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About Your Benefits

2012 Medical Plan Choices — A Review

• Prime Care Advantage — This plan changed. There will now be a deductible of $100 individual/$300 family, and most services will have a 10 percent coinsurance. Emergency room, urgent care, and office visits will still have a copay.
• Prime Advantage Value — This plan changed. The deductible will now be $300 individual/$900 family. Most services will have a 20 percent coinsurance.
• Independent Choice — The deductible and out-of-pocket maximum is changing.
• Health Plan Premiums — There is a premium change for all plans.
• Dental and Vision Premiums — There is a change to the university subsidy for employee only coverage.

Note changes to Prime Care Advantage, Prime Advantage Value, and Independent Choice plans. For a detailed comparison chart and information, visit hr.osu.edu/benefits/hb_medical.

Common Medical Plan Definitions

Annual Deductible: The amount each covered person owes for eligible expenses incurred during a plan year before the plan begins to pay. Services with a copayment are not subject to the annual deductible.
Annual Out-of-Pocket Maximum: The total amount each covered person owes in deductibles, coinsurances, and copays for eligible expenses incurred in a plan year before the plan begins to pay 100 percent. Not all services are applied to the annual out-of-pocket limits. Review the information found on the Medical Plans Summary and Comparison Chart for a complete list.
Billed Amount: The amount the provider charged to the medical plan.
Coinsurance: The percentage of the contracted provider’s fee schedule or usual, customary, and reasonable rate (UCR) that you pay for covered services after the annual deductible.
Copay: The dollar amount you owe for covered services. The copay differs by plan and type of service you receive. Services with a copay are not subject to the annual deductible.
Deductible: The amount you pay before medical services are covered.
Formulary Brand: Preferred drugs that include select brand-name medications chosen for their clinical effectiveness, safety profiles, and/or lower costs.
Generic: FDA-approved drugs containing the same active ingredients as their brand-name counterparts.
Non-Formulary Brand: Brand-name drugs not on the formulary list because of safety, efficacy, and/or cost concerns.
Provider Discount: The amount the medical provider has contracted with OSU Health Plan to reduce its charge for services.

To view all health plan premiums, including full-time, part-time, same-sex domestic partner, sponsored dependents, adult children, and annual rates, visit hr.osu.edu/benefits/hb_rates.

Receive a PHA Medical Plan Premium Credit of $30/monthly pay or $13.85/biweekly pay by completing the Your Plan for Health (YP4H) Personal Health Assessment (PHA). To complete the PHA, log in to YourPlanForHealth.com and click Personal Health Assessment under Get Started.
NOTE: Your PHA Medical Plan Premium Credit of $30/monthly pay (or $13.85/biweekly pay) will be listed under Earnings and Hours on your pay stub.

Prescription Drug Plan Design

• The Ohio State University Health Plan Prescription Drug Formulary changed to the Express Scripts National Preferred Formulary effective January 1. This could affect one of your current medications. To view the 2012 formulary listing, go to hr.osu.edu/benefits/hb_prescription.
• The annual out-of-pocket maximum for all prescription drug plans except Prime Care Connect increased from $2,000 to $2,500 per person.
• The annual out-of-pocket maximum for the Prime Care Connect plan increased from $1,000 to $1,250 per person.
• The out-of-pocket maximum for formulary medications increased from $60 to $80 at retail, and from $150 to $200 for Home Delivery.
• Prime Advantage Plus retail formulary copays increased from $25 to $35 and retail non-formulary copays increased from $45 to $60. The Home Delivery formulary copay increased from $65 to $90 and the Home Delivery non-formulary copay increased from $115 to $150.
• Over-the-counter medications such as Prilosec OTC and Omeprazole OTC are no longer covered by the prescription drug plan.
• Non-sedating antihistamines, such as Clarinex and Xyzal, are no longer covered by the prescription drug plan.

Value-Based Design (VBD) Prescription Drug Plan

Faculty, staff, and their dependents actively participating in the Your Plan for Health
Care Coordination Program for management of asthma, chronic obstructive pulmonary disease (COPD), diabetes, and/or heart disease (coronary artery disease or congestive heart failure) are eligible for the VBD. The copay for generic drugs taken for the chronic condition(s) will be waived, and the member cost share for formulary brand-name drugs taken for the chronic condition(s) will be reduced by 50 percent for eligible members. If a member chooses not to actively participate in the Care Coordination Program, he/she will not be eligible for the VBD.

