SummaCare is one of Ohio's oldest and most respected regional health insurers. Based in Akron, this carrier has provided quality medical benefits for more than two decades to consumers in the Northern part of the state. More than 60 hospitals and 10,000 additional physicians, specialists, and medical providers help shape the Network for local residents in a 20-county area. Private individual coverage (Under age 65) is offered in Portage, Medina, Stark, and Summit counties.
We provide the lowest available Summacare prices and make it easy for you to enroll in an individual or family policy. After the official Open Enrollment period expires, a special exception is required to purchase Marketplace benefits. For example, if you lose qualified coverage from an employer, or move to a different service area, a qualifying life event will cause an "SEP" exemption to be granted. Lifetime benefits are unlimited.
Senior Medigap coverage is offered to Medicare-eligible applicants. SummaCare Medicare plans have earned a Four-Star rating from CMS (Centers For Medicare and Medicaid Services). Member experience, service, complaints, reviews, and pricing accuracy are considered. The National Committee for Quality Assurance has also awarded a "commendable" rating for quality and service.
Prices are typically very competitive compared to other larger companies, and service to patients and customers is well-documented. Ethics and compliance are taken seriously, and are rigorously enforced. These rules and guidelines apply not just to employees, but also physicians, providers, hospitals and affiliated vendors. A list of participating network hospitals is shown below:
Affinity Medical Center
Fisher-Titus Medical Center
Mercy Medical Center
Northside Medical Center
Parma Medical Center
Portage Medical Center
Southwest General Health Center
Under Age 65 Plans
SummaCare actively participates in the Ohio Health Marketplace. Exchange plans are offered to individuals and families. Listed below are the available plans offered in each Metal tier. Policies are not offered in all counties. NOTE: Catastrophic plans are only offered to applicants under age 30, or any person that can prove "financial hardship." Additional plans may become available in 2018 under the Trump Administration.
Value With SCConnect Network - Three free primary-care physician (pcp) visits are provided with no copay, coinsurance, or deductible. Plan deductible is $7,150 and maximum out-of-pocket expenses are $7,150.Deductible is $3,000 and maximum out-of-pocket expenses are $7,150.
Silver 3000 With SCConnect Network - Three free pcp office visits. Thereafter, a $10 copay applies. Specialist visits are subject to a $55 copay. Chiropractic services also are subject to a $55 copay. Deductible is $3,000 and maximum out-of-pocket expenses are $7,150 with 30% coinsurance. Preferred and non-preferred generic drugs receive $5 and $15 copays. Preferred and non-preferred brand drugs receive $50 and $100 copays.
Silver 3500 Standard With SCConnect Network - $30 and $65 copays on pcp and specialist office visits. Deductible is $3,500 with maximum out-of-pocket expenses of $7,150 and 50% coinsurance. $10 and $15 copays for preferred and non-preferred generic drugs.
Silver 5000 With SCConnect Network - First three pcp office visits are free and a $10 copay applies thereafter. Specialist copay is $50 including chiropractor visits. Deductible is $5,000 with maximum out-of-pocket expenses of $7,150 and 30% coinsurance. The preferred and non-preferred generic drug copays are $5 and $10. Preferred brand drugs have a $50 copay.
SummaCare Gold 750 With SCConnect Network - First three pcp office visits are free and a $10 copay applies thereafter. Specialist copay is $50 including chiropractor visits. Deductible is $750 with maximum out-of-pocket expenses of $7,150 and 20% coinsurance. The preferred and non-preferred generic drug copays are $5 and $10. Preferred brand drugs have a $50 copay.
The monthly rates illustrated below are shown for several different scenarios. Prices vary, depending on the ages, income, and counties used.
Family of three (40 year-old parents with one child) residing in Summit County with household income of $50,000.
$389 - Silver 3000
$394 - Silver 3500 Standard
$399 - Silver 5000
$598 - Gold 750
30 year-old residing in Medina County with household income of $18,000.
