Non-emergency care received outside the MedFlex network is not covered.
If you receive routine, planned, or non-emergency care from a provider or facility that does not participate in MedFlex, you may be responsible for the full cost of the service.
Always confirm that both the provider and the facility participate in MedFlex before receiving non-emergency care.
Generally, no. You may see an in-network specialist without a referral from a primary care physician.
Some services may still require prior authorization or medical review. Employees should check plan materials or contact Medical Mutual before receiving services that may require approval, such as certain imaging services, procedures, hospital admissions, specialty medications, or durable medical equipment.
No. MedFlex is a non-gatekeeper HMO, which means you do not have to select a primary care physician and generally do not need a referral to see an in-network specialist.
However, choosing a primary care physician is encouraged. A primary care physician can help coordinate preventive care, chronic-condition management, prescriptions, follow-up care, and specialist services.
You can continue seeing your current physician if that provider participates in the Medical Mutual MedFlex network.
Participation in another Medical Mutual network does not automatically mean a provider participates in MedFlex. Before enrolling, verify each provider’s participation in MedFlex, including:
MedFlex is primarily an Ohio-based network. Before enrolling, employees should carefully confirm that their preferred doctors, specialists, hospitals, and other providers participate in the MedFlex network.
MedFlex may not be a good fit for employees or covered family members who regularly receive routine or planned healthcare outside Ohio, attend school out of state, live outside Ohio for part of the year, or rely on providers who do not participate in the MedFlex network.
MedFlex is a narrow network medical plan offered through Medical Mutual. A narrow network plan uses a smaller group of doctors, hospitals, and healthcare facilities than a traditional PPO plan. Because the network is more limited, premiums and overall healthcare costs are lower.
MedFlex uses a focused, Ohio-based network of physicians, hospitals, specialists, urgent-care centers, and other healthcare providers. The network includes providers and health systems throughout Ohio. It is designed for members who live in Ohio, work in Ohio, or primarily receive their healthcare in Ohio.
MedFlex is available to:
