MEDICAL INSURANCE PROVIDERS

OPTIONS: Eligible employees may choose from five options: Medical Mutual (Traditional Indemnity Plan or PPO Plan) or three HMO's (SummaCare, The Health Plan, (formerly HomeTown Health Network) or Kaiser Permanente). Employees may choose employee only, employee plus spouse, employee plus children or family coverage. There are no clauses for pre existing conditions on any of the five health plans.

COSTS: Deductions are taken on a pre-tax basis; i.e., there are no federal or state taxes taken from your share of the premium. Employee contributions are based on six salary levels. Please see attached work sheet (PDF).

SUMMARY OF MEDICAL PLAN FEATURES

We have prepared a chart that provides a broad comparison of the medical plans:
Summary of medical plan benefits (PDF)

Traditional Indemnity Plan Medical Mutual

http://www.mmoh.com
(800) 762-1929
Summary Plan Description (PDF)

The Traditional Indemnity Plan is an 80/20 plan. The plan offers different premium rates, deductible amounts and out-of-pocket expenses. Please see attached worksheet (PDF).

Envision Pharmaceutical Services will administer your prescription drugs. You will receive a Medical Mutual ID card and a separate RX Options ID card.

PPO Plan Medical Mutual

http://www.mmoh.com
(800) 762-1929
Summary Plan Description (PDF)

The PPO Plan is a 90/10 plan. The plan offers different premium rates, deductible amounts and out-of-pocket expenses. There are different in-network and out-of-network co-insurance payments. Please see attached worksheet (PDF).

Envision Pharmaceutical Services will administer your prescription drugs. You will receive a Medical Mutual ID card and a separate RX Options ID card.

Envision Pharmaceutical Services
http://www.envisionrx.com
(800) 361-4542
Local and mail order for Traditional Indemnity and PPO Plans only

HMO Options

There are no deductibles to be met. A visit to the doctor has a $15 co-payment. Prescription medications are available at a three-tier rate. Prescriptions will be covered by using your HMO medical card.

Please check the HMO provider directories for coverage in your county.

SummaCare
http://www.summacare.com
(330) 996-8700
Summary Plan Description (PDF)

The Health Plan, formerly HomeTown Health Network
http://www.healthplan.org
(800) 426-9013
Summary Plan Description (PDF)

Kaiser Permanente
http://www.kaiserpermanente.org
(330) 633-8759
Summary Plan Description (PDF)

APPLICATION AND CHANGE FORMS

Listed below are the application forms to be used when signing up for a health care provider as a new employee and change forms for adding or removing dependents or to change your primary care physician on the HMO's.

SummaCare
Application (PDF) (Use this if you are signing up for this coverage for the first time.)
Change form (PDF) (Use this to add or remove a dependent or change your primary care physician.)

The Health Plan
Application (PDF) (Use this if you are signing up for this coverage for the first time.)
Change form (PDF) (Use this to add or remove a dependent or change your primary care physician.)

Kaiser Permanente
Application and change form (PDF)

Medical Mutual of Ohio
Application and change form (PDF)