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Medical Mutual of Ohio – SuperMed One Standard 2500 w/ Office Copay – Ohio

A comparison of the SuperMed One Standard 2500 w/ Office Copay offered by MMOH is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
Network See Provider See Provider
Application SuperMed One Standard 2500 w/ Office Copay Application SuperMed One Standard 2500 w/ Office Copay Application
Brochure SuperMed One Standard 2500 w/ Office Copay Brochure SuperMed One Standard 2500 w/ Office Copay Brochure
Copay N/A N/A
Office Visit $25 Copay, then 100% 50% after deductible
Deductible Individual: $2,500, Family: $5,000 Individual: $5,000, Family: $10,000
Coinsurance 80% 50%
Coinsurance Limit See OOP Maximum See OOP Maximum
Out-of-Pocket Maximum N/A (Excluding the deductible) Single: $4,000, Family: $8,000
Lifetime Maximum $2,500,000 $2,500,000
Prescription Drugs
  • Rx Deductible: $250(Single), $500(Family).
  • $2,000 Benefit period maximum.
  • 80% after deductible.
    		•
  • Rx Deductible: $250(Single), $500(Family).
  • $2,000 Benefit period maximum.
  • 50% after deductible.
  • Home delivery is not covered.
    		•
    Emergency Room 80% after deductible 80% after deductible (50% after deductible if it is a non-emergency)
    Adult Preventative Care 80% after deductible 50% after deductible
    Child Preventative Care 80% after deductible 50% after deductible
    Lab / X-Ray 80% after deductible 50% after deductible.
    Maternity Optional benefit Optional benefit
    Physical Therapy 20 visits per benefit period. 80% after deductible. 20 visits per benefit period. 50% after deductible.
    Skilled Nursing $10,000 maximum per benefit period. 80% after deductible. $10,000 maximum per benefit period. 50% after deductible.
    Home Health Care 60 visits per benefit period. 80% after deductible. 60 visits per benefit period. 50% after deductible.
    Mental Health
  • Inpatient: 30 days per benefit period, 80% after deductible.
  • Outpatient: 20 visits per benefit period, 50% after deductible.
    		•
  • Inpatient: 30 days per benefit period, 50% after deductible.
  • Outpatient: 20 visits per benefit period, 50% after deductible.
    		•
    Hospital Care 80% after deductible 50% after deductible.
    Optional Benefits
  • Maternity
  • Drug Benefit
    		•
  • Maternity
  • Drug Benefit
    		•
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