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.

2023 Prime Care Connect Plan Details
Benefit Component Premier Network Standard Network
Annual Deductible Individual: $150
Family: $300
Individual: $150
Family: $300
Coinsurance You pay 15% You pay 25%
Annual Out-of-Pocket Maximum Individual: $1,500
Family: $3,000
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
1 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 clinics in a retail setting (convenience care).

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.

2023 Prime Care Connect Household Income Eligibility Requirements
Persons in Family Maximum Household Income
1 $30,578
2 $41,198
3 $51,818
4 $62,438
5 $73,058
6 $83,678
7 $94,298
8 $104,918
9 and up add $10,620 per additional person