$99 - Silver 3000
$101 - Silver 3500 Standard
$117 - Silver 5000
$173 - Gold 750
Family of two (50 year-old married couple) residing in Portage County with household income of $35,000.
$322 - Silver 3000
$327 - Silver 3500 Standard
$333 - Silver 5000
$556 - Gold 750
Family of two (55 year-old married couple) residing in Stark County with household income of $150,000.
$1,038 - Silver 3000
$1,045 - Silver 3500 Standard
$1,052 - Silver 5000
$1,330 - Gold 750
Most policies have four available tiers of benefits. Tier 1 is the least expensive option and covers most generic and some over-the-counter prescriptions with a copay. Tier 2 includes preferred brand and the most expensive generics. Tier 3 includes non-preferred brand drugs subject to a copay. Tier 4 is reserved for the most expensive drugs and a copay and/or a deductible may apply.
A "Formulary" prescription drug list is available. These medications are typically covered, assuming they are medically necessary during approved treatment. Although the list can change, once you have begun receiving a listed drug, it will continue to be covered throughout the calendar year. The entire list can be found here and is offered by both alphabetical and specific medical condition. Note: Some prescriptions may require prior approved authorization. Quantity limits may also apply.
Step therapy may be utilized if your condition requires costly prescriptions. This process may involve utilizing less expensive (and safe) drugs at the outset of treatment, and advancing (upon physician's request) to using more expensive, and possibly riskier drugs. Often, successful prior results from specific drugs, will be a reason for quick approval of the identical drug for a similar condition or illness.
Medicare Advantage Options
Recently, there was a name-change on the Medicare Advantage plans. The "Silver" and "Gold" policies were changed to "Sapphire" and "Emerald." The principal reason was to eliminate confusion some consumers were having since "Silver" and "Gold" are two of the Metal plans available on Exchanges for persons under age 65. Four plans are available (see below), although policy availability will vary, depending upon your county of residence.
Dental and vision benefits are included on all Advantage plans. Delta Dental provides preventative services, which consist of a $20 office visit copay and a $500 yearly maximum benefit. An annual exam, routine cleaning, and bitewing x-ray are included. A Delta Dental directory of providers is available upon request.
Medicare Topaz - HMO option with $0 premium and no deductible. Non-network benefits not available (unless emergency or Urgent-Care). Maximum out-of-pocket expenses are $3,600 with $0 and $45 office visit copays. Inpatient hospital expenses of $295 per day for the first five days. Tier 1, 2, 3, and 4 drug copays are $0, $15, $47, and $100.
Medicare Ruby - HMO option with $40 premium and no deductible. Non-network benefits not available (unless emergency or Urgent-Care). Maximum out-of-pocket expenses are $3,600 with $0 and $40 office visit copays. Inpatient hospital expenses of $255 per day for the first six days. Tier 1, 2, 3, and 4 drug copays are $0, $15, $47, and $100.
Medicare Sapphire - HMO option with $76 premium and no deductible. Non-network benefits available at Medicare-approved facilities. Maximum out-of-pocket expenses are $3,800 with $0 and $40 office visit copays. Inpatient hospital expenses of $295 per day for the first six days. Tier 1, 2, 3, and 4 drug copays are $0, $15, $47, and $100.
Medicare Emerald - HMO option with $180 premium and no deductible. Non-network benefits available at Medicare-approved facilities. Maximum out-of-pocket expenses are $3,400 with $0 and $25 office visit copays. Inpatient hospital expenses of $250 per day for the first seven days. Tier 1, 2, 3, and 4 drug copays are $0, $10, $45, and $95.
NOTE: In 2017, the federal government announced it had removed all penalties against its Medicare managed-care business. New applications can again be submitted after previous violations were corrected.
