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
  • Lowest monthly employee contribution and lowest deductible and out of pocket maximums
  • Covers 100% of preventive care services provided In network*
  • In-network coverage through MetroHealth only
  • Requires you to pay 100% for most Non-Network services
  • Option to participate in Health Care Flexible Spending Account
  • Benefit Period January 1st to December 31st*
  • Highest Deductible and Out of Pocket Maximum
  • Covers 100% of preventive care services provided In-Network*
  • In-network and non-network coverage available
  • Option to participate in Health Care Flexible Spending Account
  • Benefit Period January 1st to December 31st*
  • Most expensive monthly employee contribution
  • Covers 100% of preventive care services provided In-Network*
  • In-network and non-network coverage available
  • Option to participate in Health Care Flexible Spending Account
  • Benefit Period January 1st to December 31st*
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Deductible (Employee/Family) $350/$1050 Not Covered $1,100/ $3,300 $2,200/ $6,600 $600/ $1,800 Not Covered
Coinsurance After Deductible 20% After Deductible Not Covered 20% After Deductible 40% After Deductible 25% After Deductible Not Covered
Inpatient Facility Services 20% After Deductible Not Covered 20% After Deductible 40% After Deductible 25% After Deductible Not Covered
Outpatient Facility & X-Ray/Lab Services 20% After Deductible Not Covered 20% After Deductible Not Covered 25% After Deductible Not Covered
Preventive Care Office Visit $0 Copay, No Deductible Not Covered $0 Copay, No Deductible 40% After Deductible $0 Copay, No Deductible Not Covered
Office Visit—Primary Care Physician $20 Copay Not Covered $35 Copay 40% After Deductible $25 Copay Not Covered
Office Visit—Specialist $40 Copay Not Covered $50 Copay 40% After Deductible $50 Copay $1,200
Urgent Care Visit $50 Copay Not Covered $75 Copay 40% After Deductible $75 Copay $3,600
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.