DBFR Guide 2025-2026 [3-13-25].pdf

Highlights for the Upcoming Benefit Year:

The Ohio Med NN (narrow network) medical plan option will be renamed “Ohio Med Select” effective July 1, 2025.

July 1, 2025 – June 30, 2026

#1 3-13-25

Open Enrollment

May 8 – May 21

FOR OHIO POLICE & FIRE DEATH BENEFIT FUND RECIPIENTS

2 DBFR Benefits Guide

Highlights for the Upcoming Benefit Year 2

About your State of Ohio Benefits and Open Enrollment Details 3

Open Enrollment Checklist 4

Medical 5

Medical Plan Comparison Charts 8

Ohio Med Contributions 9

Centers of Excellence and the No Surprises Act 10

Telehealth Services, Nurse Lines, and Preventive Care 11

Cost Savings Tools 12

Behavioral Health 13

Prescription Drug Program 14

Wellness Program 15

Dental and Vision 16

Benefits Enrollment/Change Form 17

Benefits Contacts 23

Summary of Legal Notices 24 contents Highlights for the Upcoming Benefit Year:

• Additional anti-obesity medication coverage

• The telehealth copay will increase from $10 to $15

• Dental and vision coverage is expanding to cover most dependents aged 19-26

DBFR Benefits Guide 3

About Your State of Ohio Benefits Benefits Provided by the State of Ohio Your health benefits include medical, telehealth, prescription drug, behavioral health, dental, vision, and the wellness program – known as Take Charge | Live Well The benefit year runs from July 1 through June 30, during which services are rendered and your deductible and coinsurance are accumulated

Summary of Benefits and Coverage A requirement of the Patient Protection and Affordable Care Act, the Summary of Benefits and Coverage (SBC) is a concise document that details simple and consistent information about health plan benefits and coverage It describes the basics of your coverage and allows you to compare different coverage options It summarizes the key features of each plan, such as covered benefits, cost-sharing provisions, and limitations and exceptions All insurance companies and group health plans must use the same standard SBC form The SBC also contains a link to the required Uniform Glossary, which provides definitions of many commonly used health coverage and medical terms For each document, visit DAS.Ohio.gov/AboutMyBenefits and click the Summary of Benefits and Coverage tile

Spring Open Enrollment May 16 through May 29

Medical: Ohio Med Plan Your overall medical benefits are under one plan comprised of the medical program and other benefit programs, each administered by a third-party administrator that offers provider networks with negotiated rates and oversees payment of your benefits

Employees are assigned their third-party administrator based on the region where they live but may choose the specific plan option that works best for them: The Ohio Med PPO (preferred provider organization), Ohio Med HDHP (high deductible health plan), and the Ohio Med NN (narrow network) Medical plan options include:

• Prescription Drugs

• Wellness – known as Take Charge | Live Well

• Behavioral Health

• Telehealth

Other Benefit Programs Additional benefit programs eligible for enrollment during spring Open Enrollment include:

• Dental

• Vision

• Supplemental Life Insurance

This guide informs you and your family about benefits available this coming benefit year, which begins July 1 Eligible employees can elect to enroll or disenroll themselves and/or their dependents in medical, dental, vision, and supplemental life insurance coverage during the Open Enrollment period

If you already are enrolled in benefits:

1 Review your Benefits Summary by logging into myOhio.gov and clicking My Workspace to access benefit information for you and any dependents

2 Ensure any dependents still meet the eligibility requirements by visiting DAS.Ohio.gov/Eligibility

State of Ohio Health Plans are Self-Funded All State of Ohio health plans are self-funded programs This means the cost of benefits is funded by contributions from you and the State of Ohio All claims for services and procedures are paid directly from these contributions When the amount of claim payments is greater than the amount of contributions from employees and the state, medical costs to the fund increase Increased medical costs may cause an increase in the contribution amounts needed for future years

Employee Contributions: 15%

State Contributions: 85%

Total Contribution Available to Pay Claims

Enrollment periods

If you wish to waive your current health care coverage, you will need to do so during Open Enrollment.

If you do not have any changes to your coverage, no additional action is required.

To add a dependent to your coverage during Open Enrollment, you will be required to submit proof of eligibility when adding them in the system You are encouraged to gather all documentation needed before taking action in the system For a list of required documentation, review the Change in Status/Qualifying Events Matrix at DAS.Ohio.gov/AboutMyBenefits

Fall Open Enrollment October 15-25, 2024

Flexible Spending Accounts Only The fall Open Enrollment period offers employees the opportunity to enroll in flexible spending accounts for the 2025 calendar year Jan 1 through Dec 31, which include:

• Health Care Flexible Spending Account

• Limited Purpose Flexible Spending Account

• Dependent Care Flexible Spending Account

Enrollment in a flexible spending account is not automatic and must be completed each year during the FSA Open Enrollment period in the fall

15%

85% (Example of the Ohio Med PPO medical plan option )

Union Benefits Trust The Union Benefits Trust (UBT) offers dental, vision, and life insurance benefits for union-represented employees after one year of continuous state service is completed While enrollment is completed using myOhio.gov, any questions about eligibility or plan design should be directed to UBT at 800-228-5088 or CustomerService@BenefitsTrust.org You can also find more information at BenefitsTrust.org The same benefits for exempt employees are managed by the Ohio Department of Administrative Services

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Medical Third-Party Administrator ZIP Code Area

Third-Party Administrator ZIP Code Starts With...