• Beginning January 1, 2012, all VBD participants are required to use Express Scripts Home Delivery for all of your maintenance medications in order to receive the VBD discount. This includes medications not related to your condition(s) eligible for Care Coordination. More information on the Home Delivery process will be sent to you if you qualify and participate in the Care Coordination Program. For more information contact the OSU Health Plan at 1-800-678-6269.

Specialty Medication Plan Design

Specialty medications are generally used to treat rare or complex diseases, are high-cost, require close supervision and monitoring, frequently require special storage or handling, and have a separate benefit design. A guide and listing of specialty medications can be found online at hr.osu.edu/benefits/hb_prescription.

• The out-of-pocket maximum for specialty formulary medications increased from $60 to $80 at retail and $50 to $67 for Home Delivery

Effective January 1, 2012: Walgreens No Longer Part of the Express Scripts Network
As there are Walgreens locations in the OSU Medical Center, the university recognizes the challenge and confusion this may cause our Health Plan participants. Therefore, the university has successfully negotiated with Walgreens locations at the OSU Medical Center ONLY. Health Plan participants will continue to be able to have prescriptions filled or refilled
at these three Walgreens-OSU Medical Center locations:

The Ohio State University Medical Center

• Main, Doan Hall, 410 W 10th Ave.
• Hospital Clinic, Cramblett Hall, 456 W. 10th Ave.
• East, 1492 E. Broad St.

It is important to note that all Walgreens locations outside the OSU Medical Center are no longer in the ESI network effective January 1, 2012.

Life Insurance

The Ohio State University has contracted with Minnesota Life as our life insurance vendor effective January 1, 2012. Ohio State and Minnesota Life have redesigned certain aspects of the life and accidental death and dismemberment insurance programs to offer Ohio State faculty and staff competitive group rates, choices, and guaranteed issue coverage amounts.

• Premiums for Dependent Group Term Life (DGTLI) and Voluntary Group Term Life (VGTLI) decreased January 1.
• GTLI Age reduction schedules changed from October 1 to January 1.
• GTLI & VGTLI Accelerated Death Benefit — If you become terminally ill with a life expectancy of 12 months or less, you may request early payment of up to 100 percent of the life insurance amount.
• GTLI Continuation of Coverage — If you are no longer eligible for coverage as an active employee, you may convert your life insurance coverage to an individual life insurance policy. Premiums may be higher than those paid by active employees.
• VGTLI Employee and Spouse/SSDP after-tax rates increase with age on January 1.
• VGTLI Waiver of Premium — If you become disabled, your life insurance premiums may be waived.

You may enroll or increase VGTLI coverage at any time with completion of Evidence of Insurability (EOI) and approval of Minnesota Life.

Dependent Eligibility Certification Process

For all dependents added through Open Enrollment, you will be required to provide proof of eligibility. We also will continue confirming dependent eligibility of the population who has not verified eligibility previously. If you have already provided your dependent documentation, you will not be asked to provide additional information unless a new dependent is added to your coverage. Failure to complete the verification or provide required documentation will result in termination of coverage.

2011 Flexible Spending Accounts Reminders

Do you have any money left in your Flexible Spending Account from the 2011 plan year?
Your Health Care and/or Dependent Care Flexible Spending Accounts (FSA) have an added feature that allows for an extension of the claim period for reimbursement. This incurred plan year provides employees with two extra months after the end of the plan year to incur expenses against any remaining balance of the previous year.

2011 Extended Incurred Expense Period

If you have unused 2011 FSA dollars for the plan year that ended December 31, 2011, you can reimburse yourself for eligible expenses that were incurred between January 1 – December 31, 2011, plus an extended claim period of January 1 – February 29, 2012. However, if there is a remaining balance of funds for 2011 and the claim is incurred after February 29, 2012, you cannot be reimbursed by 2011 funds, and the remaining 2011 funds must be forfeited. You can verify your 2011 account balance via “FSA Online” at go.osu.edu/flex.

You must submit your claims from the 2011 plan year and the two-month extended incurred expense period to the Office of Human Resources by March 31, 2012. Any funds remaining in a 2011 Flexible Spending Account after March 31, 2012, will be forfeited per federal regulations.

To see your FSA claim history and payment information, visit “FSA Online” at go.osu.edu/flex. This secure website has all your FSA information for the current plan year as well as your prior year’s FSA history. You also will be able to access a comprehensive listing of all eligible and ineligible health care expenses.

Important 2011 FSA Plan Year Dates

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