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Medical Mutual of Ohio - SuperMed One – SuperMed One Standard 2500 w/o Office Copay – OHIO
A comparison of the SuperMed One Standard 2500 w/o Office Copay offered by Medical Mutual of Ohio - SuperMed One 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/o Office Copay Application | SuperMed One Standard 2500 w/o Office Copay Application |
| Brochure | SuperMed One Standard 2500 w/o Office Copay Brochure | SuperMed One Standard 2500 w/o Office Copay Brochure |
| Copay | $0 | $0 |
| Office Visit | 100% after deductible | 50% after deductible |
| Deductible | Individual $2,500, Family $5,000 | Individual $5,000, Family $10,000 |
| Coinsurance | 100% | 50% |
| Coinsurance Limit | N/A | (Excluding the deductible) Single $4,000, Family $8,000 |
| Out-of-Pocket Maximum | N/A | (Excluding the deductible) Single: $4,000, Family: $8,000 |
| Lifetime Maximum | $7,500,000 | $7,500,000 |
| Prescription Drugs | Prescription Drug Benefit Period Deductible- Single/Family $250/$500;Prescription Drug Benefit Period Maximum: $2,000;Retail 30-day supply: 80% after deductible.Home delivery 90-day supply 80% after deductible; Prescription Drug Lifetime Maximum $2,500,000 | Prescription Drug Benefit Period Deductible- Single/Family $250/$500;Prescription Drug Benefit Period Maximum: $2,000;Retail 30-day supply: 80% after deductible.Home delivery 90-day supply 80% after deductible; Prescription Drug Lifetime Maximum $2,500,000 |
| Emergency Room | 100% after deductible | 100% after deductible (50% after deductible if it is a non-emergency) |
| Adult Preventative Care | Routine Physical Exam 100% after deductible;Routine Mammogram, Routine Pap test, Routine EKG, Chest X-ray, Comprehensive Metabolic Panel, Urinalysis and Complete Blood Count (one each per benefit period)- 100% after deductible | Well Child Care Services to age nine. Exams and Immunizations are limited to a $500 maximum per benefit period; Well Child Care Exams 50% after deductible;Well Child Care Immunizations and Labs 50% after deductible |
| Child Preventative Care | Well Child Care Services to age nine. Exams and Immunizations are limited to a $500 maximum per benefit period;Well Child Care Exams 100% after deductible;Well Child Immunizations and Labs 100% after deductible | Well Child Care Services to age nine. Exams and Immunizations are limited to a $500 maximum per benefit period; Well Child Care Exams 50% after deductible;Well Child Care Immunizations and Labs 50% after deductible |
| Lab / X-Ray | 100% after deductible | 50% after deductible |
| Maternity | Optional benefit | Optional benefit |
| Physical Therapy | 20 visits per benefit period, 100% after deductible | 20 visits per benefit period, 50% after deductible |
| Skilled Nursing | 100% after deductible ($10,000 maximum per benefit period). | $10,000 maximum per benefit period, 50% after deductible |
| Home Health Care | 60 visits per benefit period, 100% after deductible | 60 visits per benefit period, 50% after deductible |
| Mental Health | Inpatient- 100% after deductible (30 days per benefit period; Substance Abuse limited to one admission per benefit period, three admissions per lifetime);Outpatient- 50% after deductible (20 visits per benefit period) | Inpatient- 50% after deductible (30 days per benefit period; Substance Abuse limited to one admission per benefit period, three admissions per lifetime);Outpatient- 50% after deductible (20 visits per benefit period |
| Hospital Care | 100% after deductible | 50% after deductible |
| Optional Benefits | Maternity,Drug Benefit | Maternity,Drug Benefit |