Anthem 437, 438, 439, 444, 445, 450, 451, 452, 453, 454, 455, 456, 457, 458, and Out of State

Medical Mutual of Ohio 430, 431, 432, 433, 434, 435, 436, 440, 441, 442, 443, 446, 447, 448, and 449

Take the actions below to ensure you are fully prepared for Open Enrollment and to access your benefits throughout the benefit year

☐ Decide who you want to cover with your medical insurance If you currently are enrolled in medical benefits with the state, review your coverage at myOhio.gov>My Workspace>myBenefits>Benefits Summary

☐ Confirm your medical third-party administrator

☐ Based on the first three digits of your home ZIP code as shown on the chart below, your medical third-party administrator is (check one)

☐ Anthem

☐ Medical Mutual of Ohio (MMO)

Medical ☐ Anthem: EnrollmentAnthem.com/StateofOhio

☐ Download Anthem’s “Sydney Health” app

☐ Medical Mutual: StateofOhio.MedMutual.com

☐ Download the Medical Mutual of Ohio app

☐ Confirm your medical and other health care providers are in the network

☐ Go to your third-party administrator’s website to search for your providers

☐ Determine the medical plan option that best suits the needs of you and your family.

☐ Ohio Med PPO

☐ Ohio Med NN

☐ Ohio Med HDHP with a Health Savings Account

Take Charge | Live Well ☐ Go to DAS.Ohio.gov/Wellness and click The Hub tile

☐ First-time users must create a personal username and password

☐ Access all of your benefits programs via the Hub, Join.VirginPulse.com/StateofOhio.

Prescription Drug ☐ OptumRx: OptumRx.com

☐ Prescription Drug coverage is included if you enroll in the medical plan

☐ Download the OptumRx app

Telehealth ☐ Complete your registration for LiveHealth Online Be prepared to connect with a doctor or physician through your mobile device or webcam when the need arises

☐ To complete your registration, log in to LiveHealthOnline.com or download the LiveHealth Online mobile app

☐ You do not need to be currently enrolled or provide your payment information to register

Dental and Vision ☐ A printed benefit card is optional and can be requested from the respective vendor below

☐ Verify dependent eligibility (see DAS.Ohio.gov/Eligibility)

☐ Download the vendor apps

Dental (For Exempt Employees) Delta Dental of Ohio: DeltaDentalOh.com

Vision (For Exempt Employees) EyeMed Vision Care: EyeMed.com

Dental and Vision (For Union-Represented Employees) Visit the Union Benefits Trust website: BenefitsTrust.org

Supplemental Life For Exempt Employees Securian Financial: LifeBenefits.com

For Union-Represented Employees Union Benefits Trust: BenefitsTrust.org

OPEN ENROLLMENT CHECKLIST

DBFR Benefits Guide 5

MEDICAL

The State of Ohio is committed to offering quality comprehensive medical coverage for you and your family The state offers one medical plan: Ohio Med To provide you with medical coverage that best meets your needs, there are three medical plan options from which to choose, including the narrow network called Ohio Med NN The following chart lists the differences between the medical plan options To help you decide which plan is right for your family, go to DAS.Ohio.gov/Medical and click the Compare the Medical Plan Options tile

Medical Plan Ohio Med is the one plan for those who enroll in medical benefits. Ohio Med Medical Plan Administrators Your administrator is determined by your home ZIP code.

Anthem and

Medical Mutual of Ohio Medical Plan Options There are three options available to you.

Ohio Med NN Narrow Network

Ohio Med PPO Preferred Provider

Organization

Ohio Med HDHP High Deductible Health Plan

Medical Plan Option Definitions

A narrow network plan is a medical plan that offers benefits only at in-network levels with set copay amounts for certain services. When you enroll in the Ohio Med NN, you may only visit providers within the network.

IMPORTANT: If you go to a provider that is out of network for non-emergency services, there is no coverage, and you will be responsible for the entire cost.

A preferred provider organization (PPO) is a medical plan that offers benefits at both in-network and out-of-network levels with set copay amounts for certain services. When you enroll in the Ohio Med PPO, you may visit any doctor and receive benefits.

However, the coverage amount is greater when you use in-network providers.

A high deductible health plan (HDHP) is a medical plan that offers benefits at both in-network and out-of-network levels typically with a higher deductible and out-of-pocket maximums than the PPO plan. The contribution is usually lower, but you pay more health care costs before the medical third-party administrator starts to pay its share. The HDHP includes a health savings account (HSA), which allows you to pay for certain medical expenses with money free from federal taxes. With the HSA, the state offers $1,000 or $2,000 for you to apply to your health care costs.

Medical Plan Option Details

• In most instances, the narrow network plan has a lower contribution amount than the Ohio Med PPO and HDHP.

• Covered services will be the same as the PPO.

• Network-level copays, coinsurance, deductibles, and out-of-pocket amounts will also be the same as the Ohio Med

PPO.

• The narrow network has a smaller network of primary care providers, specialists, and hospitals that are committed to providing a higher quality of care with improved care coordination at a more affordable price.

• There is no out-of-network benefit, except for emergencies.

• Third-party administrator plan names:

• Medical Mutual of Ohio refers to this plan as “MedFlex.”

• Anthem refers to this plan as “BlueHPN.”

• This plan has a higher recipient contribution, but a lower deductible; members must pay the full amount until the deductible is met.

• Each person covered in a family plan must meet the individual deductible or the combined family deductible, whichever occurs first, before the plan begins to pay.

• Copay amounts are set for medical services such as a visit to the doctor and for prescriptions.

