Medical Mutual PPO Plan
Group Number 500878
Benefit Period January 1, 2022 – December 31, 2022
For the family deductible and coinsurance out-of-pocket maximum, one individual on the program will never pay more than the Single Deductible/Out-of-Pocket maximum, and the whole Family combined will never pay more than the Family Deductible/Out-of-Pocket maximum. Example: Employee and Spouse enrolled. Employee has $1,500 Out-of-Pocket maximum and Spouse has $1,500 Out-of-Pocket maximum (not $3,000). The out-of-pocket maximum will include medical copays and Rx copays in addition to coinsurance and the deductible.
Office visit copayments are based on the type of provider that performs the office visit. PCP (Primary Care Physician) is a practitioner that specializes in general practice, family practice, internal medicine, obstetrics and gynecology (OB/GYN), psychiatry, psychology, and certain licensed counselors. Specialists are practitioners, other than a Primary Care Physician, who provides services within a designated specialty area of practice such as dermatologists, cardiologists, chiropractor, endocrinologist and podiatrists to name a few.
Coverage to Build a Foundation of Good Health
Medical coverage is provided through Medical Mutual (MMO) and utilizes the SuperMed PPO Network. Your plan provides two levels of coverage (In-Network and Out-of-Network) each time you or a family member receives care.
- If the provider is In-Network, there is a higher level of coverage.
- If the provider is Out-of-Network, there is a lower level of coverage which may result in higher out of pocket costs to you. Out-of-Network providers may bill you for any difference in cost between the MMO allowed amount and the provider’s fee (this is referred to as balance billing). Click on the Medical Mutual PPO Plan tab to the left to review covered services.
Once you are enrolled with Medical Mutual, you will have access to many value-added features:
- Register for My Health Plan at www.medmutual.com and gain access to time- and money-saving tools, programs, disease management programs, and discounts. All you need is your MMO identification (ID) number, birth date and email address.
- My Health Plan Dashboard includes an overview of your benefits, deductibles, claims information, what MMO paid and your financial responsibility.
- From MMO’s mobile app, members can perform advanced provider searches using GPS location, place a call to a provider with one click, and add providers to phone contacts.
- The City offers voluntary Disease Management Programs to employees and dependents covered under the Medical plan. The Disease Management Programs provide valuable information and a plan designed to meet your specific needs when living with a chronic condition. Conditions eligible for the program: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease, Diabetes, and Heart Failure. Call (800) 861-4826 and select option 2 to check eligibility and enroll.
- Effective 1/1/2019, Aetna Open Choice is the network of providers available to you when traveling outside of Ohio. Refer to the toll free number on your ID card to locate a preferred provider when you need medical services and are outside the SuperMed PPO Service area.
- The 24/7 Nurse Line provides immediate access to a trained RN who can help you make decisions about how to handle a health issue.
Disease Management Programs through Medical Mutual
The City offers voluntary Disease Management Programs to employees and dependents covered under the Medical plan. The Disease Management Programs provide valuable information and a plan designed to meet your specific needs when living with a chronic condition. Conditions eligible for the program: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease, Diabetes, and Heart Failure. Employees and dependents may call (800) 861-4826 and select option 2 to check eligibility and enroll.