Medical Benefits - Human Resources at Ohio State
Medical Benefits
End of COVID-19 Emergency
The end of the COVID-19 National and Public Health Emergencies impacts Ohio State benefits and deadlines. Read Summary of Material Modifications.
All of the benefits available to you reflect Ohio State’s commitment to provide high-quality, affordable plans and represent a significant component of your total rewards for working at Ohio State. We know that when our faculty and staff are healthy, everyone wins.
The university-sponsored medical plans provide comprehensive coverage and wellness benefits for you and your eligible dependents. All Ohio State medical plan options include preventive care with 100% coverage. Not every illness is preventable, but living healthier leads to a better quality of life, improved personal and professional productivity and lower out-of-pocket costs. From the available plan options, you choose which medical coverage and benefit levels best match the needs of you and your family.
Summaries of Benefits and Coverage (SBC)
Additional Resources
- Glossary of Health Coverage and Medical Terms
- The Ohio State University Faculty and Staff Health Plan Specific Plan Details (SPD) Document
- Summary of Material Modifications issued 5/04/2023 (Benefits coverage changes related to COVID-19)
Medical Benefit Options
Your medical benefits provide comprehensive coverage for planned and emergency care. Each plan’s provisions vary, so you have flexibility when deciding which option is right for you and your family. All of the medical plans provide coverage for the same types of medical services; however, the employee contribution rate for each plan varies based on how the plan pays for those services.
When selecting a plan, think about how frequently you visit the doctor, whether you need out-of-network coverage and how you want to balance your employee contribution rates with what you are required to pay for medical services.
All Prime Care plan options have two available networks: Premier Network and Standard Network. While members can choose providers from either network at any time, those utilizing Premier Network providers will receive a higher level of benefit coverage.
Prime Care Advantage requires that you receive medical care from a statewide network of providers. The plan requires an annual deductible and coinsurance for many services. Out-of-network services are not covered under this plan, except for emergencies. (see Prime Care Advantage Summary of Benefits and Coverage (SBC))
Prime Care Choice has lower employee contribution rates and has both network and out-of-network coverage for medical services that are typically subject to a deductible and coinsurance. When services are received in the network, your deductible and coinsurance amount are lower than when you obtain services outside of the network. (see Prime Care Choice Summary of Benefits and Coverage (SBC))
Prime Care Connect is available for individuals with limited household income. This plan is intended to help reduce the financial barriers to obtaining health care. This plan is available only to faculty and staff who meet specific income qualifications and requirements. Review the Prime Care Connect Requirements for more details, including eligibility requirements. (see Prime Care Connect Summary of Benefits and Coverage (SBC))
The Out-of-Area plan is available only to individuals who live in areas without adequate network access (see Plan Eligibility by Zip Code). Access to this coverage is also available, with a special application, to individuals enrolled in Prime Care Advantage, Prime Care Choice or Prime Care Connect who will be outside Ohio for at least 30 consecutive days. You must meet certain criteria to temporarily enroll in this plan, as detailed on the Out-of-Area Benefit Election Form. (see Out-of-Area Plan Summary of Benefits and Coverage (SBC))
Effective Jan. 1 – Dec. 31, 2023
| Provisions | Prime Care Advantage1 | Prime Care Choice1 | Prime Care Connect3 | Out-of-Area4 | ||||
|---|---|---|---|---|---|---|---|---|
| Premier Network | Standard Network | Premier Network | Standard Network | Out-of-Network3 | Premier Network | Standard Network | Non-Network | |
| Annual Deductible | Individual: $550 Family: $1,100 |
Individual: $975 Family: $1,950 |
Individual: $1,900 Family: $3,800 |
Individual: $150 Family: $300 |
Individual: $550 Family: $1,100 |
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| Annual Out-of-Pocket Maximum (including deductible) | Individual: $3,000 Family: $6,000 |
Individual: $4,350 Family: $8,700 |
Individual: $7,500 Family: $15,000 |
Individual: $1,500 Family: $3,000 |
Individual: $3,000 Family: $6,000 |
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| Coinsurance* | Plan pays 80% for most services | Plan pays 70% for most services | Plan pays 80% for most services | Plan pays 70% for most services | Plan pays 60% for most services | Plan pays 85% for most services | Plan pays 75% for most services | Plan pays 80% |
| Preventive Care* | Plan pays 100% (no deductible) |
Plan pays 100% (no deductible) |
Plan pays 60% | Plan pays 100% (no deductible) |
Plan pays 100% (no deductible) |
|||
| Office Visit – Primary Care Provider (PCP)5* | Plan pays 100% (no deductible) |
Plan pays 70% | Plan pays 100% (no deductible) |
Plan pays 70% | Plan pays 60% | Plan pays 100% (no deductible) |
You pay $20 copay | Plan pays 100% (no deductible) |
| Office Visit – Behavioral Health Provider* | Plan pays 80% (no deductible) |
Plan pays 80% | Plan pays 60% | Plan pays 100% (no deductible) |
Plan pays 80% | |||
| Office Visit – Specialist* | Plan pays 80% (no deductible) |
Plan pays 70% | Plan pays 80% | Plan pays 70% | Plan pays 60% | You pay $20 copay | You pay $30 copay | Plan pays 80% |
| Office Visit – Other Practitioners6* | Plan pays 80% | Plan pays 70% | Plan pays 80% | Plan pays 70% | Plan pays 60% | You pay $20 copay | You pay $30 copay | Plan pays 80% |