• There is a separate $3,500 single or $7,000 family out-of-pocket maximum that must be met before prescription costs may be paid at 100%.

• Prescription costs are not combined with medical to meet your out-of-pocket maximum.

• Has a lower recipient contribution than the PPO, but a higher deductible;

members must pay the full amount until the deductible is met.

• The HDHP includes an HSA with a state contribution to your account.

• If you are in a family plan, the plan will begin to pay only after the entire family deductible has been met.

• Initial expenses can be paid by you using the HSA, or you could be reimbursed after a claim has been submitted.

• Prescription costs are combined with medical to meet your out-of-pocket maximum.

• You cannot currently be enrolled in, or have a carryover balance from, the previous calendar year in any Health Care Spending Account.

• You can enroll in a Limited Purpose Spending Account.

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Medical Plan Options Why Your Medical Plan Option Decision Matters The state offers three medical plan options Your decision could have a direct effect on your flexible spending account (FSA) options, should you choose to enroll in an FSA in the fall of 2024 for the 2025 calendar year

Depending on the needs of you and your family, it is strongly recommended that you search the network of your administrator. To help determine whether your primary care provider, specialist, or hospital system is included in the narrow network option, visit the websites below for your medical plan administrator:

Medical Mutual of Ohio: StateofOhio.MedMutual.com

1 Click Find a Provider in the top menu 2 Click the OhioMed Narrow Network link 3 Click the Don’t See Your Network? View More link 4 Choose MedFlex, enter Your Location, and click the Next button 5 Choose the desired provider type

Anthem: Anthem.com/Find-Care

1 Click the Guests tile 2 From the dropdown questions, select:

• Medical

• Ohio

• Medical (Employer-sponsored)

• Blue Connection (BLUEHPN)

Important Points About the Ohio Med HDHP The deductible must be reached first before the plan pays toward any of your medical, pharmacy, or behavioral health costs If you have family coverage, the plan will begin to pay only after your entire family deductible has been met This is especially important to understand if a major medical expense or a high-cost specialty drug needs to be covered within the first few days, weeks, or months of the Ohio Med HDHP plan taking effect

For an in-network example, if your medical coverage begins July 1 and a health care emergency occurs in July, you should ensure you can pay the full out-of-pocket cost (including the deductible) for the plan option that you selected: either single coverage at $3,500 or family coverage at $7,000 After you meet your deductible (either $2,000 or $4,000 in-network), the plan would cover expenses at 80% After the full amount of the out-of-pocket maximum is paid, the plan would cover expenses at 100% It is important to note that unlike the PPO and narrow network, in the HDHP prescription and medical costs are combined to meet your out-of-pocket maximum

Specialty drugs could have a high cost (even into the thousands of dollars) Your deductible is used to pay for the specialty drug before the plan will pay To help you pay for any initial health care costs, the State of Ohio will make contributions to your HSA every pay period during the upcoming benefit year

For eligibility details, visit DAS.Ohio.gov/Eligibility

DBFR Benefits Guide 7

Save Smart with a Health Savings Account The Health Savings Account (HSA) is funded by employer and employee contributions on a pre-tax basis to help pay for eligible medical expenses, including deductibles and coinsurance The HSA is only available as part of the Ohio Med HDHP option and automatically comes with the HDHP

An HSA is set up online through Baker Tilly Vantagen, myFlexDollars.com, similar to a bank account at a brick-and-mortar bank An HSA is your personal bank account and allows you to manage your funds

• HSA funds are yours to keep

• There is no “use it or lose it” rule at the end of the year

• HSA funds stay with you even if you change jobs, leave employment with the State of Ohio, or retire

• After reaching an investment threshold of $2,100, you can:

• Invest in the mutual funds offered from Baker Tilly Vantagen

• Move investments from various funds

• Transfer money between your HSA and your investment account

Three Ways to Receive Tax Savings Typically, you:

• Won’t pay tax on money deposited in the HSA (although the IRS limits how much can be contributed each year)

• Won’t pay tax on qualified medical expenses, including dental and vision expenses

• Grow your savings tax-free, which can be used for expenses now or in retirement

Easy Access to Your Account Through the myFlexDollars mobile app or website, you can:

• Track balances and transactions

• Make an HSA contribution

• Capture and submit receipts

• Learn how to maximize your HSA

For more information, go to myFlexDollars.com

HSA Employee Contribution From Jan 1, through Dec 31, 2024, the HSA contribution limit for individual coverage is $4,150 and the limit for family coverage is $8,300 If you are 55 years of age or older, you may make a catch-up contribution up to $1,000 You can use these savings to contribute to the HSA

HSA Employer Contribution To help get your HSA started, the State of Ohio will make contributions to your HSA if you select the Ohio Med HDHP option You could receive up to $1,000 for single coverage and up to $2,000 for family coverage, paid in installments during the benefit year The employer contribution is prorated for new hires If you are eligible for, and enroll in, the Ohio Med HDHP option, you will receive the employer contribution for each year you are enrolled The employer contribution counts toward your annual maximum

HEALTH SAVINGS ACCOUNT

State of Ohio’s Contributions to Help Start Your HSA

The 2024 installment schedule is $1,000 for single and $2,000 for family and is distributed per pay throughout the year.

