and can be used for qualified medical/prescription, dental and vision expenses for you and your dependents. Unused funds, following IRS guidelines, can carry over to the next calendar year, otherwise they are forfeited. IRS contribution limits can be found at irs.gov. | ||
| Network(s): | Medical Mutual 鈥� SuperMed in Ohio and Cigna outside of Ohio | ||
DW = Deductible Waived, AD = After Deductible
Blue
CDHP stands for Consumer Directed Health Plan; a type of health plan that most often pairs with a Health Savings Account (HSA), or some other tax-advantaged account. An HSA is a savings account that lets you use pre-tax dollars to pay for a wide range of qualified health care costs, including dental and vision. Once you have met your annual out-of-pocket maximum, the plan pays the remainder of your annual medical and prescription drug costs. The Blue CDHP also acts as a PPO, allowing members to see specialists and out-of-network doctors without a referral.
| 听 | UTMC - Tier 1 | In Network - Tier 2 | Out-Of-Network - Tier 3听 |
| Deductible: | $1,600 Employee $3,200 Employee +1 $3,200 Family |
$2,000 Employee $4,000 Employee +1 $4,000 Family |
$2,500 Employee $5,000 Employee +1 $5,000 Family |
| Out-of-Pocket Max: | $2,100 Employee $4,200 Employee +1 $4,200 Family |
$3,100 Single $6,200 Single +1 $6,200 Family |
$4,100 Employee $8,200 Employee +1 $8,200 Family |
| Co-Insurance: | 95% (AD) | 85% (AD) | 70% (AD) |
| Office Visit: | 95% (AD) | 85% (AD) | 70% (AD) |
| Specialist Visit: | 95% (AD) | 85% (AD) | 70% (AD) |
| Emergency Room - Facility: | 95% (AD) | 85% (AD) | 85% (AD) |
| Emergency Room - Professional and Ancillary: | 95% (AD) | 85% (AD) | 85% (AD) |
| Urgent Care: | N/A | 85% (AD) | 70% (AD) |
| Preventive Services: | 100% (DW) | 100% (DW) | 70% (DW) |
| Diagnostic Services: | 95% (AD) | 85% (AD) | 70% (AD) |
| Accounts: | A Health Savings Account (HSA) with employer contributions is available with this plan to offset out-of-pocket medical expenses. 果冻传媒 annually contributes $500/single, $750/single+1, and $1000/family. IRS contribution limits can be found at irs.gov. | ||
| Network(s): | Medical Mutual 鈥� SuperMed in Ohio and Cigna outside of Ohio | ||
DW = Deductible Waived, AD = After Deductible
Gold Plan
Gold Plan Schedule of Benefits
Gold Plan Summary of Benefits and Coverage
Gold Plan Benefit Book
MedMutual Total Health Benefits
2060 E. 9th St. Cleveland, OH 44115
果冻传媒 Customer Service: (888) 636-3622
Provider Networks:
Medical Mutual SuperMed
Cigna (outside of Ohio)
Members can access听听for claims, benefit, and provider information.听
Download the Mobile App
| iPhone (iOS 11.0 and above) | Android (8.0 and above) |
听
Blue Plan
Blue Plan Schedule of Benefits
Blue Plan Summary of Benefits and Coverage - Single
Blue Plan Summary of Benefits and Coverage - Single+1/Family
Blue Plan Benefit Book
MedMutual Total Health Benefits
2060 E. 9th St. Cleveland, OH 44115
果冻传媒 Customer Service: (888) 636-3622
Provider Networks:
Medical Mutual SuperMed
Cigna (outside of Ohio)
Members can access听听for claims, benefit, and provider information.
Download the Mobile App
| iPhone (iOS 11.0 and above) | Android (8.0 and above) |
听
Customer Service: (866) 234-8913
Flexible Spending Accounts
The University maintains a Medical Flexible Spending Account and a Dependent Flexible Spending Account for employees.听 Employees may set aside annually, on a pre-tax basis, up to $3,200 in the Medical Flexible Spending Account and up to $5,000 in the Dependent Flexible Spending Account (to be used only for daycare expenses).
What is a Flexible Spending Account?听A Flexible Spending Account (FSA) is an IRS-approved program that enables 果冻传媒 employees to be reimbursed for certain medical and dependent care expenses on a pre-tax basis. Employees who participate in an FSA will save federal, state, and where applicable, city income taxes on all the money set aside in the FSA. In other words, taxable income is reduced by the amount you put into the FSA.
When can I enroll in Flexible Spending?听You can enroll in Flexible Spending as a New Hire/Newly Eligible employee or听during Open Enrollment or due to a qualifying event such as marriage, divorce, birth, and death.听You must re-enroll each year during open enrollment. Once enrolled, your election can only be changed or discontinued with a Qualifying Event.
How does an FSA work?听Upon request, the University will deduct the total estimated in pro-rated amounts
from the paycheck. As expenses are incurred, receipts are submitted, with a claims
form, to the FSA administrator who issues checks on a semi-monthly basis for the incurred
expenses. Unused funds, following IRS guidelines, can carry over to the next calendar
year, otherwise they are forfeited. Visit听听for IRS
contribution limits. Reimbursements can be claimed through March of the following
year. For more information,听click here.听 For a list of approved expenses, please visit .听 Please see below for additional information.听
FSA Summary Plan Description (SPD)
For enrollment, claims, and other forms, visit the Benefits听forms page.
听
3510 Irwin Simpson Road Mason, OH 45040
Customer Service: (800) 982-7715
Fax: (888) 245-8452
Email:听askpenny@chardsnyder.com
Prescription
Prescription Drug Coverage Summary
Co-pay Designs
University of Toledo Outpatient Pharmacies
Rx Local Mobile App
Cerpass Rx-Performance Formulary
Cerpass Rx-Prescription Reimbursement Form
Cerpass Rx-Preventative Medication List
Cerpass Rx-Prior Authorization List
CerpassRx-Specialty Medication List
CerpassRx-Non-Essential Drug List
CerpassRx-Quantity Limits
CerpassRx-Member Portal and Mobile App Guide
Group # HCHRX
5904 Stone Creek Dr., The Colony, TX 75056
Customer Service: (844) 636-7506
Rx BIN #: 018729
Rx PCN: GBX
1095c
1095-C FAQ
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(To gather more information on for 1095-C)