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.

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	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 – 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.

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	UTMC - Tier 1	In Network - Tier 2	Out-Of-Network - Tier 3
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. UToledo annually contributes $500/single, $750/single+1, and $1000/family. IRS contribution limits can be found at irs.gov.
Network(s):	Medical Mutual – 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

2060 E. 9th St. Cleveland, OH 44115
UToledo Customer Service: (888) 636-3622

Provider Networks:
Medical Mutual SuperMed
Cigna (outside of Ohio)

Members can access MyHealthPlan website for claims, benefit, and provider information.

Download the Mobile App


iPhone (iOS 11.0 and above)	Android (8.0 and above)

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

2060 E. 9th St. Cleveland, OH 44115
UToledo Customer Service: (888) 636-3622

Provider Networks:
Medical Mutual SuperMed
Cigna (outside of Ohio)

Members can access MyHealthPlan website for claims, benefit, and provider information.

Download the Mobile App


iPhone (iOS 11.0 and above)	Android (8.0 and above)

HSA Information (Optum Bank)
HSA Contribution Info & Form

Customer Service: (866) 234-8913

Tier 1 Providers

Flexible Spending Accounts

The University maintains a Medical Flexible Spending Account and a Dependent Flexible Spending Account for employees. 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? A Flexible Spending Account (FSA) is an IRS-approved program that enables UToledo 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? You can enroll in Flexible Spending as a New Hire/Newly Eligible employee or during Open Enrollment or due to a qualifying event such as marriage, divorce, birth, and death. 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? 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 irs.gov for IRS
contribution limits. Reimbursements can be claimed through March of the following year. For more information, click here. For a list of approved expenses, please visit Chard Snyder. Please see below for additional information.

FSA Summary Plan Description (SPD)

FSA Claim Reimbursement Form

For enrollment, claims, and other forms, visit the Benefits forms page.