Stark County Schools COG Newsletter

We know that health insurance, and the costs associated with it, can be confusing sometimes. To help make it easier to understand, here is a brief overview of cost sharing and common terms used in relation to health insurance expenses under your plan.

Cost sharing is the idea that makes health insurance possible and helps lower costs for everyone. One way to think of it is like roommates sharing the cost of rent or utilities to make them more affordable for all involved.

Typically, when you go to the doctor, you pay for part of the visit, and your health insurance pays for the rest. You are sharing the cost with your health insurance. However, how much you pay depends on your specific health plan and how much you use it.

When it comes to cost sharing, there are three typical types: Copays, Deductibles and Coinsurance.

• Deductible – This is the amount you pay before your health insurance pays. Typically, after you pay your deductible your health insurance will start sharing costs with you.
• Coinsurance – After you meet your deductible, you and your health insurance company share costs. Typically, your health insurance is responsible for the bulk of your healthcare expenses at this point, and you just pay a small percentage of them.
• Coinsurance Out-of-Pocket Maximum – This is the sum of your deductible, medical and prescription drug coinsurance. After the applicable deducible and coinsurance limits have been met, any covered charges will be paid at 100% by the plan.
• Copays – Copays only apply to this plan if you use the ER for non-emergency purposes. The co-pay for each non-emergency visit to the ER is $250, which does not apply toward your deductible or coinsurance.
• Maximum Out of Pocket – This is the sum of your deductible, coinsurance, and non-emergency care copayments. Once you reach your maximum out of pocket, your health insurance covers the healthcare costs for covered services.

A summary of all the various services covered under your health plan, along with member cost sharing information, is called a Schedule of Benefits.

• Schedule of Benefits for AultCare members
• Schedule of Benefits for Medical Mutual members.

To see your deductible, coinsurance, maximum out of pocket amounts and details on how much you have contributed year to date, Medical Mutual members can access My Health Plan, and AultCare members can access Member Portal.

If you have questions about your benefits, please call your respective health plan provider:

AultCare Customer Care
1-800-344-8858 

Medical Mutual Customer Care
1-800-382-5729

Mobile apps are a great way to access the vital health insurance information you need wherever you are. Both the AultCare and MedMutual mobile apps provide an easy and convenient way to manage your health insurance, whether you’re at home, at your doctor’s office or on the go.

Features available on the mobile apps*:

• Health Plan Information – Information regarding your policy and plan benefits
• Track Your Claims and Spending Information
  • See information regarding claims, including claim status, payments to providers and any amounts you owe
  • Review Explanation of Benefits (EOB) information for each claim
  • Check the year-to-date status of your out-of-pocket costs including deductible, coinsurance and maximum out of pocket
• Find a Provider – Search feature to find in-network providers; remember, using in-network providers will save you money
• Access Your Member ID Card
  • You always have your member ID card with you on the mobile app
  • Member ID cards can be emailed right to your providers

AultCare members

Scan the QR code that corresponds to your device to download the app.

Apple^® App Store

Google Play^TM

Medical Mutual members

Download the MedMutual app from your device app store or scan the QR code to go to the mobile app download page and select your device type from there.

*Functionality will vary by app

^© 2024 Apple Inc. All rights reserved. The App Store is a registered trademark of Apple Inc.

^© 2024 Google Inc. All rights reserved. Google Play is a trademark of Google Inc.

Life is ever changing, but we may not always remember to note those changes with our benefits providers. Please take a moment to look over these friendly reminders to make sure that you and your loved ones are taking full advantage of your benefits.

New Address

Do you have a new address? Please notify your benefits personnel.

Beneficiaries

It is a good time to ensure that your beneficiaries are up to date!

Coverage Needs

Be sure to notify your benefits personnel of any changes to your coverage needs, like a new baby or a change in marital status.

Dental Coverage

If you have Dental Coverage, you may choose any dentist to receive benefits. However, if you choose to receive covered services from a dentist who participates in the Superior Dental Care (SDC) network, you are protected from balance bills (the difference between the amount paid by Medical Mutual and the provider’s billed amount).

Vision Coverage

If you have Vision Coverage, there is no network of providers. Some providers may require you to pay the provider at the time of the service. If this happens to you, you will just need to file for reimbursement.

Long-term Medications

If you are on long-term medications, please remember that after two fills at a local pharmacy, you are required to use Caremark mail order going forward. You will need to tell your provider to send your long-term prescriptions to Caremark for you.

We’re excited to introduce the MedMutual CARE Program for Stark County Schools COG members with Medical Mutual health insurance.

MedMutual CARE gives you and your covered family members direct access to a dedicated group of nurses, pharmacists, and health plan experts who will answer your questions, work with your doctors to coordinate your care, and provide support on your health journey. This one-stop approach makes it easier than ever to get the help you need.

• Whether you have a simple question about your benefits, need help managing an existing chronic condition, or are preparing for upcoming surgery, your MedMutual CARE team will guide you along the way. And, if you have a complicated health condition that requires hospitalization or outpatient treatment, your MedMutual CARE team will collaborate with your doctors to create a personalized care plan just for you.
• Over time, you and your personal MedMutual CARE team will get to know one another, and when you call for help, you’ll probably recognize the voice on the other end of the line.
• Your MedMutual CARE team may occasionally reach out to you directly to share information and resources they think might be beneficial to you and your health.
• There is nothing you need to do to enjoy the benefits of MedMutual CARE. No sign-up is required, and there is no additional cost to you for this program.

Watch your mailbox for more information about MedMutual CARE. In the meantime, you can reach your new MedMutual CARE team at the Customer Care number on your Medical Mutual member ID card.

We’re happy to welcome Medical Mutual members to MedMutual CARE!

It’s about well-being and being well. AultCare is ready to help when you need care, and we also offer wellness plans to help keep you healthy.

AultCare is often used by our members once a health concern has already arisen. Our members can count on us to help alleviate the costs of their healthcare procedures. But, we are much more than a health plan/insurance company. Not only do we help offset healthcare costs, we coordinate health and wellness experts with valuable resources to prevent health concerns arising in the first place. Of course, sometimes health issues are inevitable, which is why we have programs and staff in place to help manage those issues, too.

We have streamlined all of our health and wellness services into a system we refer to as Care Coordination. Check out this flyer to learn more.

AultCare’s Care Coordination programs are available to AultCare members at no additional cost. We are your advocates for care, information and community resources. Our programs are facilitated by our Care Coordination team of local physicians, nurses, dietitians, pharmacists and other clinical staff that can help you tackle potential and ongoing health and wellness issues.

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Thank you for reviewing the Stark County Schools COG Newsletter!