Medical Plan - Human Resources at Ohio State
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. Informed Enrollment Online, an interactive tool to help you model your medical costs, is available in Employee Self Service.
- Prime Care Advantage SBC1
- Prime Care Choice SBC1
- Prime Care Connect SBC1
- Out-of-Area Plan SBC1
- Glossary of Health Coverage and Medical Terms
1 Summary of Benefits and Coverage
Medical Plan 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.
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 Coverage)
Prime Care Choice has lower employee contribution rates with 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 Coverage)
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 Coverage)
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 Coverage)
Effective Jan. 1 – Dec. 31, 2018
|Benefit Component||Prime Care Advantage1||Prime Care Choice1||Prime Care Connect4||Out-of-Area Plan5|
|Annual Deductible2||Individual: $450
Family: $900 for most services
Family: $1,900 for most services
Family: $3,800 for most services
Family: $300 for most services
Family: $900 for most services
|Coinsurance||Plan pays 80% for most services after deductible||Plan pays 80% for most services after deductible||Plan pays 60% for most services after deductible||Plan pays 85% for most services after deductible||Plan pays 80% for most services after deductible|
|Annual Out-of-Pocket Maximum||Individual: $2,600
|Preventive Care||Plan pays 100%||Plan pays 100%||Plan pays 60% after deductible||Plan pays 100%||Plan pays 100%|
|Office Visit – Primary Care Provider (PCP)6||Plan pays 100%||Plan pays 100%||Plan pays 60% after deductible||Plan pays 100%||Plan pays 100%|
|Office Visit – Behavioral Health||Plan pays 80%, no deductible||Plan pays 80% after deductible||Plan pays 60% after deductible||Plan pays 100%||Plan pays 80% after deductible|
|Office Visit – All Other||Plan pays 80% after deductible||Plan pays 80% after deductible||Plan pays 60% after deductible||You pay $20 copay||Plan pays 80% after deductible|
|Immediate Care – Convenient Care||Plan pays 100%||Plan pays 100%||Plan pays 60% after deductible||Plan pays 100%||Plan pays 100%|
|Immediate Care – Urgent Care||Plan pays 80%, no deductible||Plan pays 80% after deductible||Plan pays 60% after deductible||You pay $35 copay||Plan pays 80% after deductible|
|Immediate Care – After Hours Care||Plan pays 80% after deductible7||Plan pays 80% after deductible||Plan pays 60% after deductible||You pay $20 copay7||Plan pays 80% after deductible|
|Immediate Care – Emergency Care||Plan pays 80% after deductible||Plan pays 80% after deductible||Plan pays 80% after deductible||You pay $100 copay||Plan pays 80% after deductible|
|Inpatient Hospitalization||Plan pays 80% after deductible||Plan pays 80% after deductible||Plan pays 60% after deductible||You pay $200 copay||Plan pays 80% after deductible|
|Outpatient Surgery||Plan pays 80% after deductible||Plan pays 80% after deductible||Plan pays 60% after deductible||You pay $150 copay||Plan pays 80% after deductible|
|Lab and X-ray||Plan pays 80% after deductible||Plan pays 80% after deductible||Plan pays 60% after deductible||Plan pays 85%, no deductible||Plan pays 80% after deductible|
1 With application, an individual enrolled in this plan may qualify for the Out-of-Area Plan’s non-network benefits.
2 A separate deductible applies for infertility treatment and weight-loss surgery.
3 Out-of-pocket costs that you incur when receiving services from out-of-network providers will apply to the network out-of-pocket maximum.
4 Special application is required. For faculty and staff who have applied and been approved for enrollment in this plan, the network restriction will be removed if your permanent home address is outside Ohio or in select areas of Ohio without adequate network access. Review eligibility by zip code online.
5 Must meet eligibility criteria. Review eligibility by zip code online.
6 A PCP is a generalist physician designated as a family medicine, general internal medicine, geriatric medicine or general pediatrics provider. PCP services also can be provided by a Primary Care Nurse Practitioner who practices with a PCP. This benefit also applies to University Health Services and clinics in a retail setting (convenience care).
7 Utilization of services at Martha Morehouse and Gahanna AfterHours is a cost-effective alternative to the ER for more serious conditions than can be handled at convenient care or urgent care.
NOTE: This medical plan comparison chart should be used as a general guide only. Refer to the Medical Plans 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, CoreSource 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/prescription drug 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/ prescription drug 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 CoreSource 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 when outside Ohio 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 for health care.
Medical Plan FAQ
Medical claims should be submitted to CoreSource at:
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. You are covered for emergency and urgent care, outside Ohio or internationally. 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 for assistance.
Residing outside of Ohio for 30 consecutive days or more: Access to care when residing outside Ohio for an extended time is available through special enrollment in the Out-of-Area Plan. See “Medical Plan Options” in the Benefits Overview Book
Examples of circumstances to enroll in the Out-of-Area Plan:
- Your eligible child does not live with you and resides outside Ohio.
- Your eligible child is enrolled in a college outside Ohio.
- You are outside Ohio 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 at Employee Self Service, a medical/prescription drug identification card will be mailed to your home address from CoreSource. You should expect to receive your card approximately two weeks after you enroll.
To request additional identification cards, go to the CoreSource Self Service site or call CoreSource at (866) 442-8257.
If you need a temporary identification card, please go to the CoreSource Self Service site or contact HR Customer Service at (614) 292-1050 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.