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Medical 2025

Â鶹¾«Ñ¡offers two medical plans to benefits-eligible employees through -- the 85/60 PPO Plan, and the High Deductible Health Plan (HDHP). Both plans include Prescription and Vision coverage, and both plans include preventive care covered at 100% with in-network providers – all included in your premium. To search for in-network providers and view videos regarding Medical Mutual online tools and resources, visit the . 

If you need to see a doctor while traveling or if your care provider is outside the state of Ohio, your coverage will be through Cigna.

New employees have 31 days to enroll from their date of hire. If you do not select a plan within that time, you default into "refused coverage" status and you cannot select a plan until open enrollment, or until a qualifying life event occurs. Simply put, TAKE ACTION!! Review your benefits offerings and select a plan that works for you and your family.

Getting Started

How much will I pay for health insurance?

Â鶹¾«Ñ¡health insurance premiums are deducted from your paycheck twice monthly. The cost of these premiums is determined by your salary, the number of pays you’ll receive annually, and whether you are selecting single or family coverage.

Below is the contribution table, where you can see what you should expect to pay in monthly premiums, based on which Medical Mutual plan you choose.

2025 CONTRIBUTION TABLE (PDF)

Other costs, such as deductibles and out of pocket, will be determined based on the Medical Mutual plan you select. Medical Mutual offers a PPO plan and a High Deductible Health Plan (HDHP).

2025 MEDICAL PLANS COMPARISON CHART - FACULTY (PDF)

2025 MEDICAL PLANS COMPARISON CHART - STAFF (PDF)

How can I enroll my dependents?

If you have dependents to be added to your elections, you must submit a Dependent Verification Form (PDF) along with supporting documentation.  If adding a spouse, a copy of the marriage certificate is needed and if adding a child, a copy of the birth certificate(s) is needed.  If you are adding a domestic partner, you must complete the application for Domestic Partner.

Working Spouse/Domestic Partner Fee

A working spouse fee/domestic partner fee will be applied each pay for employees providing medical coverage to a spouse or domestic partner who is employed full-time, eligible for group health care coverage through their employer and elects not to enroll.

You might be eligible to waive that fee if your spouse/domestic partner is:

  • Part-time employed
  • Retired
  • Enrolled in Medicare
  • Self-employed/unemployed
  • Employed in a benefits-eligible position at Â鶹¾«Ñ¡
  • Employed, but does not qualify for or is not offered group health insurance 
  • Employed, but in a non-Â鶹¾«Ñ¡medical plan as primary coverage, utilizing Â鶹¾«Ñ¡for secondary coverage

Relevant Forms

FormWhat is it?Is it required?Due Date
Affidavit of Working Spouse/Domestic Partner Insurance Status (PDF)Use this form to declare the employment and insurance status of your spouse/domestic partner.  YES31 Days after your hire date

 

Medical Mutual Plan Details

Coverage highlights of the 85/60 plan

On the Medical Mutual plans, your medical premium includes prescription and vision benefits. The 85/60 health insurance plan offers a lower deductible, but a higher monthly premium. The plan covers preventive annual exams, immunizations, and preventive screenings at no cost to the employee. Other in-network inpatient, outpatient, and diagnostic services are covered at 85% after the deductible is satisfied. Out-of-network coverage for these services is covered at 60% after the deductible has been satisfied.

With the 85/60 plan, preventive care is covered at 100% with in-network providers. There is a $300 dollar deductible for single coverage and $600 deductible for family coverage for non-preventive services. After the initial deductible of $300 is met, then this plan will begin to cover services at 85% of the costs for in-network services and 60% costs for out-of-network services. Examples of preventive care services (PDF) are annual exams, immunizations, and preventive screenings.

You will need to continue paying 15% of the health care services until you meet the annual co-insurance maximum. The co-insurance maximum is $1,500 for single coverage or $3,000 for family coverage when using in-network providers. Also, with the 85/60 plan, there is a $15 copay for a primary care physician and a $30 copay for a specialist. The copays do not go towards your deductibles.

You can enroll in a Flexible Spending Account (FSA) to use pre-tax dollars to pay for eligible healthcare expenses incurred by you or your eligible dependents. Dependent Care FSAs allow you to use pre-tax dollars to pay for DAYCARE expenses for dependents up to the age of 13 or for elderly care. Visit our FSA and HSA web page for more information.

Complete coverage details of the 85/60 plan

85/60 Medical plan booklets for Plan Year 2025 will be available in mid-January.

 

Coverage highlights of the High Deductible Health Plan (HDHP)

You probably noticed that the High Deductible Health Plan (HDHP) has a higher deductible and lower monthly premiums than a typical health plan like the university’s 85/60 PPO plan. If you would typically choose your health plan by premium cost, be sure you understand the tradeoff for a lower monthly premium.

The HDHP requires you or your family to pay the full cost of your health care, including your medications, until you reach a fixed dollar amount. This is called your plan’s annual deductible.

