Frequently Asked Questions

OhioHealthy has done much to simplify health plan benefits and create a streamlined experience. Even so, we recognize that healthcare and health plans can be complicated. It’s natural to have questions and we’re here to help. Below are answers to some of our plan members’ most asked questions. 

Please note that the following are general guidelines for health plans offered by OhioHealthy. While most of the answers apply to all OhioHealthy plans, there may be some slight differences in your plan. 

 If you need answers to other questions or want to know about a specific plan and benefits, please call a Member Advocate from 8:00 a.m. to 5:00 p.m. Monday through Friday at the phone number listed on your ID card. 

Tax Information

IMPORTANT HEALTH COVERAGE TAX DOCUMENTS (1095-B for ACA members)

To request a copy of form 1095-B for Health Coverage, please contact OhioHealthy by one of the following options:

Phone: 833-865-1185

Email: inquiry@ohiohealthyplans.com

Address:

OhioHealthy 
OhioHealth David P. Blom Administrative Campus
3430 OhioHealth Parkway
Columbus, OH 43202

Enrollment

Contact a Member Advocate at the number listed on your ID card.

Member ID Cards

Contact a Member Advocate for assistance. If your enrollment via your plan sponsor has been processed, a Member Advocate will be able to give you your unique member ID number. This number allows a doctor to verify your eligibility and bill your services to OhioHealthy. If your doctor requires you to present a card at the time of service, a Member Advocate will fax a sample of your card to the doctor’s office. You also have access to an electronic ID card by signing into your OhioHealthy account or downloading the OhioHealthy App.

Your member ID card identifies you as a covered member of OhioHealthy. Your card contains helpful information for your providers of service, including where to call for prior authorization. It also has helpful contact information including how to reach our Member Advocates, telemedicine provider and our after-hours nurse advice line.

No. Unless you ordered a new card online or through a Member Advocate, your information may have changed. Always present your new ID card to your doctor.

You can contact a Member Advocate for assistance, or you can request a card by signing into your OhioHealthy account. Once ordered, the card should arrive in 7-10 business days. 

Options for Treatment

You have the best experience when you choose the right care from the start. When you need care, you may have more options than you realize—ones that could save you time and money. 

If you are experiencing a life-threatening emergency, call 911 or go to the nearest Emergency Department. 

For non-emergency care, contact your primary care physician to schedule an appointment. Depending on your physician, virtual care from your mobile device or computer may be an option. If you don’t have a primary care physician, use the OhioHealthy Provider Search Tool. 

If your primary care physician is not available: 

Option 1 | CONTACT A MEMBER ADVOCATE 

Contact a Member Advocate Monday through Friday 8:00 AM – 5:00 PM by calling the number on the back of your member ID card. 

Option 2 | CALL THE FREE NURSE SUPPORT LINE 

Contact a licensed nurse 24/7 for support or questions by calling (866) 366-6877. 

Option 3 | SCHEDULE A VIRTUAL CARE VISIT 

Schedule a virtual visit with Teladoc through the convenience of your mobile device or computer. Teladoc is a national network of on-demand providers offering 24/7 access to board-certified physicians. Download the Teladoc Mobile App or visit Teladoc to get started. 

Have questions about where to go for care? Contact a Member Advocate by calling the number on the back of your member ID card. 

OhioHealthy understands the importance of maintaining your health coverage without interruption in your medical treatments. If you have a future procedure scheduled, or if you are currently receiving treatment for an on-going condition by a provider not in the network you may need added support in your switch to OhioHealthy. If this applies to you, please submit a Transition of Care Assessment within 30 days of the OhioHealthy plan coverage start date. Transition of care to an in-network provider should be accomplished within 90 days of starting coverage.

Once your Transition of Care Assessment has been reviewed, a member of the care management team will contact you to assist with finding in-network providers and create a plan to ensure a smooth transition. 

 

The 24/7 MyNurse Support Line nurses have training in emergency medicine, acute care, OB-GYN and pediatric care. A nurse will ask you to describe your medical situation in as much detail as possible. Be sure to mention any other medical contions that you have, such as diabetes or hypertension.

