2016 individual and family plans - get health insurance ... · 2016 individual and family plans a...

2016 Individual and Family PlansA different kind of health insurancefor individuals, families and small businesses.

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A different kind of partner. InHealth Mutual was created to be a better option for Ohioans. We are a

health insurance CO-OP—a Consumer Operated and Oriented Plan. That

means that together, we are making long-term decisions that impact health

insurance in a positive way. InHealth is changing health insurance from the inside.

With very different goals. We are not the same type of insurance carrier you have worked with in the

past. We’re different because our goals are different. Those include increasing

competition to put pressure on rates, improving access to care and reinvesting

any profits back into our members through enhanced benefits and lower

premiums. In fact, you won’t catch us making short-term decisions to increase

value to shareholders because we don’t have them. Instead, we answer to our

members right here in Ohio.

Ultimately, with InHealth, as time goes by we’ll only get better because our

focus is on the one thing an insurance company should be about— providing

you and your family with quality, affordable health coverage so you can access

the health services you need. A philosophy that leads to insurance that truly

works better.

Where you have a say. As Ohio’s only health insurance CO-OP, our Board of Directors includes our

members! A novel concept, we know, and, it’s just one of the ways you can be

sure InHealth will stay on track and accountable to you. Beginning January 1,

2016, our members will comprise the majority of our Board of Directors

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Strong, growing, financially solid and here for you. We are financially strong as a result of our business model and operational efficiency

given our deliberate low overhead, measured growth strategy and large statewide broker

distribution network.

Further, we are on target with our goals and have adequate capital reserves. And, we

are delighted to report that we have a healthy split of individuals/families and small

businesses that come from every one of Ohio’s 88 counties who trust us with their health

insurance needs.

Plus, to meet our capital needs and solvency requirements, the federal government

provided us with a start-up loan and a solvency loan to support your health care needs. So

you can be sure that we have the solid foundation to back the promises we make.

Built for Ohioans by Ohioans We are an Ohio-based small business with employees, families, friends and neighbors that

live and work in Ohio. We understand the economics of living and working in the Buckeye

state. And, we are dedicated to providing quality insurance products and initiating cost

innovations to benefit you and your family, as well as our communities. Within our wide

variety of customized plans, you’ll find the right option to meet your needs.

You’ll see we have:

• Many affordable plans

• Convenient enrollment options including online

• Multiple plan offerings to best meet your needs

• Online self-service tools and capabilities

• Claims tracking

• Local and professional customer service

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Member Direct Connect To help you better understand just what a health insurance CO-OP is, the benefits uniquely

available to you as a member, and your opportunities to participate, we offer Member

Direct Connect meetings several times throughout the year. These sessions help you get

the most out of your health insurance, understand how to use your benefits and all the

services your broker provides. Plus it is your chance to give us direct feedback to help us

better serve you. Member Direct Connects include:

• Presentations based on the expressed needs of the members attending

• Healthy food

• Networking opportunities

• Fun – we often have raffles with great prizes, like FitBits and sporting event tickets

Formulary updates are available onlineAs part of InHealth’s commitment to continuous quality improvement, our Pharmacy

Benefits Manager updates our formulary on a quarterly basis. The most recent version of

the formulary is always available on our website.

We’ve added retail payment locationsIndividual members can make cash payments at CVS Pharmacy or Dollar General locations

throughout Ohio when you bring your invoices to make payments of $1,000 or under.

Multiple payments can be made when the amount due is above $1,000.

New initiatives to serve you.

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How InHealth helps members advance their wellness goals

• Statewide provider network consisting of approximately 300 Ohiohospitals, over 25,000 physicians, nearly 5,000 ancillary providers andover 11,000 non-physician providers in all 88 counties

• Providing Essential Health Benefits

• Preventive care covered 100%*

• Disease management programs† including those for asthma, diabetes,depression, coronary artery disease, congestive heart failure and renaldisease

• Wellness programs† including our Miracles and Milestones maternityprogram

• Pharmacy benefits that are accessible at over 1,500 locations aroundOhio or by the convenience of mail order

• 24/7 nurse advice line

• Monthly e-newsletters, screening reminders, and online resources tohelp you make informed health decisions

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*The range of preventive care services covered at no cost share when provided in-networkare designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members.

