Prime Care Connect Requirements - Human Resources at Ohio State

Prime Care Connect Requirements

The Prime Care Connect medical plan is designed for those with limited household income and intended to reduce the financial reasons that may prevent them from getting appropriate and timely health care. The plan is supported by The Ohio State University Health Plan, Inc.

Application can be made during the university’s Open Enrollment period or within 30 days of a change in the number of family members which results in you meeting ALL eligibility requirements. A decrease in household income during the plan year is not an event that allows enrollment during the plan year. Household income is based on the prior year’s tax return. If approved and application was made due to an event, Prime Care Connect coverage will be effective on the event date. If approved, and application was made during Open Enrollment, coverage will be effective January 1 of next year. A letter will be sent from OSU Health Plan advising you of the final decision. If you are enrolled in one of the university’s other medical plans and your application is approved, your coverage will be automatically changed to Prime Care Connect.

If you believe that you meet ALL eligibility criteria, contact the OSU Health Plan at 614-292-4700 or 800-678-6269 and a customer service representative will provide information to help you with the application process. Forms will be mailed, and you will be asked to complete and sign a brief application, provide proof of household income, and any other necessary documentation, and return the completed paperwork to OSU Health Plan. All applications are treated as confidential. Eligibility approvals will be sent to the Office of Human Resources for processing plan enrollment; however, no information contained in the application is made available to your employer.

The premium deduction for Prime Care Connect is the same as Prime Care Advantage, but the member and their dependents will have lower out-of-pocket cost due to reduced copayments, coinsurance and out-of-pocket maximum. Plan details can be found in the Faculty and Staff Health Plans Specific Plan Details.

Benefit Component Premier Network Standard Network
Annual Deductible1 Individual: $150; Family: $300
Coinsurance You pay 15% You pay 25%
Annual Out-of-Pocket Maximum Individual: $1,500; Family: $3,000
Preventive Care Plan pays 100%
Office Visit: Primary Care Provider (PCP)2 You pay $0 copay You pay $20 copay
Office Visit: Specialist You pay $20 copay You pay $30 copay
Urgent Care You pay $35 copay
Emergency Room (waived if admitted) You pay $100 copay
Inpatient Hospitalization You pay $200 copay You pay $300 copay
Outpatient Surgery You pay $100 copay You pay $150 copay
1 A separate deductible applies for infertility treatment.
2 A PCP is a generalist physician designated as a family medicine, general internal medicine, geriatric medicine or general pediatrics provider. Primary care services can also be provided by a primary care nurse practitioner who practices with a PCP. This benefit also applies to University Health Connect, Convenient Care, and The Little Clinic visits.

Eligibility Requirements

These specific criteria must be met to qualify for Prime Care Connect:

You must meet ALL of the following criteria:

  • Full-time Ohio State faculty or staff employee (75%–100%) who is eligible for the full-time medical contribution rate, and
  • Taxable household income that does not exceed 175% of the federal poverty level (listed below).
    Note: COTC, OSUP, graduate associates, temporary employees, and affiliated groups are not eligible for this plan.
Persons in Family Maximum Household Income
1 $21,858
2 $29,593
3 $37,328
4 $45,063
5 $52,798
6 $60,533
7 $68,268
8 $76,003
9 and up add $7,735 per additional person

 

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