SkyCare EPO
Choices are good, especially when they offer you the opportunity to save money.
Two years ago we introduced the MetroHealth Select EPO plan – it is now renamed the SkyCare EPO plan.
This plan requires that you receive your healthcare from one of the many SkyWay Network facilities and providers. There are many in Cuyahoga and Medina counties, and Lake Health facilities are also included in the network. So, if you live or work in Lake County, this will be of interest to you.
Click HERE for a list of locations.
Please note, the Lake Health Beachwood location is not in-network.
The design of this plan is suited for folks who need regular healthcare but would appreciate lower out-of-pocket costs. The chart below compares the SkyCare EPO to the MMO PPO plan. You can see the advantages: lower deductibles, lower out-of-pocket maximums, lower copays…you get the idea.
But remember, and this is VERY IMPORTANT, you must get health care from one of the SkyWay network providers. MetroHealth offers 11 convenient pharmacy locations as well as home delivery for prescriptions. Visit metrohealth.org/pharmacy for complete information. There are no benefits, other than for emergency care, if you do not use a network doctor, lab, pharmacy, outpatient facility or hospital.
The SkyWay network has more than 25 MetroHealth locations in Cuyahoga and Medina counties.
RESOURCES
| In-Network Benefits | ||
| Plan Name | SkyCare EPO | MMO PPO |
| Deductibles | $500/$1,000 | $1,250/$2,500 |
| Coinsurance | 90% | 80% |
| Out-of-Pocket Maximum | $2,000/$4,000 | $3,250/$6,500 |
| General Services | ||
| Preventive Care Office Visit | 100% | 100% |
| Primary Care Physician Office Visit | $20 Copay | $25 Copay |
| Specialist Office Visit | $40 Copay | $50 Copay |
| X-Ray/Lab Services | 90% | 80%* |
| Urgent Care | $25 Copay | $30 Copay |
| ER - Emergency Services | $150 Copay | $150 Copay |
| ER - Non-Emergency Services | $500 Copay + Deductible/Coinsurance | $500 Copay + Deductible/Coinsurance |
| Facility Based Services | ||
| Inpatient Services | 90% | 80% |
| Outpatient & X-Ray/Lab Services | 90% | 80%* |
| Prescription Drug Benefits | Metro Pharmacy | CVS/Caremark |
| Retail Generic / Tier 1 | $10 Copay(30-day Supply) | $10 Copay |
| Retail Brand Formulary / Tier 2 | $20 Copay(30-day Supply) | 20%, $25 Min / $75 Max |
| Retail Brand Non-Formulary / Tier 3 | $40 Copay(30-day Supply) | 40%, $40 Min / $150 Max |
| Mail Generic / Tier 1 | $10 Copay (90-day Supply) | $25 Copay |
| Mail Brand Formulary / Tier 2 | $50 Copay (90-day Supply) | 20%, $60 Min / $150 Max |
| Mail Brand Non-Formulary / Tier 3 | $80 Copay (90-day Supply) | 40%, $90 Min / $300 Max |
*Payment for specific non-emergency lab services are limited to 80% of the Maximum Allowable Cost
The SkyCare EPO Health Plan covers the same services as the PPO plans. A key distinction that is part of any exclusive provider organization health plan is that medical services are only available from network providers and hospitals. With this plan, medical services obtained from providers and hospitals that are not part of the SkyWay network are not covered.
Fees for services from SkyWay network providers are generally lower than those for the same services obtained from providers in the MMO network. Members enrolling in this plan will have lower deductibles, out-of-pocket maximums and copayments than the other plans. Additionally, this plan will pay 90% of medical expenses incurred after the deductible is satisfied. Members can obtain their prescriptions using pharmacies that are part of the SkyWay or CVS/Caremark networks. Members enrolled in this plan will have lower copayments if they use SkyWay network pharmacies.
For the most up-to-date listing of health centers and physician nearest you, please visit metrohealth.org/locations or lakehealth.org/locations
