Medical Benefits
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.
Documents and Resources
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)
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)
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)
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)
Under the Affordable Care Act, group health plans and insurance companies must provide participants with a Summary of Benefits and Coverage (SBC) for each benefit option and a glossary of terms commonly used in health insurance coverage. All group health plans and insurance companies use the same standard format for their SBCs and glossary. Our SBCs and glossary are available below and paper copies are available free of charge by contacting HR Connection at 614-247-myHR (6947) or 800-678-6010.
2024 Summaries of Benefits and Coverage
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, Luminare Health (formerly 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 Luminare Health (formerly 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 Ohio 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 Luminare Health (formerly 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 Luminare Health through the “message center”. You can download the app for free from the app store from Apple or Google Play.
Who processes our medical plan claims?
Medical claims should be submitted to Luminare Health (formerly Trustmark) at:
Luminare Health
P.O. Box 4386
Clinton, IA 52733
Where can I check to see if my doctor is part of Ohio State’s statewide network?
You can search for network plan providers at OSU Health Plan Member Search or by calling OSU Health Plan at (800) 678-6269.
When can I change from one medical plan to another?
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.
When will I receive a medical identification card?
After you complete the medical plan enrollment process in Workday, a medical identification card will be mailed to your home address from Luminare Health (formerly Trustmark). You should expect to receive your card approximately two weeks after you enroll.
To request additional identification cards or need a temporary identification card, go to the Luminare Health Self Service site or call Luminare Health at (866) 442-8257.
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.