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MedFlex may be a good option for eligible non-bargaining and AFSCME employees who:

Before choosing MedFlex, employees should:

Not necessarily. A hospital may participate in MedFlex, but individual professionals involved in your care may have separate network status. This can include surgeons, anesthesiologists, radiologists, pathologists, ambulance providers, and other physician groups.

Before planned care, verify that the hospital or facility and the professionals expected to provide your care participate in MedFlex.

Preventive services are covered when received from an in-network MedFlex provider or facility.

To avoid unexpected costs, use MedFlex providers for preventive appointments and confirm that the provider, laboratory, imaging center, and any facility involved in your care participate in the MedFlex network.

No. Prescription-drug coverage under MedFlex is the same as prescription-drug coverage under ÐÔ¸£ÎåÔÂÌì’s other medical plans.

Employees enrolled in MedFlex will have the same prescription-drug formulary, pharmacy network, and applicable prescription rules as employees enrolled in ÐÔ¸£ÎåÔÂÌì’s other medical-plan options. This includes applicable requirements for prior authorization, step therapy, quantity limits, specialty medications, and preferred pharmacy use.

If you have a medical emergency while traveling, seek emergency care immediately.

For non-emergency care while traveling, contact Medical Mutual before receiving services whenever possible. Because MedFlex is an Ohio-based network and non-emergency out-of-network care is not covered, routine or planned care outside the network may result in full financial responsibility for the service.

In an emergency, call 911 or go to the nearest emergency department. Emergency services are covered regardless of whether the provider or hospital participates in MedFlex.

After the emergency is stabilized, contact Medical Mutual as soon as possible for guidance about follow-up care, transfer, admission, or continuing treatment. Whenever possible, ongoing care should be moved to an in-network MedFlex provider or facility.

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.