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When comparing the Ohio Med PPO and Ohio Med NN medical plan options, the Ohio Med NN only covers in-network providers for non-emergency events. Regardless of the plan you choose, you can access cost-comparison tools found on your medical and prescription drug third-party administrator websites Use these tools to determine how you can save on expenses for services such as nurse lines, telehealth, doctor visits, retail clinics, and urgent care clinics

Comparing Medical Plan Options

Ohio Med PPO and Ohio Med NN Ohio Med HDHP

In-Network Providers (PPO and

Narrow Network)

Out-of-Network Providers

(PPO Only)

In-Network Providers

Out-of-Network Providers

Deductible Single $400 $800 $2,000 $4,000

Family $800 $1,600 $4,000 $8,000

Office Visits

Doctor $30 $50 Deductible/ 20% Coinsurance

Deductible/ 40% Coinsurance

Specialist $35 $55 Deductible/ 20% Coinsurance

Deductible/ 40% Coinsurance

Out-of-Pocket Maximum

Single $2,500 Medical/

Behavioral Health Combined

$5,000 Medical/ Behavioral Health

Combined

$3,500 Medical/ Behavioral Health/

Pharmacy Combined

$7,000 Medical/Pharmacy/ Behavioral Health

Combined

Family $5,000 Medical/

Behavioral Health Combined

$10,000 Medical/ Behavioral Health

Combined

$7,000 Medical/ Behavioral Health/

Pharmacy Combined

$14,000 Medical/Pharmacy/ Behavioral Health

Combined

Prescription Drugs

Retail (30-day supply) $10 / $40 / $75 N/A Deductible/

20% Coinsurance N/A

Home Delivery (90-day supply) $25 / $100 / $187.50 N/A Deductible/

20% Coinsurance N/A

Pharmacy Out-of-pocket Limit $3,500 / $7,000 N/A Included in

Medical Included in

Medical

Medical Care Comparison - Where To Go For Care

Ohio Med PPO and Ohio Med NN Ohio Med HDHP

Doctors in Your Plan Doctors in Your Plan Average Cost

Preventive Care 100% 100% $0

Telehealth Services $15 Deductible/Coinsurance $59

Doctor Visits $30 Deductible/Coinsurance $127

Specialist Visits $35 Deductible/Coinsurance $152

Retail Health Clinics $30 Deductible/Coinsurance $55

Urgent Care Clinic $40 Deductible/Coinsurance $107

Free Standing or Hospital Emergency Room

$150 / 80% Deductible/Coinsurance $1,540

DBFR Benefits Guide 9

Ohio PPO Contributions

Monthly Paid OP&F Death Benefit Fund Recipient contributions

Recipient Share State Share Total

Single $126.78 $716.11 $842.89

Family $347.30 $1,965.68 $2,312.98

The recipient share rates represent the total amount that will be automatically deducted from your monthly pension disbursement provided by the Ohio Police & Fire Pension Fund.

Ohio Med HDHP Contributions

Monthly Paid OP&F Death Benefit Fund Recipient Contributions

Recipient Share State Share Total

Single $84.96 $760.69 $845.65

Family $148.31 $1,330.81 $1,478.12

The recipient share rates represent the total amount that will be automatically deducted from your monthly pension disbursement provided by the Ohio Police & Fire Pension Fund.

Ohio Med NN Contributions

Monthly Paid OP&F Death Benefit Fund Recipient Contributions

Recipient Share State Share Total

Single $83.56 $716.11 $799.67

Family $228.70 $1,965.68 $2,194.38

The recipient share rates represent the total amount that will be automatically deducted from your monthly pension disbursement provided by the Ohio Police & Fire Pension Fund.

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Centers of Excellence:

Get Specialized Care and Save What it is: A center of excellence is a program within a health care institution assembled to have a high concentration of expertise and related resources centered on a particular area of medicine, delivering associated care in a comprehensive, interdisciplinary fashion to work toward improving patient outcomes

Why it’s important: At a center of excellence, a team of health care providers who specialize in one medical area work together to provide a higher level of service, demonstrate patient safety practices, and deliver better results and outcomes

Specialized procedures: The following procedures are covered by the third-party administrators under the centers of excellence designation:

• Bariatric surgery

• Transplants

• Cardiac

• Spine surgery

• Cancer

How you can benefit: Because the medical team specializes in a specific area of care, costs may be less, and there may be a value-added benefit to improve overall health care outcomes

Anthem: Sydney Health

Medical Mutual of Ohio

LiveHealth Online (Telehealth)

OptumRx (Prescription Drug)

Virgin Pulse (Take Charge | Live Well)

Optum Behavioral Health:

LiveAndWorkWell.com

EyeMed Vision Care

Delta Dental

Baker Tilly Vantagen:

myFlexDollars.com

ComPsych:

GuidanceResources.com (Ohio EAP)

Stay Connected 24/7 with These Apps Download the following apps from the Apple Store or Google Play:

SUICIDE PREVENTION

You could save a life … possibly your own If you are, or someone you know is, contemplating or may be at risk of attempting suicide, there is hope Call the 988 Suicide & Crisis Lifeline available 24/7 Call, text, or chat 988 to be connected to trained counselors who are part of the Lifeline network If there is an emergency or you think you may harm yourself, call 911 immediately

For resources about suicide prevention, visit and enter the Web ID: OhioEAP.

DBFR Benefits Guide 11

Get the Medical Treatment and Advice You Need Quicker for Minimal Cost Telehealth Services – Livehealth Online

Don’t have time to go to the doctor? Feeling under the weather?

Don’t want to fight traffic to get to the doctor? Searching for care after hours?

