Appeal Form for Medical Plan Network Out-of-Area Eligibility

Ohio State Medical Plan members may appeal to be considered for the Out-of-Area medical plan or specialty care eligibility if they believe their ZIP code does not meet the established standards for the statewide network or if they require specialty care that is not available within their area.

To file an appeal, print the Appeal Form for Medical Plan Network Out-of-Area Eligibility. The completed form may be faxed or mailed to Ohio State's Managed Health Care Systems (the "Medical Plan") according to instructions on the bottom of the form.

Member Concern Record

Ohio State health plan members are entitled to express concern or dissatisfaction with the quality of care, quality of service or administrative process they experience by a provider on the OSU Managed Health Care Systems (MHCS) network, a MHCS or human resources representative or one of the health plan’s vendors.

To file a concern, print the Member Concern Form. The completed form may be faxed or mailed to MHCS according to instructions on the bottom of the form. Or, you may contact a MHCS customer service representative at (614) 292-4700 or (800) 678-6269.