Prime Care Connect Requirements

The Prime Care Connect medical benefit is designed for those with limited household income and intended to reduce some of the financial barriers that may prevent members from getting appropriate and timely health care. OSU Health Plan, Inc. (OSU Health Plan) is an administrator for The Ohio State University Faculty and Staff Health Plan that manages many aspects of the medical coverage, including the determination of eligibility for Prime Care Connect.

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. If application is made during Open Enrollment, approved coverage will be effective at the beginning of the next plan year on January 1.

You should enroll in one of the university’s other medical benefit options while your Prime Care Connect application is 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.

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. The appropriate forms will be provided and can also be found on the OSU Health Plan website. 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. 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.

The employee contribution amount for Prime Care Connect is the same as for Prime Care Advantage, but enrolled members will have lower out-of-pocket cost for health care needs due to the benefit’s lower copayments, coinsurance and out-of-pocket maximum amounts. Benefit details can be found in the Faculty and Staff Health Plans’ Specific Plan Details document.

Eligibility Requirements

All of these criteria must be met to qualify for Prime Care Connect:

• 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
• Prior year’s adjusted gross household income does not exceed 225% of the federal poverty level (listed below).

Note: Affiliated Group members and Graduate Associates participating in Ohio State’s medical benefits are not eligible for this coverage.