Without leaving your home, LiveHealth Online allows you to:

• Visit with a doctor through live video chat 24/7

• Select your choice of U S board-certified doctors from among those available at the time of service

Video chat with a board-certified doctor or psychiatrist, or licensed therapist. The doctor can assess your condition, recommend a treatment plan, and even prescribe basic medications (not narcotics or controlled substances) for pickup at a nearby pharmacy

Visit with a licensed therapist or board-certified psychiatrist When stress, anxiety, or depression occurs, talking with a therapist online may be the most convenient solution In most cases, an appointment can be made to talk with a therapist in four days or less

Save time and money. Download the free LiveHealth Online app on your mobile device to get the care you need by video chatting with a doctor online for the following conditions and more:

• Flu • Skin infection

• Allergies • Tooth pain

• Headache • Minor rash

• Cold • Behavioral health

• Fever • Stress

• Pink eye • Anxiety

• Sore throat • Depression

With just a $15 copay for the Ohio Med NN and Ohio Med PPO or $59 or less for the Ohio Med HDHP, LiveHealth Online costs much less than a trip to an emergency room, an urgent care center, or even a walk-in clinic Prices vary for behavioral health visits for HDHP members: up to $80 for a therapist, $95 for a psychologist, $175 for an initial visit with a psychiatrist, and $75 for follow-up visits For details about the state’s telehealth services, visit DAS.Ohio.gov/Telehealth

LiveHealth Online Registration Employees enrolled in the State of Ohio medical plan have been pre-registered in LiveHealth Online Go to the LiveHealth Online website, LiveHealthOnline.com, or the mobile app Complete the registration process so you’re ready to use telehealth when it’s needed Spouses will need to create their own account

For life-threatening health situations, call 9-1-1 or go to an emergency room for immediate assessment and treatment

24-Hour Nurse Lines Offer Free Consultation For non-life-threatening health-related questions, employees enrolled in the State of Ohio medical plan may contact the 24-Hour Nurse Line provided by your medical third-party administrator

Anthem: 800-337-4770

Medical Mutual of Ohio: 888-912-0636 Calling the free nurse line can help you obtain the answers to your health-related questions wherever you are, whenever you need it

Preventive Care: Stay Healthy, Save Money Preventing and detecting disease early is important to living a healthy life The better your health, the lower your health care costs are likely to be One of the most important healthy actions you can take is to schedule regular check-ups and screenings with your primary care physician

The Ohio Med NN, Ohio Med PPO, and Ohio Med HDHP medical plan options offer many services with no deductible, no copayment, and no coinsurance for network providers Other services are available for the normal copayment, coinsurance, and deductible amounts

For a list of exams, screenings, and immunizations covered at no cost, visit DAS.Ohio.gov/Medical, and click the Preventive Care tile

TELEHEALTH

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Be a Better Health Care Consumer Being a smart consumer and making informed choices are ways to keep your cost and the state’s cost of medical claims down You can start by choosing a primary care physician and keeping regular visits Developing a relationship with your physician can reduce trips to the emergency room or urgent care facility Taking advantage of preventive care coverage is another way to stay healthy

Recommended: To determine which plan design best fits your needs, use the cost comparison tools from your medical third-party administrator (Anthem or Medical Mutual of Ohio) to determine your annual health care spending needs and trends For the cost comparison tools provided by Anthem and Medical Mutual of Ohio, see the Did You Know section to the right

Where to Get Care Non-Emergency Your third-party administrator can assist with finding quality in-network care at a lower cost

• Anthem: 800-337-4770

• Medical Mutual: 888-912-0636

Home/Local

• Call your primary doctor

• He/she knows you and your health best

After-Hours or Traveling

• Call your doctor for advice, if possible

• Ask questions and understand your options if he/she isn’t able to see you

• Contact LiveHealth Online via the app or your webcam

Need Surgery? Choose Wisely Compare Hospitals

• Leapfrog Group Hospital Safety Score:

HospitalSafetyGrade.org.

• Gold standard: Measures quality, safety, performance, and transparency

• Review results online at no cost

• Medicare: Medicare.gov/HospitalCompare

• Find & compare providers near you

Source: Health Action Council

Finding The Right Care

Options What It Is Best For

24-Hour Nurse Lines (Free)

Talk with a nurse Anthem: 800-337-4770 Medical Mutual: 888-912-0636

Non-life-threatening health-related questions or concerns

Telehealth Services

Visiting with a doctor, therapist, or psychiatrist via a smartphone, tablet, or computer with a webcam using LiveHealth Online

Getting care 24/7 easily and conveniently for cold/flu, sinus infections, coughs, sore throats, and behavioral health services

Doctor’s Office

Visiting your primary care physician or a physician within your third-party administrator’s network

Check-ups, physicals, infections, minor sprains, sore/ strep throat, coughs, cold/flu, vaccines

Walk-in Clinic

Clinic in retail store or pharmacy staffed by nurse practitioners

Basic care: Ear/sinus infections, sore/strep throat, minor sprains, bronchitis, coughs, cold/flu, vaccines

Urgent Care Center

Self-standing center or located in health facility;

staffed by physicians and nurses

Serious, non-life-threatening care: Fractures or sprains needing X-rays, deep cuts needing stitches, severe rashes

Emergency Room

Free-standing or hospital department open 24/7;

staffed and equipped for life-threatening care

Threats to life or limb: Chest pain, difficulty breathing, seizures, major fracture, head trauma, bleeding, allergic reaction, loss of consciousness

Did You Know… Providers in your network may charge significantly different rates for the same procedure Similar to searching for a new car, to find the best price, it’s best to do comparison shopping