The staff is well-prepared to answer medical or behavioral health questions for members and their dependents. However, since they are unable to access medical records, they cannot diagnose or treat medical conditions, order labs, write prescriptions, order home health services, or initiate hospital admissions or discharges. 

Depending on the situation, you may be advised about appropriate home treatments or a visit to your doctor may be advised. If necessary, the nurse may direct you to a plan urgent care center or Emergency Department.

Emergency Care

An emergency is the sudden onset of a medical condition with such severe symptoms or pain that an average person with an average knowledge of health and medicine would seek medical care immediately because there may be serious risk to your physical or mental health or that of your unborn child. 

Some examples of situations that would require the use of an Eemergency Ddepartment include but are not limited to: 

  • Heart attack or severe chest pain 
  • Loss of pulse or breathing 
  • Stroke 
  • Poisoning 
  • Loss of consciousness 
  • Seizures 

In any life-threatening emergency situation, always call 911 or go to the closest Emergency Department. 

If you received emergency care and are admitted, you or a family member should contact OhioHealthy within 48 hours (two business days) or as soon as medically possible. This enables OhioHealthy to arrange for appropriate follow-up care, if necessary. 

The following conditions do not ordinarily require Emergency Department treatment, and may be more appropriately treated in your doctor’s office, or at an urgent care center covered by your plan: 

  • Sprains or strains 
  • Chronic conditions such as arthritis, bursitis, or backaches 
  • Minor injuries and puncture wounds of skin 
  • Colds, flu, fever, sore throat 
  • Ear infection 
  • Sinus infection 
  • Urinary tract infections 

An Emergency Department is designed, staffed, and equipped to treat life-threatening conditions.  

An urgent care center is a more appropriate place to seek treatment for sudden acute illness and minor injuries when your doctor’s office is closed or not available.  

Copayments and coinsurance amounts for Emergency Department visits are generally higher than copayments for urgent care visits. If you are transferred to an Emergency Department from an urgent care center, you will be charged an Emergency Department copayment or coinsurance.

No. In case of an emergency, you should always call 911 or go to your nearest Emergency Department. In non-emergent situations, if you are unsure where to go for the treatment of your condition, you can call your primary care doctor's office or the 24/7 MyNurse Support Line.  

Your OhioHealthy plan includes coverage for emergency services when you are outside the service area. If you have an unexpected illness or injury when outside of the service area, you should call a Member Advocate at the number on your ID card. If it is after business hours, contact the 24/7 MyNurse Support Line at the number on your ID card. 

If you are in a life-threatening emergency, call 911 or go to the closest Emergency Department. 

OhioHealthy may review all Emergency Department care retrospectively (after the fact) to determine if a medical emergency did exist. If an emergency did not exist, you may be responsible for payment for all services. 

If you received emergency care and are admitted, you or a family member should contact OhioHealthy within 48 hours (two business days) or as soon as medically possible. This enables OhioHealthy to immediately begin reviewing your care and to arrange for appropriate follow-up care. 

Be prepared to give the following information: 

  • Member name 
  • Reason for treatment 
  • Hospital name 
  • City and state where treatment is occurring 
  • Name of treating doctor 

The doctor or hospital may also call the Medical or Behavioral Health Preauthorization number on the back of your card. 

As part of your OhioHealthy coverage, a member of our clinical team will follow your case from beginning to end. He or she will review your medical record, check your progress and arrange for your continuing care needs after you leave the hospital.

Behavioral Health Services

You may contact either a Member Advocate or your primary care physician for guidance prior to seeing a behavioral health provider.

No. If you need to be hospitalized, your behavioral health provider (not your primary care physician) will arrange for your admission to the appropriate in-network facility.

In an emergency, always call 911 or go to the nearest Emergency Department. For nonemergency behavioral health information, contact your behavioral health provider, a Member Advocate or the 24/7 MyNurse Support Line. The Member Advocate and 24/7 MyNurse Support Line numbers are listed on the back of your member ID card.

