Medical Mutual Of Ohio
Employee Benefits Handbook - Submitting Claims
After the claim is paid, Medical Mutual 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. ... To ensure fast claim filing, you may wish to review this booklet or contact Medical Mutual to determine if the health care service is covered. Show your identification card to the provider and determine if the provider is in the Ohio Med network. Ask the provider to file the claim on your behalf. Remember, not all services are covered by this or any insurance plan. Ineligible expenses are your responsibility. ... [Read More]
Employee Benefits Handbook - Receiving Out-of-Network Services
Out-of-country benefits are paid at 60 percent, the same as out-of-state, with the exception that payments are based on the monetary exchange rate that existed at the time of service. Bills and documentation of services rendered must be provided in English and sent to Medical Mutual at the above address. ... Your Ohio Med plan provides coverage for any doctor, facility or hospital in the world. The Covered Services and Exclusions described in this book apply to both out-of-state and out-of-country care. You also can determine eligible services by calling customer service at (800) 822-1152. ... [Read More]
Employee Benefits Handbook - Summary of Ohio Med PPO Benefits
For routine office visits, house calls and outpatient consultations, you pay $15 for each visit to a network provider and $30 to a non-network provider. All covered services performed in a network physician’s office and billed by that office are covered at 80 percent in network after you pay the $15 office visit copay. Any age or frequency limitations are waived. Services performed in and billed by a non-network physician’s office are covered at 60 percent after you pay the $30 office copay. ... [Read More]
DAS/HRD Benefits - Pathways - March 2004
In the past, this “use it or lose it” aspect of the account has been a stumbling block for some participants. However, the IRS regulations were broadened last year to allow participants to use account funds to purchase certain over-the-counter medical supplies that were formerly disallowed or have recently changed status such as cold, flu and allergy medicine. As a result, participants can spend account money remaining near the end of the year on many over-the-counter pharmacy products. ... [Read More]
DAS/HRD Benefits - Pathways Index
Open Enrollment Begins May 3 Medical Mutual Continues as Ohio Med Administrator How to Enroll and Make Changes Governor's Healthy Ohioans Fitness Challenge Agency Wellness Survey National Employee Health and Fitness Week New Pharmacy Benefit Manager for Ohio Med Telephone System Not Available for Open Enrollment Schedule Your Visit to an Open Enrollment Fair So You've Been Diagnosed with a Serious Illness: What Happens Next? Drug and ER Copays to Increase FDA Calls for Close Monitoring of Antidepressant Use Information on Generic Drugs Long Term Care: Helps to Ensure Financial Security at Any Age Corrections to Health Care Booklet ... [Read More]
Employee Benefits Handbook - The Ohio Med Plan
The out-of-pocket maximum is the total amount you must pay out of your own pocket before your plan covers your medical expenses at 100% for the plan year. 1 The out-of-pocket maximum offers financial protection by limiting the total amount you must pay toward health care services in any benefit year. Once your coinsurance reaches the out-of-pocket maximum amount, the plan will pay 100 percent of allowed charges to the end of the benefit year. There is no limit to the amount Ohio Med will pay per year, except in the case of human organ transplants which are limited to $1 million in a lifetime. ... [Read More]
Employee Benefits Handbook - Summary of Ohio Med PPO Benefits
In order for an organ/tissue transplant to be a covered service, the inpatient stay must be pre-authorized. In addition, the proposed course of treatment must be pre-determined and approved by Medical Mutual (except for corneal transplants). Failure to obtain a pre-determination and approval of the proposed course of treatment will result in a predetermination penalty of $350. ... These programs, not subject to deductible or copays, offer education and support for patients to assist in the self management of asthma, diabetes, coronary artery disease and cancer. The Ohio Med Health Partners program offers employees and family members 24/7 personal health consultants including nurses, health educators and dieticians who are available to answer questions about your condition, chart your progress and explain medications and identify any complications. Call Matria Healthcare to learn more or to get started at (888) 250-8854 or visit Matria on the Web to learn more. For maternity care call Medical Mutual at (800) 822-1152 to enroll or learn more. ... [Read More]
Employee Benefits Handbook - Glossary
. Ohio Med. Special intensive medical evaluation of persons with designated illnesses or injuries. These are usually severe and potentially high-cost situations, such as serious head injuries, neonatal cases and back injuries. The goal is to develop medically acceptable, less costly alternate courses of treatment. For example, Case Management may suggest rental of special equipment and provision of full-time nursing care at home in lieu of extended hospitalization. ... [Read More]
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