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.
| 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.
| 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.
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.