UToledo Human Resources

2026 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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  UToledo Health - Tier 1 In-Network - Tier 2 Out-Of-Network - Tier 3
Deductible: $200 Employee
$400 Employee +1
$400 Family
$400 Employee
$800 Employee +1
$800 Family
$1,200 Employee
$2,400 Employee +1
$2,400 Family
Out-of-Pocket Max: $1,300 Employee
$2,600 Employee +1
$2,600 Family
$2,600 Employee
$5,200 Employee +1
$5,200 Family
$4,200 Employee
$8,200 Employee + 1
$8,200 Family
Co-Insurance: 95% (AD) 85% (AD) 70% (AD)
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.

Printable PDF

  UToledo Health - Tier 1 In Network - Tier 2 Out-Of-Network - Tier 3 
Deductible: $1,700 Employee
$3,400 Employee +1
$3,400 Family
$2,100 Employee
$4,200 Employee +1
$4,200 Family
$2,600 Employee
$5,200 Employee +1
$5,200 Family
Out-of-Pocket Max: $2,200 Employee
$4,400 Employee +1
$4,400 Family
$3,200 Single
$6,400 Single +1
$6,400 Family
$4,200 Employee
$8,400 Employee +1
$8,400 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
MedMutual Total Health Benefits

Medical Mutual Logo - link to medmutual.com

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. 

Healthy Outlooks Fall/Winter 2025 Edition

Blue Plan

Medical Mutual Logo - link to medmutual.com

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.

Healthy Outlooks Fall/Winter 2025 Edition

 

 

 

HSA Information (Optum Bank)
HSA Contribution Info & Form

Optum Bank Logo - Link to optumbank.com

Customer Service: (866) 234-8913

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 $3,400 in the Medical Flexible Spending Account and up to $7,500 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.

 

Chard Snyder Logo - Link to chard-snyder.com

3510 Irwin Simpson Road Mason, OH 45040
Customer Service: (800) 982-7715
Fax: (888) 245-8452
Email: askpenny@chardsnyder.com

Weight Management Program: Patient Guide

The University of Toledo is pleased to include weight management as a part of our benefit package. Our UToledo Health Weight Management team is here to support employees and their covered dependents in improving your health, achieving sustainable, long‑term weight loss, and providing safe access to weight management medications when appropriate. Please review the following information thoroughly to see if you or your dependent qualify for coverage and are prepared to commit to the program requirements.

Care Team

Our program provides coordinated, evidence based care for individuals seeking support with obesity and metabolic health. You will work with a team that may include:

  • Physicians certified by the American Board of Obesity Medicine (ABOM)
  • Pharmacists
  • Registered dietitians
  • Behavioral health specialists

Who Is Eligible?  

Employees and dependents covered under UToledo insurance and commit to required visits and lifestyle support may qualify if they meet any of the following criteria:

  • BMI ≥ 30 or BMI ≥ 27 with an FDA indicated obesity related comorbidity.
  • You are pre or post bariatric surgery and need metabolic optimization.
  • You are currently using weight management medications on your own but want to participate in a personally designed weight management program where medications may be covered.

Note: You may choose to pay out of pocket for weight management medications without participating in the program. Insurance coverage requires full program participation.

Program Expectations

To remain eligible for medication coverage, patients must:

  • Attend all scheduled physician, pharmacist and dietitian visits.
  • Achieve at least 5% total body weight loss within 6 months of starting medication.
  • Maintain progress or stable weight after the initial 6 month period.
  • Actively following your care plan.
  • Reschedule missed appointments within 4–6 weeks.
  • Avoid repeated cancellations or missed appointments. Two consecutive no shows will result in loss of medication coverage.

