Prime Care Connect Requirements

Prime Care Connect is medical coverage designed for those with a limited household income. It is intended to reduce some of the financial barriers that may prevent employees from getting appropriate and timely health care.

This option provides the same quality health care and comprehensive coverage as other Ohio State medical plans, and you’ll pay less when you seek medical care or fill a prescription.

You’re eligible to apply for Prime Care Connect if:

  • You are a full-time Ohio State faculty or staff employee (75% – 100%) in a regular, term, or seasonal position and eligible for the full-time medical contribution rate, and
  • Your household income is not greater than the following amounts (as reported on your tax return, IRS Form 1040):

Note: You must meet both requirements above. Affiliated Group members and Graduate Associates participating in Ohio State’s medical benefits are not eligible for this coverage.

2024 Prime Care Connect Household Income Eligibility Requirements
Persons in Family Maximum Household Income
1 $32,805
2 $44,370
3 $55,935
4 $67,500
5 $79,065
6 $90,630
7 $102,195
8 $113,760
9 and up add $11,565 per additional person

Your Costs

The employee contribution for Prime Care Connect is the same as for Prime Care Advantage, but Prime Care Connect members pay less for medical care. Benefit details can be found in the Faculty and Staff Health Plans’ Specific Plan Details document.

2024 Prime Care Connect Plan Details
Benefit Component Premier Network Standard Network
Annual Deductible Individual: $150
Family: $300
Coinsurance You pay 15% You pay 25%
Annual Out-of-Pocket Maximum Individual: $1,500
Family: $3,000
Preventive Care You pay $0 You pay $0
Office Visit: Primary Care Provider (PCP)1 You pay $0 You pay $20 copay
Office Visit: Specialist You pay $20 copay You pay $30 copay
Urgent Care You pay $35 copay You pay $35 copay
Emergency Room (waived if admitted) You pay $100 copay You pay $100 copay
Inpatient Hospitalization You pay $200 copay You pay $300 copay
Outpatient Surgery You pay $100 copay You pay $150 copay

Submitting an Application

The Ohio State University Health Plan (OSU Health Plan) manages the determination of eligibility for Prime Care Connect.

You will be asked to complete and sign an application, provide proof of household income along with any other necessary documentation, and return the completed paperwork to OSU Health Plan. All applications are treated as confidential.

Application assistance

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 specialist will provide information to help you with the application process. Applications and instructions on how to apply can also be found on the OSU Health Plan website.

Applications can be submitted 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. If you apply during Open Enrollment, approved coverage will be effective at the beginning of the next plan year on Jan. 1.

Evaluation and Approval

You should enroll in one of the university’s other medical benefit options while your Prime Care Connect application is being evaluated. If the application is approved, your coverage will be automatically changed to Prime Care Connect. A letter will be sent from OSU Health Plan advising you of the final eligibility determination.

Eligibility approvals will be sent to the Office of Human Resources for processing benefit enrollment; however, no information contained in the application is made available to your employer.