OCA Medical Benefits

Medical Mutual

The Fund’s comprehensive medical benefit provides you and your dependents with coverage when you need it most. Below are just some of the benefits included under the medical coverage:
  • Office Visits (including Primary Care, Specialist, Urgent Care and Telehealth)
  • Preventive Screenings and Exams
  • X-Rays and Laboratory Expenses
  • Hospital Room and Board
  • Emergency Medical Treatment
  • Inpatient and Outpatient Surgeries
  • Chemotherapy
  • Chiropractic & Podiatry Care
  • Mental Health and Substance Abuse
  • Organ Transplant
  • Physical, Occupational and Speech Therapies
  • Hospice Care

In-Network vs. Out of Network

The Fund uses the Medical Mutual PPO provider network, allowing you to see any provider you choose without needing a referral to see a Specialist or designating a Primary Care Physician before seeking care. Medical Mutual has special arrangements and receives certain discounts from participating providers, which means if you use an in-network provider, you also pay a lower coinsurance percentage. Participants residing outside of Ohio have only the in-network level of benefits. The out-of-network level of benefits does not apply to out-of-state participants. To locate a Network Doctor or Hospital near your home, visit the Medical Mutual website. For a PPO Network Provider, the Fund will pay 90% of the discounted amount, after you satisfy the annual deductible. After you reach your annual Coinsurance Limit, the Fund pays 100%.

Non PPO Network covered medical expenses will be paid at 80% of the discounted amount, after you satisfy the annual deductible. After you reach your annual Coinsurance Limit, the Fund pays 100%. However, you may be responsible for a balance bill if you choose to use a Non PPO Network Provider. For a further breakdown of benefits and coverage, please review the current Summary of Benefits and Coverage or Summary Plan Description Booklet. Please note that this information is a summary of your benefits; please consult the SPD for a full description.