Medical Coverage

PPO (Preferred Provider Organization) Plan

Download the Coverage Chart to view deductibles, co-insurance, out-of-pocket maximums, office visit copays and coverages for a variety of categories.

The Affordable Care Act (or health care reform law) requires that all members receive a Summary of Benefits Coverage (SBC). This document, provided by Anthem Blue Cross/ Blue Shield, may be downloaded below or a hard copy requested by emailing benefits@ohio.edu. 

• 2013 Benefits Coverage Chart and Rates- 2013 
  
  
• Summary of Benefits Coverage (SBC)- Administrators, Faculty and Non-Bargaining Classified

• 2012 Benefit Rates & Coverage Chart
  (effective through June 30, 2013)
  

AFSCME members

The Collective Bargaining Agreement will supersede this information in case of discrepancies.

• Benefits Coverage Chart and Rates for AFSCME- 2013
  
  
• Summary of Benefits Coverage (SBC)- AFSCME
  
  

Anthem Blue Cross/Blue Shield

Ohio University's PPO medical plan is administered by Anthem Blue Cross/ Blue Shield. Employees may contact Anthem directly with questions regarding their coverage. Anthem also offers a

web portal where members can log in and manage their accounts.

The PPO plan is a "preferred provider organization." A PPO is a program in which a network of doctors, hospitals and other healthcare providers agree to provide medical services to plan enrollees at special, negotiated rates. Each healthcare provider in the network must meet and maintain strict quality requirements.

When you use network providers for your healthcare, you will have to pay a co-payment at the time of your service. Most services are covered at 80% or 90%. You will still receive coverage when you see healthcare providers outside of the network, although you will receive a lower benefit level.

Opt-out/ Waive Insurance Coverage

Employees with medical coverage outside of the university may complete the Ohio University Waiver of Group Health Insurance Form. Proof of alternate coverage, such as a copy of an ID card, must be submitted with this form.

Pre-existing Conditions

There are no preexisting condition limitations for Ohio University's medical plans. You can change plans during open enrollment without concern that your present medical conditions would not be immediately covered.

Pre-certification Requirement

Ohio University follows Anthem's standard predetermination and precertification requirements for both inpatient and outpatient procedures. Some procedures may require authorization prior to services being rendered. Call 1-866-776-4793 or check with your provider to determine whether your procedure requires prior authorization. All inpatient hospital admissions require precertification.