Prime Care Advantage

The plan now requires an annual deductible and coinsurance for most services.

However, copays for certain common services are maintained, such as urgent care, emergency room and physician office visits. These services are not subject to the annual deductible.

This plan has a statewide network:

When INSIDE Franklin County - services need to be received through an OSU Health Plan network provider.

Services may also be received OUTSIDE Franklin County (within Ohio) by providers in the Medical Mutual of Ohio (MMO) SuperMed Plus Network.

Click here to review the list of network providers.

Please Note that:

1. MMO SuperMed Plus providers and facilities inside Franklin County are NOT covered unless they are an OSU Health Plan network provider.
2. Services may be received out of the network on an emergency basis only.

For a more detailed review of plan coverage, review the comparison chart. For information on 2012 premiums see the rates.

If you or your eligible dependents will be out of the area for an extended period of time, you may enroll in the Prime Care Advantage plan and apply for access to the Out-of-Area Plan for the specified individual(s), while outside of Ohio on an extended basis. To apply for Out-of-Area coverage, you must meet certain criteria. Find out if you qualify for Out-of-Area coverage and complete an application by clicking here.

Prime Advantage Value

Prime Advantage Value has the potential for more out-of-pocket expenses, as the plan requires an annual deductible and coinsurance for most services.

This plan has a statewide network:

When INSIDE Franklin County - services need to be received through an OSU Health Plan network provider.

Services may also be received OUTSIDE Franklin County (within Ohio) by providers in the Medical Mutual of Ohio (MMO) SuperMed Plus Network.

Click here to review the list of network providers.

Please Note that:

1. MMO SuperMed Plus providers and facilities inside Franklin County are NOT covered unless they are part of an OSU Health Plan network provider.
2. Services may be received out of the network on an emergency basis only.

For a more detailed review of plan coverage, review the comparison chart. For information on 2012 premiums see the rates.

If you or your eligible dependents will be out of the area for an extended period of time, you may enroll in the Prime Advantage Value plan and apply for access to the Out-of-Area plan for the specified individual(s), while outside of Ohio on an extended basis. To apply for Out-of-Area coverage, you must meet certain criteria. Find out if you qualify for Out-of-Area coverage and complete an application by clicking here.

Prime Advantage Plus

Prime Advantage Plus offers network and non-network coverage at a higher premium. When services are received in the network, the coverage offers copays for most services. When non-network services are used, most services have an annual deductible and coinsurance.

Network services are provided through:

When INSIDE Franklin County - services need to be received through an OSU Health Plan network provider.

Services may also be received OUTSIDE Franklin County (within Ohio) by providers in the Medical Mutual of Ohio (MMO) SuperMed Plus Network. Note: MMO SuperMed Plus providers and facilities inside Franklin County are paid as non-network unless the provider is part of the OSU Health Plan network.

Click here to review the list of network providers.

For a more detailed review of plan coverage, review the comparison chart. For information on 2012 premiums see the rates.

If you or your eligible dependents will be out of the area for an extended period of time, you may enroll in the Prime Advantage Plus plan and apply for access to the Out-of-Area Plan for the specified individual(s), while outside of Ohio on an extended basis. To apply for Out-of-Area coverage, you must meet certain criteria. Find out if you qualify for Out-of-Area coverage and complete an application.

Independent Choice Plan

All of the services under this plan can be obtained through non-network providers. Because there are no network discounts available, this plan has the highest premiums. It requires an annual deductible and coinsurance for all services.

You may realize lower out-of-pocket expenses if you utilize providers in the Medical Mutual of Ohio (MMO) SuperMed Plus Network. Click here to review the list of providers.

For a more detailed review of plan coverage, review the comparison chart. For information on 2012 premiums see the rates.

Prime Care Connect

Prime Care Connect is a medical plan that provides some relief from the financial barriers to receiving necessary care for certain individuals in lower income brackets. If you are interested in applying, please call The Ohio State University Health Plan Inc. at (614) 292-4700 or 1-800-678-6269 to begin the application process. More information is available in the Prime Care Connect Guide.

For a more detailed review of plan coverage, review the comparison chart. For information on 2012 premiums see the rates.

Out-of-Area Plan

Faculty and staff who live in select areas without adequate network access are eligible to enroll in the Out-of-Area Plan. Determine if your zip code qualifies you for this plan, follow link to plan eligibility by zip code.

While in Ohio, members may use network providers to receive a greater benefit. When network providers are utilized, claims will be paid at the same coverage level as Prime Care Advantage.

For a more detailed review of plan coverage, review the comparison chart. For information on 2012 premiums see the rates.

Additional Access to Out-of-Area Plan
Access to the Out-of-Area Plan is also available for individuals enrolled in the Prime Care Advantage, Prime Advantage Value, or Prime Advantage Plus plans who will be outside the plan’s network area for an extended period of time. Examples of qualifying circumstances include:

• You have an eligible dependent child who does not live with you and who resides outside Ohio
• You have an eligible dependent who is enrolled in a college outside Ohio
• You are outside Ohio on an approved leave of absence or an approved sabbatical
• You are outside Ohio during an off-duty quarter if you have a nine-month appointment and receive compensation and benefits over a 12-month period

Non-network services are covered when outside of network access. While in Ohio, network providers must be utilized. Coverage for family members staying inside the network remains the same. 

To apply for this plan (if enrolling in Prime Care Advantage, Prime Advantage Value or Prime Advantage Plus), follow the link to complete an application for Out-of-Area coverage.