Plan Documents


To find your plan-specific documents — Summary of Benefits, Evidence of Coverage, and Annual Notice of Changes — navigate to your service-area region (based on your county of residence) and select the name of the plan you are enrolled in. You can find your plan name on your member ID card.

2025 Plan Name Changes

Several of our plans will have a new name beginning Jan. 1, 2025:

  • Mount Carmel MediGold Cash Back No Premium (HMO) will change to Mount Carmel MediGold Cash Back (HMO) in all regions.
  • Mount Carmel MediGold Cash Back No Premium MA Only (HMO) will change to Mount Carmel MediGold Glory No RX (HMO) in all regions.
  • Mount Carmel MediGold No Premium Choice (PPO) to Mount Carmel MediGold Choice (PPO) in the Northwest Ohio region.
  • Mount Carmel MediGold No Premium Choice (PPO) will change to Mount Carmel MediGold Premium Choice (PPO) in the Central and Southwest regions.

The menus below have been updated to reflect the 2025 plan names.

Central Ohio

(If you live in Clinton, Coshocton, Delaware, Fairfield, Fayette, Franklin, Gallia*, Guernsey, Harrison, Highland, Hocking, Holmes, Jackson, Knox, Licking, Logan, Madison, Meigs, Monroe, Morgan, Muskingum, Noble, Perry, Pickaway, Pike, Richland*, Ross, Union, Vinton, or Washington county)

2025

On Jan. 1, 2025, we will be combining Mount Carmel MediGold Choice (PPO) with one of our plans, Mount Carmel MediGold Premium Choice (PPO). The information in your Annual Notice of Changes explains the differences between your current benefits in Mount Carmel MediGold Choice (PPO) and the benefits you will have on Jan. 1, 2025, as a member of Mount Carmel MediGold Premium Choice (PPO). Unless you choose another plan, we will automatically enroll you in Mount Carmel MediGold Premium Choice (PPO) in 2025. 

Annual Notice of Change

2024

This is an employer group health plan available to eligible Mount Carmel retirees.

2025

2024

*Mount Carmel MediGold available effective 1/1/2025.

Northwest Ohio 

(If you live in Allen, Crawford, Defiance, Fulton, Hancock, Hardin, Henry, Lucas, Mercer, Morrow, Ottawa, Paulding, Putnam, Seneca, Van Wert, Wood, or Wyandot county)

Southwest Ohio 

(If you live in Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Darke, Greene, Hamilton, Miami, Montgomery, Preble, Shelby or Warren county)

2025

On Jan. 1, 2025, we will be combining Mount Carmel MediGold Choice (PPO) with one of our plans, Mount Carmel MediGold Premium Choice (PPO). The information in your Annual Notice of Changes explains the differences between your current benefits in Mount Carmel MediGold Choice (PPO) and the benefits you will have on Jan. 1, 2025, as a member of Mount Carmel MediGold Premium Choice (PPO). Unless you choose another plan, we will automatically enroll you in Mount Carmel MediGold Premium Choice (PPO) in 2025. 

Annual Notice of Change

2024

This is an employer group health plan available to eligible Mount Carmel retirees.

2025

2024

Other Coverage Information

Provider Directory 

Mount Carmel MediGold offers a large network of high-quality providers. You can use the Provider/Pharmacy directories below to find network providers and pharmacies in your area. You can also search the directory on the Find a Provider page of our website. 

Central Ohio 2024-2025 Provider Directory (last updated 10/04/24)

Central Ohio 2024-2025 Pharmacy Directory (last updated 10/04/24)

Northwest Ohio 2024-2025 combined Provider and Pharmacy Directory (last updated 10/04/24)

Southwest Ohio 2024-2025 Provider Directory (last updated 10/04/24)

Southwest Ohio 2024-2025 Pharmacy Directory (last updated 10/04/24)

At any time, you can request a printed copy of an Ohio Provider/Pharmacy Directory by calling Member Services. Our team is also happy to answer any questions you may have about our network providers, including their qualifications and any changes in the pharmacy network.

 

This page was last updated 10/07/2024