Whether you’re needing lab work, X-rays, or a medical procedure, researching the costs at different providers could help you save money

To best manage your health care spend, go to your third-party administrator’s website and use the cost comparison tool

Anthem:

EnrollmentAnthem.com/StateofOhio

Medical Mutual of Ohio:

StateofOhio.MedMutual.com

COST-SAVINGS TOOLS

Shopping for the Right Care:

How to Save Money and Ensure Quality Standards

DBFR Benefits Guide 13

As an eligible recipient enrolling in medical coverage – no matter whether you choose the Ohio Med PPO, Ohio Med NN, or the Ohio Med HDHP – you automatically receive coverage in the following benefit programs and services:

• Behavioral Health (administered by Optum Behavioral Health)

• Prescription Drug (administered by OptumRx)

• Wellness – known as Take Charge | Live Well (administered by

Virgin Pulse)

• Telehealth services (administered by LiveHealth Online)

Specialized mental health and substance use services are included with your selected medical plan (either Ohio Med PPO, Ohio Med NN, or Ohio Med HDHP) and provided under a single program administered by Optum Behavioral Health

Confidential phone assessments and referral services are available to enrolled recipientss and dependents 24/7 for a variety of behavioral health issues, such as:

• Substance use disorders

• Depression

• Autism spectrum disorder

• Grief and loss

• Marital, family and relational issues

• Mental health illnesses

• Stress

To compare the deductible and out-of-pocket costs in the Ohio Med PPO, Ohio Med NN, and Ohio Med HDHP options, go to DAS.Ohio.

gov/BehavioralHealth

ABOUT YOUR COMPLETE

MEDICAL COVERAGE

BEHAVIORAL HEALTH

YOUR MENTAL HEALTH AND WELL-BEING

DESERVE AN ANNUAL CHECK-UP, TOO

Your health and well-being journey is important, and now you can get personalized care through a new digital experience

You can now get an enhanced experience to get the tailored support you need for your personal well-being journey that will allow you to:

• Get connected: Connect immediately with an expert or schedule appointments for services

• Get guidance: Assesses your area of need and directs you to the care options, tools, and resources most appropriate to your focus area

• Get assessed: Evaluate your needs across six primary care pillars and get personalized results and well-being plans to your specific needs

ComPsych, the Ohio Employee Assistance Program’s third-party administrator, has a digital experience available on their GuidanceResources portal at GuidanceResources.com or on their GuidanceNowSM app

14 DBFR Benefits Guide

Included with your selected medical plan, OptumRx provides prescription drug benefits for enrolled State of Ohio employees and their dependents

Anti-Obesity Medication Added to Coverage Zepbound will be added to the list of covered anti-obesity medications effective July 1, 2024 As with the other medications (Saxenda, Wegovy, and Xenical), prior authorization will be required before a prescription can be covered

Diabetes Management Program Members are eligible for free diabetic supplies and medication if they have had a hemoglobin A1C test within the past 12 months of being a member of the Ohio Med PPO or Ohio Med NN Specific test values and results are not required, only that the member has had the test Members enrolled in the Ohio Med HDHP are not eligible for free diabetic supplies Certain diabetic supplies and equipment are covered by your medical third-party administrator

Specialty Drug Management Program Some specialized medications for serious medical conditions such as cancer, cystic fibrosis, and rheumatoid arthritis must be obtained from Optum Specialty (the specialty pharmacy) and can only be filled for 30 days or less Your order may be shipped to your home or workplace, if permitted A program description and a list of medications are at DAS.Ohio.gov/PrescriptionDrug, under “Specialty Drug Updates ”

Prescription Costs

Ohio Med PPO and Ohio Med NN Copayment Costs Ohio Med HDHP

Coinsurance Costs

Type of Medication

30-Day Supply at Retail

Copayment

30-Day Supply Specialty

Copayment

90-Day Supply at Retail

Copayment

90-Day Supply at Mail-order Copayment

All Types of Medication

Generic $10 $10 $30 $25

You pay 100% until the deductible is met, then 20% until the out-of-pocket limit is met.

Deductible amounts:

$2,000 single/ $4,000 family

Preferred Brand-Name $40 $40 $120 $100

Non-Preferred Brand-Name, Generic Unavailable

$75 $75 $225 $187.50

Non-Preferred Brand-Name, Generic Available

$75 plus the difference between the cost of the brand-name and generic drug

$75 plus the difference between the cost of the brand-name and generic drug

$225 plus the difference between the cost of the brand-name and generic drug

$187.50 plus the difference between the cost of the brand-name and generic drug

Out-of-Pocket Maximum* $3,500 single/$7,000 family $3,500 single/$7,000 family

The amount charged to the individual for generic, preferred brand, and non-preferred brand medications will not be greater than the actual cost of the medication. Therefore, the amount charged may be less than the flat-dollar copay.

The maximum copay for oral oncology medications will be $100 for a 30-day supply. For more details, visit DAS.Ohio.gov/PrescriptionDrug.

* Pharmacy copays do not apply toward the medical/behavioral health plan deductibles and the annual out-of-pocket maximum for the Ohio Med PPO and the Ohio Med NN.