Authorization for Use or Disclosure of Medical Information 

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that health plans protect the confidentiality of your private health information. OhioHealthy will not use or further disclose HIPAA protected health information (PHI) except as necessary for treatment, payment, and health plan operations, as permitted or required by law, or as authorized by you.  

A complete description of your rights under HIPAA can be found in the OhioHealthy Integrated Notice of Privacy Practices. A copy of the notice will be included in your Evidence of Coverage (EOC) or Certificate of Insurance (COI) when you enroll. You can view a copy of our privacy notice online. 

The state of Ohio also has laws in place to protect the privacy of our members’ insurance information. We will not release data about you unless you have authorized it, or as permitted or required by law. OhioHealthy requires an Authorization of Designated Agent form whenever anyone other than the OhioHealthy member needs to obtain and/or change health information. You can download a copy of the form under Forms and Documents, or by calling a Member Advocate at the number on your ID card. 

Under HIPAA and Ohio law you have certain rights to see and copy health information about you. Under HIPAA you have the right to request an accounting of certain disclosures of the information and under certain circumstances, amend the information. You have the right to file a complaint with OhioHealthy or with the Secretary of the U.S. Department of Health and Human Services if you believe your rights under HIPAA have been violated. 

Referrals

You do not need a referral from your primary care doctor for specialist care. If you and your doctor decide you need to see a specialist, your doctor will coordinate your care and you can make your own appointment. 

Before you see a specialist, you should confirm that the specialist is in the OhioHealthy Network. Use the Find Doctors and Locations search tool or contact a Member Advocate at the number on your ID card to make sure that your specialist is in the network. 

It is your responsibility to ensure that you are using in-network doctors and locations.  

If you have an OhioHealthy plan and your doctor directs you to a non-network doctor, you will be responsible for payment of these services. You have the option of using in-network doctors or out-of-network doctors. Claims from out-of-network doctors will be paid at a reduced benefit level and you will usually pay higher deductible, copay and coinsurance amounts. You may also be balance-billed for any charges in excess of your plan’s maximum allowable charges. 

To find an in-network doctor, use the Find Doctors and Locations search tool, or call a Member Advocate at the number on your member ID card. 

Yes, but some tests may require preauthorization by OhioHealthy. You can call a Member Advocate or your specialist can call the preauthorization number on the back of your ID card to confirm.

No. Your plan does not require referrals. Members may schedule an appointment for a routine annual exam with any OB-GYN in OhioHealthy’s Network.

Yes, during your pregnancy, your OB can serve as your primary care doctor. As a plan member, you are automatically eligible for the OhioHealthy Pregnancy Program. This program is designed to provide education and support to pregnant women. To learn more and register, call 1 (614) 485-7941 or email caremanagement@ohiohealthyplans.com.

It is your responsibility to ensure that you are using in-network or OhioHealthy doctors and locations.

You have the option of using OhioHealthy providers or non-OhioHealthy providers. Because OhioHealthy does not have cost-saving contracts in place with providers not in our network, you will usually pay more for their services. You may also be balance billed for any charges more than your plan’s maximum allowable charges. 

To find an in-network doctor, use the Find Doctors and Locations search tool, or call a Member Advocate at the number on your member ID card. 

Website and Mobile App 

If you are age 14 or older and a covered member of the health plan, simply go to the registration page. You will need to have your member ID card available when registering. 

Your OhioHealthy account is mobile friendly and has all of the convenient features you need to stay connected including: 

  • Find/print ID cards 
  • Find/locate providers 
  • Estimate costs through the treatment cost calculator 
  • Contact a member advocate 
  • Check the status of an open and/or paid claim 
  • Update contact information 
  • Schedule virtual care visits for medical and behavioral healthcare 

Not yet registered? Register now 

Yes. Download the “OhioHealthy app” from the Apple Store or Google Play.

Image of what the OhioHealthy App logo looks like

On the login screen, select "Forgot your username or password?" and follow the reset instructions. You may also contact a Member Advocate for assistance.