†Restrictions apply. Some of these benefits are not available to members enrolled in catastrophic and HSA plans.

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2016 Individual and Family Product GuideBelow you will find an overview of our product portfolio. We created it with you in mind—satisfying your health insurance needs whether you are covering yourself or you have an entire family to cover.

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Individual and Family Plan Catastrophic# 2016 Bronze 1

Plan Availability* Off-FFM and On-FFM Off-FFM and On-FFM

Benefits Network Non-Network Network Non-Network

Deductible (Individual/Family) $6,850/13,700 $20,550/$41,100 $6,300/$12,600 $18,900/$37,800

Embedded or Aggregate Ded. † Embedded Embedded

Co-Insurance % (What YOU pay after your deductible) ‡

0% 50% 40% 50%

Maximum Out-of-Pocket § (Individual/Family) (Includes Deductible, Co-Insurance and All Co-Pays)

$6,850/$13,700 $20,550/$41,100 $6,850/$13,700 $20,550/$41,100

Office Visit

Primary/Behavioral Health Provider 0% 50% $50 50%

Specialist 0% 50% $110 50%

Preventive Service || No Charge 50% No Charge 50%

Inpatient Hospitalization 0% 50% 40% 50%

Imaging 0% 50% 40% 50%

Maternity 0% 50% 40% 50%

Urgent Care 0% 50% $80 50%

Ambulance 0% 50% 40% 50%

Emergency Room 0% 0% 40% 40%

Prescription Drug

Retail Pharmacy

Generic 0% 50%(min $60) $25 50% (min $60)

Preferred Brand 0% 50%(min $60) $95 50% (min $60)

Non-Preferred Brand 0% 50%(min $60) $190 50% (min $60)

Specialty 0% 50%(min $60) 25% 50% (min $60)

Mail Order (90 Days Supply) ¶ 0% N/A 2x Retail N/A

*Pediatric Dental: EHB is included with all Off-FFM Plans. Pediatric Dental EHB is not included in On-FFM Plans.†Embedded Deductible: Each covered family member only needs to satisfy their individual deductible, not the entire family deductible,

prior to receiving plan benefits. Aggregate Deductible: For Family coverage, the entire Family Annual Deductible must be met before co-pay or coinsurance is applied

for any individual family member.‡Co-Insurance: The percentage the member pays after deductible.

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Individual and Family Plan 2016 Bronze 2 HSA 2016 Silver 1



Deductible (Individual/Family) $6,250/$12,500 $12,700/$25,400 $2,250/$4,500 $6,750/$13,500

Embedded or Aggregate Ded. † Aggregate Embedded


0% 50% 30% 50%


$6,250/$12,500 $25,400/$50,800 $6,750/$13,500 $20,250/$40,500

Office Visit

Primary/Behavioral Health Provider 0% 50% $30 50%

Specialist 0% 50% $50 50%



Imaging 0% 50% $250 50%

Maternity 0% 50% 30% 50%

Urgent Care 0% 50% $75 50%

Ambulance 0% 50% $150 50%

Emergency Room 0% 0% $300 $300

Prescription Drug

Retail Pharmacy

Generic 0% 50% (min $60) $15 50% (min $60)

Preferred Brand 0% 50% (min $60) $60 50% (min $60)

Non-Preferred Brand 0% 50% (min $60) $100 50% (min $60)

Specialty 0% 50% (min $60) 25% 50% (min $60)

Mail Order (90 Days Supply) ¶ 0% N/A 2x Retail N/A

§Out-of-Pocket Limit: The Out-of-Pocket Limit for any single Individual covered under a Family Policy shall not exceed the 2016 federalMaximum Out-of-Pocket Limit of $6,850.00. Such limitation only applies to In Network benefits; this limitation does not apply to theOut of Network Out-of-Pocket Limit.

||Preventive Services: The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive servicesto be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and Brecommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention(CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and ServicesAdministration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibilityand benefits for all members.

