SummaCare Benefits

New For 2027

No changes in the medical benefits.
Prescription Drug Benefit changes include:
- Tier 1 Summa+ copay increase from $5 to $10.
- 90 Day supply at Summa+ decreased, from 3x the 30 Day copay, to 2.5x the 30 Day copay.
- Mac and Health Mart pharmacies removed from Summa+.
- Mail order copays are now equal to the Summa+ 90 Day supply copays.

Provider Networks

If you reside inside the 20 core counties, you must use providers that participate with NewHealthConnect – Summa Health. The only exception is urgent and emergent care. The core counties are: Ashland, Ashtabula, Carroll, Cuyahoga, Erie, Geauga, Holmes, Huron, Lake, Lorain, Mahoning, Medina, Ottawa, Portage, Sandusky, Stark Summit, Trumbull, Tuscarawas and Wayne.
If you reside inside Ohio, but outside the 20 core counties, your network is Ohio PPO Connect.
If you reside outside Ohio, the national network is First Health.
If you or your dependent live outside the 20 core counties, you must complete the "Resident Outside SummaCare's Service Area Request" form annually. Outside of Ohio employees do not need to apply.
Search for a provider:
- NewHealthConnect – Summa Health: providers within the 20 core counties in Ohio
- Ohio PPO Connect: providers in Ohio, but outside the 20 core counties
- First Health: providers if you reside outside of Ohio

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Gold Plan

This is a copay plan with an inpatient deductible. This means you pay a fixed fee for covered services under the plan. Below is a highlight of the cost for services when rendered with Summa+ providers.

$0 Primary Care Office Visit
$0 Preventive Care
$0 Durable Medical Equipment
$0 Lab work
$0 Radiology
$0 Surgery at Ambulatory Surgery Center
$10 tier 1 prescriptions
$25 Specialist Office Visit
$40 Urgent Care Visit
$150 Outpatient Surgery
$500 Inpatient Hospital Stay

For a complete listing of services please access the Schedule of Benefits link below.

Employee Schedule of Benefits

Employee Outside Ohio SOB

Silver Plan

This plan is subject to a deductible and then paid at a coinsurance until the maximum out-of-pocket has been met. A deductible is a dollar amount each individual must pay out-of-pocket before the plan begins to make payment. Once the deductible has been met; the plan pays a portion of the services and the member pays a portion (coinsurance) up to the individual maximum out-of-pocket. There are a handful of services that are subject to a copay only. Below is a highlight of the cost for services when rendered with Summa+ providers.

Individual Deductible $1,000
Individual Maximum Out-of-Pocket $4,000
Coinsurance 15%
$0 Preventive Care
$15 Primary Care Office Visit
$30 Specialist Office Visit
$15 Lab work
$40 Urgent Care
$250 Emergency Room

All other services are first subject to deductible and then 15% coinsurance For a complete listing of services please access the Schedule of Benefits link below