Benefits Guides
Review the Cost Sharing Summary for a detailed listing of deductibles, co-insurance, plan year maximums and office visit co-pays as well as an alphabetical listing of the PPO Medical Plan Coverage Chart listing in-network and out-of-network coverage for a variety of categories.
View the 2024-25 Benefits Summary [PDF]
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 Sydney Health mobile app [PDF] allows users to access their digital member ID card, search for network providers and view deductibles, copays and cost sharing.
The PPO plan is a "preferred provider organization." A PPO is a program in which a network of doctors, hospitals and other health care providers agree to provide medical services to plan enrollees at special, negotiated rates. Each health care provider in the network must meet and maintain strict quality requirements.
When you use network providers for your health care, you will have to pay a co-payment at the time of your service. Most services are covered at 80% after the deductible has been met. You will still receive coverage when you see health care providers outside of the network, although you will receive a lower benefit level.
Transparency in Coverage (TIC) regulations require health insurers and group health plans to create machine readable files (MRFs) that contain the negotiated rates for in-network providers and allowed amounts derived from historical claims for out-of-network providers. These files are available on Anthem's website ( https://www.anthem.com/machine-readable-file/search) . Ohio University's tax ID number, 31-6402113, is needed to access information.
Opt-out/ Waive Insurance Coverage
Employees with medical coverage outside of the university may choose to waive Ohio University health insurance .
Pre-existing Conditions
There are no pre-existing 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 pre-certification 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 pre-certification.
Notice of Privacy Practices
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 .
- Summary of Benefits Coverage (SBC)- Administrators, Faculty and AFSCME 3200 [PDF]
- Summary of Benefits Coverage (SBC)- AFSCME 1699 [PDF]
Ohio University is legally obligated to provide the following document which details what the plan provides and how it operates.