Medical Benefits

Individual & Family Plan Documents

As a SummaCare Individual & Family member, your plan includes comprehensive benefits that will cover you when you do not have employer group insurance and are not yet eligible for Medicare.

Ohio House Bill 315 Rider

Schedule of Benefits (SOBs)

SummaCare Individual and Family Plans come with a detailed Schedule of Benefits outlining your coverage, including copayments, coinsurance, deductibles, and out-of-pocket maximums. This document provides a clear breakdown of what you will pay for various healthcare services, such as doctor visits, hospital stays, and prescription drugs. Understanding your Schedule of Benefits can help you plan for medical expenses and maximize your coverage. Review your specific plan’s SOB to get a full picture of your benefits and costs. To view Schedules of Benefits (SOBs), click here.

Plan Extras

SummaCare Individual and Family Plans include medical and pharmacy coverage, health and wellness services and programs, and essential health benefits including pediatric vision and maternity are included in all plans. Learn more about what’s included.

Financial Assistance

You may qualify for financial assistance in the form of an advanced premium tax credit and/or cost-sharing subsidy if applicable to your household. To be eligible for savings on your monthly premium, you must be under age 65 and not eligible for coverage through your employer, Medicare or Medicaid. Savings is based upon income, household size and plan options available in your area. Get an estimate of potential cost savings available.

Important Determination, Appeals & Grievances Information

If we make a medical coverage decision that you are not satisfied with, you can appeal this decision. An appeal is a formal way of asking us to review and change a coverage decision we have made. Learn more about our appeals and grievances process in your Evidence of Coverage document, as well as how to appeal a decision.