Benefits

Benefits

Health Benefits: Medical Plans

If you are unsure whether or not you are eligible for this benefit, go to Benefit Eligibility.

The university-sponsored medical plans provide comprehensive coverage for you and your eligible dependents. You choose which medical coverage and benefit levels best match the needs of you and your family.

Prime Care Connect
2014 Guidelines

The Prime Care Connect Medical Plan is designed for individuals with limited household income and is intended to reduce the financial barriers to obtaining appropriate and timely health care. The plan is supported administratively by The Ohio State University Health Plan, Inc.

Application can be made during the university’s Open Enrollment period or within 31 days of an event which results in you meeting ALL eligibility requirements. If approved and application was made due to an event, Prime Care Connect coverage will be effective on the event date. If approved and application was made during Open Enrollment coverage will be effective January 1. A letter will be sent from OSU Health Plan advising you of the final decision. If you are enrolled in one of the university’s other medical plans coverage and your application is approved your coverage will be automatically changed to Prime Care Connect.

If you believe that you meet ALL eligibility criteria, contact the OSU Health Plan at 614-292-4700 or 800-678-6269 and a customer service representative will provide information to help you with the application process. Forms will be mailed and you will be asked to complete and sign a brief application, provide proof of household income, and return the completed paperwork to the OSU Health Plan. All applications are treated as confidential. Eligibility approvals will be sent to the Office of Human Resources for appropriate processing of plan enrollment; however, no information contained in the application is made available to your employer.

The monthly or biweekly premium deduction for Prime Care Connect is the same as Prime Care Advantage, but the member and their dependents will have out-of-pocket savings due to reduced copays and out-of-pocket maximums for most services. The detailed summary is listed on the Medical Plan Summary and Comparison. The prescription drug benefit for this plan is separate, a summary is available in the Prescription Drug Program Summary Chart.

Benefit Component
Annual Out-of-Pocket Maximum
Annual Deductible1
Coinsurance
Preventive Care
Office visits: Primary care physician
Office visits: Specialist
Emergency Care
Urgent Care
Inpatient Hospitalization
Outpatient Surgery
Outpatient Procedures

Prime Care Connect Coverage
Individual: $1,000; Family: $3,000
None for most services
Plan pays 100% for most services
Plan pays 100%
You pay $0/copay
You pay $10/copay
You pay $50/copay
You pay $10/copay
You pay $100/copay
You pay $100/copay
You pay $35/copay2

1A separate deductible applies for infertility treatment and weight-loss surgery.
2Copay applies to all outpatient procedures. A listing of these procedures is available online at osuhealthplan.com/members.

These specific criteria must be met to qualify for Prime Care Connect:

Eligibility Requirements:

You must meet ALL of the following criteria:

  • Completion of the Your Plan for Health (YP4H) Personal Health & Well-Being Assessment (PHA)
  • Full-time employee (75%–100%) who is eligible for the full-time medical contribution rate, and
  • At least one year of continuous faculty or staff employment at Ohio State, and
  • Household income that does not exceed 175% of the federal poverty level:

Persons in Family
1
2
3
4
5
6
7
8
9 and up

Maximum Household Income
$20,108
$27,143
$34,178
$41,213
$48,248
$55,283
$62,318
$69,353
add $7,035 per person