Current Estimated SummaCare Medicare Advantage Monthly Rates In Selected Counties:
Allen, Fulton, Hancock, Huron, Marion, Putnam, Sandusky, Seneca, and Erie Counties
Ruby - $43
Saphire - $96
Ashland and Holmes Counties
Ruby - $40
Saphire - $76
Ashtabula, Tuscarawas, and Lorain Counties
Ruby - $40
Saphire - $76
Emerald - $180
Auglaize, Hardin, Henry, Defiance, Mercer, Morrow, Ottawa, Paulding, Richland, Van Wert, Williams, Wyandot, and Crawford Counties
Saphire - $96
Cuyahoga, Geauga, Columbiana, Lake, Mahoning, Medina, Portage, Stark, Sumitt, Trumbull, Wayne, and Carroll Counties
Topaz - $0
Ruby - $40
Saphire - $76
Emerald - $180
Lucas and Wood Counties
Topaz - $0
Ruby - $43
Saphire - $96
Small Employer Plans (2-50 Employees)
Group coverage at very competitive rates is also available. Listed below are several of the most popular and budget-friendly policy options for both employer and worker. The three available networks are SCConnect, SCSelect, and SCPremier. "Healthy You" programs that are available, include wellness services, utilization management, case management, disease management, and pregnancy management.
Bronze 5500 HSA-17
Silver 2800 HSA-17
Silver 3500 HSA-17
Silver 5000-17 80
Silver 5000-17 100
Group Ancillary Products
Dental - Guardian Dental features several plans that provide your workers with a different levels of coverage. Basic preventative and cleanings are covered, along with major services. Billing is separate from the primary healthcare policy.
Voluntary Employee - Various benefits are available with easy online enrollment.
Life And Accidental Death - Lincoln Financial provides guarantee-issue life insurance coverage (2-50 employees) without medical underwriting.
Vision - Benefits are provided by EyeMed Vision Care, who features a large countrywide network. Standard eye examinations are subject to only a $10 copay, and up to $160 towards the purchase of frames is available.
Primary Service Area
If you reside in Northern portion of Ohio, SummaCare is a viable healthcare option that is reputable and affordable. We are always happy to help with any information, comparison or the application process for an individual or family.The 20-County primary service area (Group) consists of the following counties:
Ottawa, Sandusky, Erie, Huron, Ashland, Lorain, Medina, Holmes, Summit, Cuyahoga, Lake, Geauga, Ashtabula, Trumball, Portage, Mahoning, Carroll, Stark, Tuscarawas, and Wayne.
NOTE: When seeking treatment (non-emergency) outside of this area, utilizing "PHCS Healthy Directions" will lower costs. Provider network information, including physician and hospital lookup can be found here.
2012: Catholic Health Partners had previously agreed to purchase a minority ownership in Summa for approximately $250 Million. However, the transaction is on hold until there is a restructure that satisfies Bishop Richard Lennon of the Catholic Diocese of Cleveland.
The main area of concern is the treatment for sterilizations, abortions and contraceptives. However, an auxiliary tax-exempt company will handle the purchase which satisfy all parties.
2013: SummaCare is participating in the Ohio Exchange, which began Open Enrollment on October 1st (You can view rates by requesting a quote on our website). The cheapest plan offered will be the "Individual Value" policy, which is considered a "catastrophic" option. Thus, it will be offered to applicants under age 30 along with other persons who meet specific eligibility guidelines.
Also offered is a $6,350 deductible Bronze policy, $5,000 deductible Silver policy, and $750 Gold policy. We are not aware of any Platinum options offered at this time.
2014: Open Enrollment starts in less than one week and many new options are available for the 2015 Ohio Marketplace. Bronze and Silver plans appear to be their most competitive niche when compared to the carriers offering policies in the Northeastern part of the state.
2017: Proposed rate increases for 2017 plans were relatively mild. For example, QHP Qualified Individual plans were 6.22%, QHP Individual plans were 4.98%, QHP Small Group was 1.51%, and QHP Qualified Small Group was 4.78%.