¶Mail Order: Specialty Prescription Drugs limited to 30 Day Supply.#Catastrophic Plans: First three office visits covered prior to deductible.

NOTE: The Policy has certain exclusions and limitations. This document is for illustrative purposes only. This is not a contract for insurance. The Policy will contain a complete list of covered services. For costs and complete details of coverage call your insurance agent or InHealth Mutual.

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Individual and Family Plan 2016 Silver 2 HSA 2016 Silver 3 HSA




Embedded or Aggregate Ded. † Aggregate Embedded


0% 50% 0% 50%


$3,750/$7,500 $20,000/$40,000 $4,000/$8,000 $20,000/$40,000

Office Visit

Primary/Behavioral Health Provider 0% 50% 0% 50%

Specialist 0% 50% 0% 50%



Imaging 0% 50% 0% 50%

Maternity 0% 50% 0% 50%

Urgent Care 0% 50% 0% 50%

Ambulance 0% 50% 0% 50%

Emergency Room 0% 0% 0% 0%

Prescription Drug

Retail Pharmacy

Generic 0% 50% (min $60) 0% 50% (min $60)

Preferred Brand 0% 50% (min $60) 0% 50% (min $60)

Non-Preferred Brand 0% 50% (min $60) 0% 50% (min $60)


Mail Order (90 Days Supply) ¶ 0% N/A 0% N/A



for any individual family member.‡Co-Insurance: The percentage the member pays after deductible.

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Individual and Family Plan 2016 Gold 1 2016 Gold 2




Embedded or Aggregate Ded. † Embedded Embedded


20% 50% 20% 50%


$3,500/$7,000 $10,500/$21,000 $4,500/$9,000 $15,000/$30,000

Office Visit

Primary/Behavioral Health Provider $20 50% $20 50%

Specialist $40 50% $40 50%



Imaging $250 50% 20% 50%

Maternity 20% 50% 20% 50%

Urgent Care $75 50% $75 50%

Ambulance $150 50% $150 50%

Emergency Room $300 $300 20% 20%

Prescription Drug

Retail Pharmacy

Generic $10 50% (min $60) $10 50% (min $60)

Preferred Brand $40 50% (min $60) $40 50% (min $60)

Non-Preferred Brand $60 50% (min $60) $60 50% (min $60)


Mail Order (90 Days Supply) ¶ 2x Retail N/A 2x Retail N/A

§Out-of-Pocket Limit: The Out-of-Pocket Limit for any single Individual covered under a Family Policy shall not exceed the 2016 federalMaximum Out-of-Pocket Limit of $6,850.00. Such limitation only applies to In Network benefits; this limitation does not apply to theOut of Network Out-of-Pocket Limit.

||Preventive Services: The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive servicesto be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and Brecommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention(CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and ServicesAdministration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibilityand benefits for all members.

¶Mail Order: Specialty Prescription Drugs limited to 30 Day Supply.


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Individual and Family Plan 2016 Gold 3 HSA

Plan Availability* Off-FFM and On-FFM

Benefits Network Non-Network

Deductible (Individual/Family) $2,250/$4,500 $5,000/$10,000

Embedded or Aggregate Ded. † Aggregate

Co-Insurance % (What YOU pay after your deductible) ‡ 0% 50%


$2,250/$4,500 $10,000/$20,000

Office Visit

Primary/Behavioral Health Provider 0% 50%

Specialist 0% 50%

Preventive Service || No Charge 50%

Inpatient Hospitalization 0% 50%

Imaging 0% 50%

Maternity 0% 50%

Urgent Care 0% 50%

Ambulance 0% 50%

Emergency Room 0% 0%

Prescription Drug

Retail Pharmacy

Generic 0% 50% (min $60)

Preferred Brand 0% 50% (min $60)

Non-Preferred Brand 0% 50% (min $60)

Specialty 0% 50% (min $60)

Mail Order (90 Days Supply) ¶ 0% N/A



for any individual family member.‡Co-Insurance: The percentage the member pays after deductible.§Out-of-Pocket Limit: The Out-of-Pocket Limit for any single Individual covered under a Family Policy shall not exceed the 2016 federal

Maximum Out-of-Pocket Limit of $6,850.00. Such limitation only applies to In Network benefits; this limitation does not apply to the Out of Network Out-of-Pocket Limit.

||Preventive Services: The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members.

¶Mail Order: Specialty Prescription Drugs limited to 30 Day Supply.


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Doctors you trust, coverage you need. With InHealth, our extensive network

of doctors and hospitals provides the

foundation for the health plans we’ve

created. With our robust provider

network, we work tirelessly to ensure

members receive the right care at

the right place at the right time. We

want you to access the care you need

from the providers you know and trust

because when you seek the appropriate

level of care, it’s a win-win.

Convenient prescription care helps you

better comply with your doctor’s orders.

And, you can receive medications

from local independent pharmacies

and national chains, alike. In fact, our

Pharmacy Benefits Manager has worked

hard to provide suitable and affordable

methods to access the medications

you need. We even provide mail order

delivery directly to you—frequently at

a reduced cost. And, you can manage

prescriptions online.

Plus, finding the information you need

is easy. Visit www.inhealthohio.org to

find a list of providers in our network,

nearby pharmacies, or medications on

our formulary.

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Plan FeaturesWhen you choose InHealth for your health insurance plan, you can be sure that we will

exceed your expectations with competitive rates and excellent coverage. Plus, we provide

all InHealth members with professional, local customer service that is just a phone call away.

Essential Health BenefitsOur plans cover all 10 of the Essential Health Benefits as defined under the Patient

Protection and Affordable Care Act of 2010. These basic categories include:

• Ambulatory patient services (outpatient)

• Emergency services

• Hospitalization

• Maternity and newborn care

• Mental health and substance use disorder services, including behavioral healthtreatment

• Prescription drugs

• Rehabilitative and habilitative services and devices

• Laboratory services

• Preventive and wellness services and chronic disease management

• Pediatric services, including dental and vision care

Prescription Drug BenefitsWe know how important medications are to your health and wellbeing. Therefore,

prescription drug benefits are included with every plan we offer. We partner with ProCare

Rx, our pharmacy benefits manager, to offer solutions that ensure you receive the care and

attention you deserve. At InHealth, we:

• Coordinate and integrate your care between multiple clinical areas, when needed

• Encourage the use of formulary drugs (a formulary is a list of preferred brand-nameand generic medications for which members pay a lower out-of-pocket charge)

• Provide members with prescription drug benefit consultations

• Ensure that high-cost specialty drugs are managed consistently and cost effectively,whether they are administered as part of medical services or through a prescription

• Enable members to view both medical and prescription drug claims online

• Give members the ability to manage prescriptions online

We believe that effectively integrating prescription drug benefits with InHealth plans helps

enhance your member experience and improve your overall health. That’s why our focus is

on delivering a prescription drug benefit that balances quality care with total costs, which is

especially important when managing chronic and/or complex conditions.

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Covered ServicesCharges for medically necessary services are subject to the calendar-year deductible,

coinsurance, or, for out-of-network providers, reasonable and customary fee schedules.

Services include:

The policy information within this brochure/document has certain exclusions and

limitations. For costs and complete details of the coverage, call your insurance agent or

InHealth Mutual.

• Acupuncture

• Ambulance services

• Behavioral healthservices

• Clinical trials

• Chiropractic care

• Diabetic equipmenteducation and supplies

• Durable MedicalEquipment

• Emergency care andurgent care services

• Habilitative services

• Home care services

• Hospice services

• Human organ andtissue transplant (bonemarrow/stem cell)services

• Inpatient services

• Maternity services

• Medical supplies, durablemedical equipment, andappliances

• Outpatient services

• Physician home visitsand office services

• Prescription drugbenefits

• Surgical services

• Reconstructive services

• Rehabilitative services,including physical,speech, occupational,and pulmonarytherapy and cardiacrehabilitation

• Mastectomy

• Sterilization

• Temporomandibular/craniomandibularjoint disorder andcraniomandibular jawdisorder

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Preventive Care. Preventive care is important to InHealth. After all, we are seeking to change the

industry’s paradigm from a focus on sickness and disease to one of wellness and

prevention. While InHealth provides the quality coverage you need, we would rather

help you prevent illness altogether. Preventive care helps reduce your healthcare

costs and is one of the most important steps you can take to manage your health

and improve your quality of life. With routine preventive care, you can identify and

address risk factors before they lead to illness.

