SummaCare Individual FAQs
When can I enroll in an Individual and Family plan?
  • The open enrollment period to shop for and purchase individual health insurance coverage for 2018 is November 1, 2017 through December 15, 2017. This means that in order to secure coverage for 2018, you must purchase a plan within this enrollment period. After December 15, you can only enroll in a plan if you have a Qualifying Event that creates a Special Election Period.
What type of plans does SummaCare offer?
  • SummaCare’s plans are a Preferred Provider Organization (PPO) plan type available to individuals and families living in Summit, Stark, Portage and Medina counties and feature the SCConnect network. Plans are categorized into metal tiers to help you understand how you and SummaCare will split the costs of your health care. Percentages shown can include a combination of deductibles, copays and coinsurance.
    Metal TierGood choice ifSummaCare pays*You pay*
    BronzeYou want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.60%40%
    SilverYou’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered. Silver plans are also available for cost-sharing reductions.70%30%
    GoldYou’re willing to pay more each month to have more costs covered when you get medical treatment. If you access care frequently, a Gold plan could be a good value.80%20%
    CatastrophicAvailable for people under 30 or with certain exemptions. Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like a serious illness or injury but you pay most routine medical expenses yourself. Not available with a subsidy or premium tax credit.
    *Percentages are estimated averages.
What is an HSA?
  • A Health Savings Account (HSA) combines high deductible health insurance with a tax-favored savings account. The funds in the savings account can be used towards qualified medical expenses including co-payments, deductibles and services that are not covered by a SummaCare HSA-qualified health plan. View the complete list of Qualified Medical Expenses.
Which doctors and hospitals can I use?
  • SummaCare Individual and Family plans feature the SCConnect network. This network provides access to many of the area’s finest physicians, facilities and hospitals including Summa Health System, Mercy Medical Center (Canton) and Akron Children’s Hospital.
How do I know if my doctor or hospital is in-network? What if I see a doctor who is not in-network?
  • Using a doctor, hospitals, and providers outside of the network will be subject to the out-of-network deductible and out-of-pocket maximum.
How much will I pay for services?
  • Each SummaCare Individual & Family plan has different service costs to allow you to choose the plan that is right for you. Specific plan information can be found on the Summary of Benefits and Coverage (SBC) Plan Details document. This summary provides answers to important questions like “What is the overall deductible?” and “Is there an out-of-pocket limit to my expenses?”
What happens if I need to see a specialist?
  • You can see the specialist you choose without a referral from a physician or permission from this plan. On select plans, each visit is subject to a deductible if you choose an in-network provider.
Do I need prior authorization for services?
  • Certain services require prior authorization in order to be covered under your health plan. Your in-network providers are responsible for obtaining authorization 48 hours prior to the provision of services. If you use a provider that is not in your network, it is your responsibility to obtain any required prior authorization.
How do I estimate my household income?
  • In order to estimate your premium subsidy amount, you will need to provide your expected annual household income for the year you want coverage, not last year’s income. Income is counted for you, your spouse, and everyone you’ll claim as a tax dependent on your federal tax return. Include their income even if they don’t need health coverage. If you are unemployed make sure you include your unemployment compensation.