| Immediate Care – Convenient Care Clinic* | Plan pays 100% (no deductible) |
Plan pays 100% (no deductible) |
Plan pays 60% | Plan pays 100% (no deductible) |
Plan pays 100% (no deductible) |
|||
| Immediate Care – Urgent Center* | Plan pays 80% (no deductible) |
Plan pays 80% | Plan pays 60% | You pay $35 copay | Plan pays 80% | |||
| Immediate Care – Emergency Care* | Plan pays 80% | Plan pays 80% | You pay $100 copay | Plan pays 80% | ||||
| Inpatient Hospitalization* | Plan pays 80% | Plan pays 70% | Plan pays 80% | Plan pays 70% | Plan pays 60% | You pay $200 copay7 | You pay $300 copay7 | Plan pays 80% |
| Outpatient Surgery and Procedures* | Plan pays 80% | Plan pays 70% | Plan pays 80% | Plan pays 70% | Plan pays 60% | You pay $100 copay7 | You pay $150 copay7 | Plan pays 80% |
| Outpatient Lab and X-ray* | Plan pays 80% | Plan pays 70% | Plan pays 80% | Plan pays 70% | Plan pays 60% | Plan pays 85% (no deductible) |
Plan pays 75% (no deductible) |
Plan pays 80% |
| *after deductible, unless noted otherwise
1 With application, an individual may qualify to enrolled in Out-of-Area non-network benefits. |
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NOTE: This comparison chart should be used as a general guide only. Refer to the Faculty and Staff Health Plan – Specific Plan Details for further information. If the information provided in this summary chart differs from the online document, the online document will govern.
Using the Benefit
Based upon the medical plan you choose, you may be required to seek care at a network provider while some plans cover services obtained from an out-of-network provider. In either case, Trustmark processes your medical claims.
For a list of statewide network providers, visit the OSU Health Plan Member Search.
If you use a network provider:
- Present your medical card to the provider at the time of service.
- No claim forms are necessary for network medical services. Your provider should file claims directly to the address listed on the back of your medical card.
If you use an out-of-network provider:
- Your provider may require you to pay for services in full and you will be reimbursed from Trustmark by filing a claim.
- To file a claim use the Health Insurance Claim Form.
Emergency care is covered worldwide under the university’s faculty and staff medical plans. Access to non-emergency care for individuals living outside the network area (see Plan Eligibility by Zip Code) for more than 30 consecutive days is available through special enrollment in the Out-of-Area Plan by completing the Out-of-Area Benefit Election Form.
Ohio State Travel Assistance
Any individual enrolled in one of the university’s faculty and staff medical plans automatically has access to Ohio State Travel Assistance services.
The Trustmark mobile app is available to make it easier for you to manage your medical benefit. You can access information such as the status of your deductible and out-of-pocket maximum, view claims and show your medical ID card to providers. You may ask questions and receive answers from Trustmark through the “message center”. You can download the app for free from the app store from Apple or Google Play.
Medical Plan FAQ
Medical claims should be submitted to Trustmark at:
Trustmark
P.O. Box 2310
Mt. Clemens, MI 48046
You can search for network plan providers at OSU Health Plan Member Search or by calling OSU Health Plan at (800) 678-6269.
When traveling: Any individual enrolled in one of the university-sponsored medical plans automatically has access to Ohio State Travel Assistance services at no cost to enrollees. Ohio State’s Prime Care medical plans provide benefits for emergency and urgent care services with no network restrictions outside Ohio. To determine your coverage level and to determine if your plan covers non-emergency care from out-of-network providers read the Medical Plans-Specific Plan Details or contact OSU Health Plan at (614) 292-4700, option 0, for assistance.
Residing outside the network area for 30 consecutive days or more: Access to care when residing outside the network area for an extended time is available to individuals enrolled in Prime Care Advantage, Prime Care Choice or Prime Care Connect through special enrollment in the Out-of-Area Plan. To enroll, complete an Out-of-Area Benefit Election Form (see Plan Eligibility by Zip Code).
Examples of circumstances for an individual to enroll in the Out-of-Area Plan:
- Your eligible child does not live with you and resides outside the network area.
- Your eligible child is enrolled in a college outside the network area.
- You are living outside the network area for 30 consecutive days or more.
You may change your medical plan election during Open Enrollment or in connection with certain qualified status changes including loss of other coverage for you or your eligible dependents or gaining a dependent as a result of marriage, birth, adoption or placement for adoption. In addition, a medical plan change can be made when an employee has a change in employment which results in a medical plan contribution tier change, such as changing from part-time to full-time or vice versa.
After you complete the medical plan enrollment process in Workday, a medical identification card will be mailed to your home address from Trustmark. You should expect to receive your card approximately two weeks after you enroll.
To request additional identification cards, go to the Trustmark Self Service site or call Trustmark at (866) 442-8257.
If you need a temporary identification card, please go to the Trustmark Self Service site or contact HR Connection at (614) 247-myHR (6947) for assistance.
This is intended to be an overview. Refer to the Plan Document for complete information. In the event the information on these pages differs from the Plan Document, the Plan Document will govern.
