MedFlex EPO
You must receive your healthcare from one of the many in-network facilities and providers. The providers include University Hospital system, LakeHealth and Summa. The Cleveland Clinic is not in the network.
Compared to the MMO PPO plan this plan has Lower Deductibles, Lower Out-of-Pocket Maximums and Lower Copays. Please refer to the chart below for details on specific benefits and how they compare to the SkyCare EPO plan.
MedFlex EPO plan also has lower premiums than the MMO PPO: for single coverage you save $216 a year and for family coverage you save $780 a year.
But remember, and this is VERY IMPORTANT, you must get healthcare from one of the many in-network facilities and providers. The providers include University Hospital system, LakeHealth and Summa. The Cleveland Clinic is not in the network.
To find a provider, go to https://providersearch.medmutual.com and in the Provider Directory choose “Group”, then choose your provider type, then under “Choose a network you would like to search” click “MedFlex” and follow the prompts.
RESOURCES
What’s an EPO Plan?
An Exclusive Provider Organization plan (EPO plan), is a health plan that offers a local network of providers. However, if you choose to get care outside of the plan’s network, the cost will not be covered except in an emergency. The Diocese offers two EPO choices, both of which have lower costs and lower out-of-pocket expenses than the MMO PPO plan.
| Plan Name | MEDFLEX EPO | SKYCARE EPO | ||
| Network | Non-Network | Network | Non-Network | |
| Deductibles | $750/$1,500 | Not Covered | $500/$1,000 | Not Covered |
| Coinsurance | 80% | Not Covered | 90% | Not Covered |
| Out-of-Pocket Maximum | 2,500/$5,000 | Not Covered | $2,000/$4,000 | Not Covered |
| General Services | ||||
| Preventive Care Office Visit | 100% | Not Covered | 100% | Not Covered |
| Primary Care Physician Office Visit | $20 Copay | Not Covered | $20 Copay | Not Covered |
| Specialist Office Visit | $40 Copay | Not Covered | $40 Copay | Not Covered |
| X-Ray/Lab Services | 80% | Not Covered | 90% | Not Covered |
| Urgent Care | $25 Copay | Not Covered | $25 Copay | Not Covered |
| ER - Emergency Services | $150 Copay, then 100% Paid | $150 Copay, then 100% Paid | ||
| ER - Non-Emergency Services | $500 Copay, Ded./Coins. | Not Covered | $500 Copay, Ded./Coins. | Not Covered |
| Facility Based Services | Facility Based Services | Facility Based Services | ||
| Inpatient Services | 80% | Not Covered | 90% | Not Covered |
| Outpatient & X-Ray/Lab Services | 80% | Not Covered | 90% | Not Covered |
| Prescription Drug Benefits | CVS/Caremark | CVS/Caremark | SkyWay Pharmacy | CVS/Caremark |
| Retail Generic / Tier 1 | $10 Copay | $10 Copay | $10 Copay | |
| Retail Brand Formulary / Tier 2 | 20%, $25 Minimum / $75 Maximum | $20 Copay | 20%, $25 Minimum / $75 Maximum | |
| Retail Brand Non-Formulary / Tier 3 | 40%, $40 Minimum / $150 Maximum | $40 Copay | 40%, $40 Minimum / $150 Maximum | |
| Mail Generic / Tier 1 | $25 Copay | $10 Copay | $25 Copay | |
| Mail Brand Formulary / Tier 2 | 20%, $60 Minimum / $150 Maximum | $50 Copay | 20%, $60 Minimum / $150 Maximum | |
| Mail Brand Non-Formulary / Tier 3 | 40%, $90 Minimum / $300 Maximum | $80 Copay | 40%, $90 Minimum / $300 Maximum | |
| Monthly Premiums (No Incentives) Single / Family | $157 / $576 | $148 / $543 |