With the HDHP, non-preventive medication drugs must be paid for in full until the deductible is met. Once your annual deductible has been met, covered medical expenses are covered at 100% and prescription drugs are covered at the coinsurance levels.

The HDHO is a non-grandfathered health plan and must cover routine immunizations and other services required by healthcare reform (the Patient Protection and Affordable Care Act (ACA).

If these services are performed by an in-network provider, members cannot be charged a copayment, coinsurance or deductible. Out-of-network charges may apply if the services are performed by a non-network provider.

Like all university medical plans, preventive care is covered at 100%. This means when you receive annual physicals, mammograms, colonoscopies and well-child care, there is no deductible or coinsurance. Remember, immunizations are covered by the medical plan only.

Plan Highlights

  • With the election of an HDHP, a Health Savings Account (HSA) can be created for you. For the 2024 plan year, Â鶹¾«Ñ¡will contribute to your HSA $1,300 for single plans or $2,000 for family plans. To increase your savings in your HSA, you can elect to contribute to the HSA at any time throughout the year. You can also increase or decrease your contributions throughout the year. Another great thing about an HSA is that it allows you to use your pre-tax dollars to pay for eligible healthcare expenses incurred by you or your eligible dependents. 
  • Got Dependents? No problem! You can enroll in the Dependent Care FSA that allows you to use pre-tax dollars to pay for DAYCARE expenses for dependents up to the age of 13 or for elderly care; however, be aware that you cannot increase or decrease your elections to your FSA during the plan year. Visit our FSA and HSA web page for more information. 
  • Preventive services are covered at 100% with in-network providers at NO COST to you. Examples of preventive care services (PDF) are annual exams, immunizations, and preventive screenings.   
  • Deductible for in-network providers:  $3,200 for single coverage and $5,400 for family coverage.
  • Coinsurance for in-network providers: $0.00
  • Office Co-pays: $0.00
  • Out of Pocket Maximum for in-network providers:  $3,000 for single coverage and $5,400 for family coverage.
  • Employer contribution to your health savings account (HSA) of $1,300 for single coverage and $2,000 for family coverage effective at the first of the year!
  • Preventive Services for Medical Mutual High Deductible Health Plan and 85/60 PPO plan (PDF)
  • Preventive Therapy Drug List (PDF) 
Complete coverage details of the High Deductible Health Plan (HDHP)

The High Deductible Medical plan booklets for Plan Year 2025 will be available in mid-January.

 

How does my prescription coverage work when enrolled in a High Deductible Health Plan?

When enrolled in the High Deductible Health Plan, you can expect to pay the negotiated price for your prescriptions, that are not on the Preventative Drug List, until your HDHP annual deductible is met. The cost of these prescriptions will go towards meeting your annual deductible.  Once your deductible is met, your prescription co-insurance will apply (see below) and the maximum you would pay for your prescription will be $60. For more information about your prescription coverage, visit our CVS/Caremark prescription webpage.  

To get pricing information for prescriptions under the HDHP plan, you can contact CVS/Caremark at 1-888-202-1654.

Prescription co-insurances:

  • 10% coinsurance of the negotiated price for generic medications
  • 20% coinsurance of the negotiated price for brand-name prescriptions when a generic equivalent is not available
  • 40% coinsurance of the negotiated price for brand-name prescriptions when a generic equivalent is available

If you or your dependents are taking prescriptions appearing on the Preventive Therapy Drug List (PDF), the cost of that drug is not subject to your deductible. However, co-insurance will apply as stated above and the co-insurance amount will be applied to your combined medical/prescription maximum out-of-pocket deductible.

What if I don't select coverage through Kent State?

Can I opt-out of Â鶹¾«Ñ¡coverage? What does that mean for me if I do?

Sometimes employees have other insurance through their parents or a spouse/domestic partner. If you are not covered under Kent State's insurance, you can receive $50 per pay ($100 per month) for opting out. Opting out means that you chose not to receive the medical, vision, prescription, and dental benefits through Kent State. To receive the cash incentive, you will need to submit an affidavit of alternate coverage (PDF). 

Note: The Opt-Out election must be completed each year in the Open Enrollment portal, and a current signed affidavit must be on file to receive the incentive.

If I opt-out of Kent Coverage, then lose insurance, what then?

If you opted out and later lost insurance coverage, you can enroll in Kent State's plans under a Qualifying Event. A qualifying event is a major life event such as loss of insurance coverage, birth, adoption, marriage, and/or divorce. Qualifying life events may make you eligible to enroll in benefits or make changes to your benefits outside of the annual open enrollment period. Just email benefits@kent.edu within 31 days of the qualifying event to enroll or make any necessary changes to your benefits.

What is default status and what does it mean for me?

New Employees have 31 days to enroll from their date of hire. If you do not select a plan within that time, you default into "refused coverage" status and you cannot select a plan until open enrollment, or until a qualifying life event occurs. Simply put, TAKE ACTION! Review your benefits offerings and select a plan that works for you and your family.

Resources

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