Medication Coverage Requirements

To have weight management medications covered, you must:

  • Receive prescriptions from an approved ABOM certified or partnered provider, including:  
    • Dr. Yara Tovar, endocrinology
    • Dr. Hoda Shabpiray, internal medicine
    • Dr. Shuhao Qiu, internal medicine
    • Dr. Jyothi Pappula, family medicine
    • Dr. Chayanika Pal, family medicine
    • Dr. Shalini Niranjan, family medicine
    • Dr. Mariam Mina, family medicine
  • Fill prescriptions at a UToledo Health Outpatient Pharmacy:
    • UT Access Pharmacy, inside the Comprehensive Care Center at 3333 Glendale Ave.
    • Main Campus Pharmacy, at the University Health Center at 1735 W. Rocket Drive
    • Health Science Campus Pharmacy, in the Medical Pavillion at 1125 Hospital Drive

Please note that appointments are limited and based on provider capacity for new patients.

How to Get Started

  1. For those with a UToledo Health primary care provider (PCP), ask your PCP to send a referral to bariatrics for the weight management program. If your PCP is within Family Medicine, you will be scheduled with a Family Medicine provider. If your PCP is Internal Medicine, you will be scheduled with an Internal Medicine provider.
  2. If your PCP is not with UToledo Health, have your PCP fax a referral to 419.383.2962.
  3. For those without a PCP, please call 419.383.5000 to establish care with a UToledo Health PCP. 

Medication Information

  • Weight management medications are not automatically covered and require prior authorization. Allow extra time when refilling your prescription.
  • Weight management medications covered through the program and UToledo insurance include Wegovy, Zepbound, Qsymia, Contrave and phentermine.
  • Ozempic and Mounjaro are only covered for patients with diabetes. They are not covered for weight management.

Program Visit Schedule

Patients will be expected to follow up every 4-6 weeks for the first few months with visits alternating between provider, dietician and pharmacist. Patients can expect to attend 9-12 visits in the first year. 

Ongoing Coverage Requirements

To maintain insurance coverage:

  • Achieve at least 5% total body weight loss within 6 months of starting medication.
  • Maintain progress or stable weight after the initial 6 month period.
  • Actively follow your care plan, including staying on schedule with provider visits and medication titration. Cancelling required appointments or two consecutive no shows will lead to termination of medication authorization.

We’re Here to Help

If you have any questions about the program or medication coverage, please reach out to the Benefits office at benefits@utoledo.edu or Bree Meinzer, pharmacy manager for managed care, at breanna.meinzer@utoledo.edu or 419.383.1591

Frequently Asked Questions

Do I have to participate in this program if I’m already taking a medication for weight management?

No, you can continue to obtain your medication the same way you have been obtaining it. If you would like to have it covered under the insurance, you will need to participate in the program. Once enrolled in the program, your provider will review your current treatment to determine the best option and plan for you moving forward.

Will there be a copay for the office visits?

Yes, based on your insurance plan there will be copays or coinsurance responsibility for each visit. Some of these may be considered a specialist visit.

What if I miss an appointment?

You should call to reschedule your appointment. Multiple missed appointments or lack of rescheduling appointments may lead to dismissal from the program.

How do I remain in the program?

To have continued coverage of weight management medication, you must achieve ≥5% weight loss within 6 months, maintain progress of weight loss, and stay on schedule with provider visits and medication. Not achieving these may result in dismissal from the program.

What if the medication I’m taking for weight management is different from what is covered by UToledo insurance?

Weight management medications covered through the program and UToledo insurance include Wegovy, Zepbound, Qsymia, Contrave and phentermine. If you are taking a different medication, you will be evaluated by your provider to determine the best option and plan for you moving forward. You may be switched to a covered medication.

Who should I reach out to if I have questions about the program, medication coverage or process?

Please reach out to the Benefits office at benefits@utoledo.edu or Bree Meinzer, pharmacy manager for managed care, at breanna.meinzer@utoledo.edu or 419.383.1591.

1095c

1095-C FAQ
MyUT Portal (To view your 1095-c electronically)
IRS Website (To gather more information on for 1095-C)

Last Updated: 1/8/26