When you receive preventive care services from a provider in our network, your

services are covered with no cost-sharing, no copay, coinsurance or deductible.

However, out-of-network charges may apply if the services are performed by a

non-network provider. Preventive care visits include complete physical exams,

vaccines to prevent disease, cancer screening tests and certain lab tests.*

Most preventive care falls into one of the following broad categories:

• Office visits for preventive physical exams (e.g. adult physicals and well-child

visits)

• Screening tests (e.g. diabetes, cholesterol, high blood pressure, colonoscopy,

PSA-Prostate Specific Antigen, and STDs)

• Adult and child immunizations (e.g. hepatitis, shingles, flu, pneumonia, and

chicken pox)

• Counseling and education interventions (e.g. diet and nutrition, disease

prevention and alcohol or drug abuse)

• Women’s Services (e.g. contraception, prenatal services, breast cancer

screenings, routine mammograms, and well woman routine OB/GYN visits and

well child visits)

The list of covered preventive services is subject to change based on federal and

state regulations. For the most current standards that apply to all InHealth plans,

please contact Customer Care at 1-800-580-8502 or visit:

https://www.healthcare.gov/health-care-law-protections/free-preventive-care/

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*The range of preventive care services covered at no cost share when provided in-network aredesigned to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members.

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We are in this together with resources to help members get and stay healthy.

At InHealth, we encourage members to take responsibility for their own health. Whether

you participate in our wellness programs, seek wellness advice on your own, or work with

your doctor to develop personalized health regimens, the result is better health. And, of

course, healthier members help us fulfill our promise of lower premiums for all.

InHealth CaresTo empower and stabilize members with chronic diseases, we offer patient-centered

chronic disease management programs that currently cover six disease states. Along with

services that support health and wellness and give options for healthcare services, we also

provide clinical oversight of services, member advocacy, member clinical support, member

education, and improved access and availability to appropriate and necessary care.

As you consider and investigate medical options, turn to InHealth for educational,

oversight and management support through:

• Utilization management programs

• Care coordination and case management programs

• 24/7 nurse advice line

• Chronic disease management 12-module education programs* that include free case management, self-care, educational materials and more.

• Asthma

• Depression

• Diabetes

• Coronary Artery Disease

• Congestive Heart Failure

• Renal Disease

• Wellness programs* including maternity which also provides a Baby Welcome kit with a diaper bag, baby monitor and breast pump or first month of formula

Ask your broker for more detailed information on these programs.

15*Restrictions apply. Some of these benefits are not available to members enrolled in catastrophic and HSA plans.

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Disease Management Programs*Chronic disease, according to the Ohio Department of Health, is the leading cause of death and disability in our state and our nation. In fact, nearly 60% of all Ohioans reported having at least one of the following 10 chronic diseases or clinical risk factors—arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, heart disease, high cholesterol, high blood pressure and stroke. Our InHealth Cares Disease Management Programs empower our members with chronic diseases to prevent the progress of these diseases while stabilizing their symptoms to improve the quality of their lives.

InHealth’s Disease Management offerings are 12-module education programs that begin providing benefits as soon as the member is enrolled and continue after the member completes the program. Further, for our members who suffer from more than one chronic disease, the education process is concurrent.

Upon enrollment, each member in our Disease Management Program is assigned a case manager/disease education manager who monitors claims every three months to ensure medication and health care provider visits are in line with the enrollee’s care plan.

The key elements of these programs include disease education, self-monitoring, physician visits, medication compliance, nutrition, and exercise (if appropriate) whereby our members learn essential self-management strategies to help live better on a daily basis, decrease ER visits and reduce hospital stays. For members enrolled in these programs, there will not be a copay for any visit associated with managing their disease (PCP and specialist). This does NOT apply to ER visits or hospitalizations. Ask your broker for more detailed information on these programs.