Not All Drugs are Covered Some drugs are not covered at all, and some require the use of alternative medications before being approved This is known as “step therapy ” Examples include, but are not limited to, medications used for heartburn, glaucoma, multiple sclerosis, diabetes, asthma, elevated triglycerides, migraines, osteoporosis, nasal allergies, sleep disturbances, and high blood pressure Additional medications requiring step therapy may be added at any time If this occurs, members currently using the affected drugs will be notified in advance by mail

A program description and a list of medications are at DAS.Ohio.gov/PrescriptionDrug, under “Prescription Drug Updates ”

OptumRx Offers Price and Save, Tracking Tools Important information is available at OptumRx.com You will need your pharmacy member ID number located on your OptumRx card to log in Your ID begins with the letter “A ” For questions, contact OptumRx at 866- 854-8850 Easy access to the OptumRx website allows you to:

• Compare mail-order prices and prices at local pharmacies

• Find your lowest copay

• Locate a pharmacy and get driving directions

• Manage your mail-order prescriptions, including options to request a refill or track an order

PRESCRIPTION DRUGS

DBFR Benefits Guide 15

Biometric Screening Incentive

Required Steps Actions Completion and

Submission Dates Employee Incentive

Spouse Incentive

Step 1 Health Risk Assessment

• Online Questionnaire completed through Virgin Pulse Hub.

Complete and submit between July 1 and December 15 , 2024.

$1,000

Paid in February 2025.*

$350

Paid in February 2025.*

Step 2

Biometric Screening

Biometric Screening Options:

• State worksites.

• Quest Patient Service Center.

• Physician form.

Step 3

Next-Steps Consult Call

• Next-Steps Consult call through Virgin Pulse.

• Initial review of screening results at the time of the biometric screening is not considered the follow-up session with a health care professional.

Complete Step 3 after the biometric screening and before December 31, 2024.

*Payment date is approximate.

Bonus Incentive

Bonus for Completing Biometric Screening in

Consecutive Benefit Years

If you received a biometric screening incentive lat benefit year (July 1, 2023, through June 30, 2024) and complete all three Biometric Screening Incentive steps above during the current benefit year, you will receive this bonus incentive.

$250

Paid in July 2025.*

$100

Paid in July 2025.*

*Payment date is approximate.

Preventive Care Screening Incentive

Action Completion and Submission Dates Employee Incentive

Spouse Incentive

Preventive Care Screening with a Primary Care Physician

Could include a wellness visit/ annual physical or other preventative screening(s), such as a mammogram, colonoscopy, and/or other screenings, as recommended.

Complete your preventative care screening between July 1, 2024, through May 31, 2025, and Virgin Pulse will automatically process your incentive. It could take up to 90 days for Virgin Pulse to receive your claim data.

$500

Paid in July 2025.*

$200

Paid in July 2025.*

*Payment date is approximate.

Take Charge | Live Well – the state’s wellness program – is committed to helping you achieve your wellness goals Having a plan and taking the necessary steps are important in maintaining good health or improving your health Streamlined with a new incentive structure, Take Charge | Live Well will focus on knowing your health numbers by completing a Health Risk Assessment, a biometric screening, and a conversation with a Virgin Pulse health guide When completing these and the additional incentives, you can earn up to $1,750 and your spouse up to $650 Through Virgin Pulse, the program’s administrator, you will continue to have access to helpful resources such as coaching, Wellbeats, nutrition and sleep guides, Journey’s, RethinkCare mindfulness program, and much more

16 DBFR Benefits Guide

For Exempt Employees Beyond the health care benefits offered through the state’s medical plan, consider taking care of your overall health with dental and vision coverage In addition, supplemental life insurance offers a cost-effective option and peace of mind knowing you’re covered in the event of a tragedy

DENTAL AND VISION

Take Care of Your Overall Health

Dental The Delta Dental PPO POS plan, offered at no cost to employees through Delta Dental of Ohio, provides exempt employees with access to two networks of dentists: the Delta Dental PPO network and the Delta Dental Premier network Delta Dental pays the least for out-of-network dentists

Why dental insurance? Maintaining overall good health and well-being includes getting essential preventive care, which lowers your costs for other dental and oral health procedures Having quality dental coverage leads to regular dental care, which is important to your general health Smile confidently with good oral care

Although you can go to any licensed dentist of your choice and receive benefits, you will generally pay less when you go to a dentist within the Delta Dental PPO or Delta Dental Premier network

Dental coverage includes diagnostic and preventive services (such as cleanings and X-rays), basic restorative services (such as fillings), major restorative services (such as crowns and bridges), and orthodontia

Vision Vision benefits provide much more than eye exams Vision wellness, offered at no cost to employees, includes correction needs, especially as you age, and can help to monitor your vision to be prepared when changes to your vision may occur Taking care of your vision is also a part of your overall health At times during an exam, a doctor can detect other health issues such as diabetes, high blood pressure, some cancers, and more With your vision benefit, the plan includes coverage for prescription eyeglasses and contacts, LASIK eye surgery, and low vision aids

Vision coverage is offered to exempt employees through EyeMed Vision Care The EyeMed Insight network encompasses many providers Employees and their family members who choose to receive services outside of the vision plan network may be subject to a reduction in benefits Whether you need a vision exam, glasses or contacts, or other vision services, EyeMed’s comprehensive vision plan has you covered

In addition, the benefit plan also offers a discount for hearing care

To learn more, visit the Vision webpage: DAS.Ohio.gov/Vision

DBFR Benefits Guide 17 o o o o o o pl ea se p rin t l eg ib ly

18 DBFR Benefits Guide

DBFR Benefits Guide 19

20 DBFR Benefits Guide an d ot he r i nf or m at io n th at w ill a llo w u s t o id en tif y yo u.

W e m ay a ls o as k to se e yo ur d riv er

’s li ce ns e or o th er id en tif yi ng d

DBFR Benefits Guide 21 en t’s s”

