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FAQs Individual

We’re Local, We’re Friendly, We’re Affordable Health Insurance

When can I enroll in an Individual and Family plan?

The open enrollment period to shop for and purchase 2023 individual and family health insurance coverage is now through January 15, 2023. If you need coverage and it is outside of the enrollment period, you must have a qualifying event that creates a Special Enrollment Period for you to enroll in a plan. Enroll by December 15 for January 1, 2023 coverage and by January 15 for February 1 coverage.

What type of plans does SummaCare offer?

SummaCare’s plans are Health Maintenance Organization (HMO) plans available to individuals and families living in Summit, Stark, Portage and Medina counties and feature the SCConnect network. This means that all care except for emergency or urgent care situations must be through this network of providers. SummaCare’s plans do not require you to have a referral to see a specialist. Plans are categorized into metal tiers to help you understand how you and SummaCare will split the costs of your health care. Percentages shown can include a combination of deductibles, copays and coinsurance.

Which doctors and hospitals can I use?

SummaCare Individual and Family plans feature the SCConnect network. This network provides access to many of the area’s finest physicians, facilities and hospitals including Summa Health, Cleveland Clinic Mercy Hospital (Canton) and Akron Children’s Hospital. Click here to see a list of hospitals and a map of the service area. 

What is an HSA?

A Health Savings Account (HSA) combines high deductible health insurance with a tax-favored savings account. The funds in the savings account can be used towards qualified medical expenses including co-payments, deductibles and services that are not covered by a SummaCare HSA-qualified health plan. .

How do I know if my doctor or hospital is in-network?

Search the SCConnect network to find a doctor, hospital and/or facility.

What if I see a doctor who is not in-network?

Using a doctor, hospitals, and providers outside of the network will be subject to the out-of-network deductible and out-of-pocket maximum.

How much will I pay for services?

Each SummaCare Individual & Family plan has different service costs to allow you to choose the plan that is right for you. Specific plan information can be found on the Summary of Benefits and Coverage (SBC) Plan Details document. This summary provides answers to important questions like “What is the overall deductible?” and “Is there an out-of-pocket limit to my expenses?”

What happens if I need to see a specialist?

You can see the specialist you choose without a referral from a physician or permission from this plan. On select plans, each visit is subject to a deductible if you choose an in-network provider.

Do I need prior authorization for services?

Certain services require prior authorization in order to be covered under your health plan. Your in-network providers are responsible for obtaining authorization 48 hours prior to the provision of services. If you use a provider that is not in your network, it is your responsibility to obtain any required prior authorization. Learn more about services that require prior authorization. 

How do I estimate my household income?

In order to estimate your premium subsidy amount, you will need to provide your expected annual household income for the year you want coverage, not last year’s income. Income is counted for you, your spouse, and everyone you’ll claim as a tax dependent on your federal tax return. Include their income even if they don’t need health coverage. If you are unemployed make sure you include your unemployment compensation.

Questions?  We are here to help.

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