How to enroll in our Disease Management and Wellness ProgramsA diagnosis alone does not automatically enroll a member in a disease management program. Enrollment is a separate step, and it’s simple. Members just call the customer number associated with the program in which they are planning to enroll and an InHealth Care Coordinator will walk them through the process.

Here are the numbers you’ll need to enroll:

• Call Toll Free at 888-258-7621 for Diabetes, Asthma, Coronary Artery Disease,Congestive Heart Failure and Kidney Disease

• Call Toll Free 844-523-3990 to enroll in the Depression and/or Maternity Programs

16*Restrictions apply. Some of these benefits are not available to members enrolled incatastrophic and HSA plans.

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Savings and Wellness Programs

17*Restrictions apply. Some of these benefits are not available to members enrolled incatastrophic and HSA plans.

HealthSmart Assessment - We encourage physicians to use this tool during a preventive screening office visit to capture information annually about our members’ existing and preexisting diagnoses and procedures so they can make better health care decisions and we can create a better insurance product. This preventive screening is not subject to coinsurance or deductibles.

HealthSmart Check List – Each year, members who complete and return this simple 12-question health assessment during their first sixty days of coverage (new enrollees and renewing members) are eligible for an annual one-time reduction of $250 off of their Plan Year 2016 annual deductible. Families are eligible for a maximum reduction of $500.

Miracles and Milestones - Your Baby’s Development and Your Baby’s First Year - For our expectant members, our maternity program* includes monthly calendars that take new mothers step-by-step through pregnancy and birth, and baby’s first year. In addition, we provide a Baby Welcome Kit with the guidebook What to Expect When You’re Expecting, a diaper bag, baby monitor and breast pump or first month of formula.

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InHealth is responding to the communityInHealth is committed to your health and the health of our communities throughout

Ohio. Through listening tours, regional meetings, and advisory committees, we are

learning what it takes to respond to the needs and wants of all Ohioans. In fact, many of

our innovations were inspired by these conversations. These include:

• Our 2+2 program featuring two free visits to a primary care physician and two freevisits to a behavioral health specialist above and beyond what’s covered through preventive care.

• Health Savings Accounts

• Acupuncture: Up to $40/visit; $1,000/year

• Pediatric dental benefits built in to all Off-Exchange individual plans

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Managing your insurance onlineAs your dedicated healthcare partner, InHealth Mutual offers easy-to-access and understand online tools that make managing health insurance easy for you.

Member PortalYou can conveniently manage your individual InHealth Plan on the member portal at www.inhealthohio.org. This online resource provides a secure and private portal to check benefits, find a pharmacy or doctor, check on claims, pay premiums, find tips for healthy living and much more. The InHealth Member Portal includes:

• Access important documents

• Member Policy

• Benefits Sheet

• Explanation of Benefits

• Summary of Benefits and Coverage

• Privacy Statement

• HIPAA Statement

• Contact Information

• HealthSmart Check List

• Order a new ID card

• View your Member Handbook

• Review member rights and responsibilities

• View and pay your premium

• Find a doctor/hospital (Provider Network search)

• Find a pharmacy (Pharmacy Network search)

• Obtain Important Pharmacy Information and documents

• Manage prescription drugs

• Check a medication (Formulary)

• Pharmacy mail order brochure

• Pocket Formulary

• Pharmacy paper claim form

• Preventive Prescription Drug List

• Learn how to file complaints and appeals

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Notes:

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Notes:

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Notes:

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CHM_SMM153_0915

The policy information within this brochure has certain exclusions and limitations. For costs and complete details of coverage, call your insurance agent.

For additional information about InHealth or to request a proposal please contactour home office to be connected to your local representative at 866-982-5644.

OUR MISSION: InHealth Mutual is a nonprofit insurer built for members by members to provide quality, affordable health insurance that is responsive to the needs and wants of all Ohioans.

InHealth Mutual is a trade name of Coordinated Health Mutual, Inc

We were built for you.

Toll-Free: 866-982-5644 Local: 614-212-6004

www.inhealthohio.org

501 W. Schrock RoadWesterville, OH 43081

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2016 individual and family plans - get health insurance ... · 2016 individual and family plans a...

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