Medical Comparison Chart

This summary of benefits is designed to provide a high-level overview of Cleveland State University’s Medical and Prescription Drug benefits.

Should there be a conflict between this summary and the actual terms and provisions of the plan documents, the terms of the plan documents and contracts will govern in all cases. You will not gain any new benefits because of a misstatement or an omission in this overview.

Benefit Period January 1–December 31*

           
MetroHealth Select (Skyway) Medical Mutual Value Plan Medical Mutual Traditional Plan
  • CSU Health and Wellness Services are provided at no cost to Faculty and Staff
  • Covers 100% of preventive care services provided in-network (according to age and gender)
  • Primarily utilizes MetroHealth Select Healthcare Professionals
  • Requires you to pay 100% for most Non-Network services
  • Option to participate in Health Care Flexible Spending Account
  • CSU Health and Wellness Services are provided at no cost to Faculty and Staff
  • Covers 100% of preventive care services provided in-network (according to age and gender)
  • In-Network coverage through Medical Mutual SuperMed Network
  • Option to participate in Health Care Flexible Spending Account
  • CSU Health and Wellness Services are provided at no cost to Faculty and Staff
  • Covers 100% of preventive care services provided in-network (according to age and gender)
  • In-Network coverage through Medical Mutual SuperMed Network
  • Option to participate in Health Care Flexible Spending Account
In-Network Non-Network In-Network Non-Network In-Network Non-Network
Deductible
Individual $350 Not covered $1,100 $2,200 $600 $1,200
Family $1,050 Not covered $3,300 $6,600 $1,800 $3,600
Coinsurance After Deductible 20%, after deductible Not covered 20% after deductible 40% after deductible 25% after deductible 40% after deductible
Inpatient Facility Services 20%, after deductible Not covered 20% after deductible 40% after deductible 25% after deductible 40% after deductible
Outpatient Facility & X-Ray/ Lab Services 20%, after deductible Not covered 20% after deductible Not covered 25% after deductible 40% after deductible
Preventive Care Office Visit $0 copay, no deductible Not covered $0 copay, no deductible 40% after deductible $0 copay, no deductible 40% after deductible
Office Visit—Primary Care Physician $20 copay Not covered $35 copay 40% after deductible $25 copay 40% after deductible
Office Visit—Specialist $40 copay Not covered $50 copay 40% after deductible $50 copay 40% after deductible
Urgent Care Visit $50 copay Not covered $75 copay 40% after deductible $75 copay 40% after deductible
Emergency Room Visit (copay waived if admitted) 0% after $250 copay 0% after $250 copay $350 copay +20% after deductible $350 copay +20% after deductible $300 copay +25% after deductible $300 copay +25% after deductible
Emergency Room Visit—Non- Emergency $250 copay + 20% after deductible Not covered $350 copay +20% after deductible $350 copay +40% after deductible $300 copay +25% after deductible $300 copay +40% after deductible

* The benefit period is based on a calendar year and it is the period of time during which covered services are rendered and benefit maximums, deductibles, and out-of-pocket maximums are accumulated.