22 DBFR Benefits Guide

NOTES

DBFR Benefits Guide 23

TIP:

When placing a call, please ensure you have the documentation you might need during the call:

▪ Group Number

▪ OH/ID Workforce User ID

▪ Explanation of Benefits if call is regarding a claim

Medical Anthem 844-891-8359 Nurse Line: 800-337-4770 EnrollmentAnthem.com/StateofOhio Group Number: W59989

Medical Mutual of Ohio 800-822-1152 Nurse Line: 888-912-0636 StateofOhio.MedMutual.com Group Number: 228000

Health Savings Account Baker Tilly Vantagen 833-559-0002 Available 8 a m to 8 p m Monday through Friday myFlexDollars.com support@myFlexDollars.com

Prescription Drug OptumRx 866-854-8850 OptumRx.com Rx Group Number: STOH

Behavioral Health Optum Behavioral Health 800-852-1091 LiveAndWorkWell.com Group Number: 1507 Website Access Code: 00832

Telehealth LiveHealth Online 888-548-3432 LiveHealthOnline.com

Take Charge | Live Well Virgin Pulse 833-977-2074 Join.VirginPulse.com/StateofOhio

Dental Delta Dental of Ohio 800-524-0149 DeltaDentalOH.com Delta Dental PPO POS Group Number: 9273-0001

Vision EyeMed Vision Care 888-838-4033 EyeMed.com Group Number: 1016475

Ohio Department of Administrative Services myBenefits Support Center Team 614-466-8857, option 2 800-409-1205, option 2 DAS.Ohio.gov/Benefits myBenefits@DAS.Ohio.gov

BENEFITS CONTACTS

Ohio Department of Administrative Services State Human Resources Division 30 E. Broad St., 40th Floor Columbus, OH 43215

SUMMARY OF LEGAL NOTICES

Your legal rights to protect your privacy and health coverage are important to us Please take a moment to review the following information and visit DAS.Ohio.gov/Benefits > About my Benefits > Legal Notices

• HIPAA Privacy Notice | You have the right of privacy and access to your personal health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA), including the right to request restrictions, amendments, and confidential communication The State, including its Health Plans and Business Associates, may only use and disclose your PHI as authorized by law or legal purposes, for your health services or treatment, for payment or Plan operation, or for public health administration The State is required to provide a notice to you if a breach of your PHI has occurred

• HIPAA Special Enrollment Notice | HIPAA requires a special enrollment period for the following situations: 1) when a covered individual loses eligibility or if the employer stops contributing toward the other coverage from another plan; or, 2) when there is a new dependent because of marriage, birth, adoption, or placement for adoption Enrollment must be requested within 31 days after the coverage ends or the qualifying event occurred

• COBRA Notice | Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you experience a qualifying event that results in the termination of your health coverage, the State is required to provide you an opportunity to temporarily extend coverage for a certain period, at your expense

• Notice on Creditable Coverage (Medicare Part D: Prescription Drug Coverage) | The State has determined that its prescription drug coverage is, on average, expected to pay out as much as standard Medicare prescription drug coverage and is considered Creditable Coverage Because of this, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan If you do decide to join, you may be required to provide a copy of the full notice to prove you maintained creditable coverage

• Health Insurance Marketplace Coverage Options | The Patient Protection and Affordable Care Act (PPACA) requires the State to issue a notice to all employees informing them that they can purchase medical coverage from the Health Insurance Marketplace This coverage option is in addition to the State medical coverage

• Wellness Program Notice | Take Charge | Live Well is a voluntary wellness program available to those enrolled in the State Plan You have rights under Americans with Disabilities Act of 1990 (ADA), the Genetic Information Nondiscrimination Act of 2008 (GINA), and HIPAA, including requesting a reasonable alternative for incentives paid for health-related activities

• Notice of Non-Discrimination | The State of Ohio is an equal opportunity employer, disability inclusive state, and model employer of individuals with disabilities The State does not discriminate based on protected statuses established by Federal Law, Ohio Law, and Executive Order of the Governor in employment-related decisions If you believed you have experienced discrimination, you have a right to file a complaint

• Women’s Health and Cancer Rights Act of 1998 Notice | The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that requires coverage to patients who choose to have breast reconstruction in connection with a mastectomy

• Patient Protection Disclosures | The Affordable Care Act (ACA) requires the State to provide the following disclosures:

• Designation of Primary Care Provider: You have the right to designate any primary care provider, including a pediatrician, who participates in our network and who is available to accept you or your family members

• OBGYN Care Without Prior Authorization: You have the right to obtain obstetrical or gynecological care without prior authorization

• Newborns’ and Mothers’ Health Protection Act Notice | Under the Newborns’ Act, the State cannot restrict benefits or require prior authorization for mothers or newborns for a hospital stay in connection with childbirth of less than 48 hours after vaginal delivery or 96 hours after cesarean section The attending provider, after consultation with the mother, may discharge earlier but cannot receive incentive or disincentive for this decision

• Michelle’s Law Notice | The State permits dental/vision coverage for dependent children who are under age 23, unmarried, and a full-time student enrolled at an accredited institution of learning on a full-time basis Michelle’s Law requires an extension of eligibility where a dependent loses their full-time student status due to a medical leave of absence

• MHPAEA Notice | The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires health insurers and group health plans that offer mental health and substance use disorder benefits to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care