Notices - Human Resources at Ohio State
Health and Welfare Benefits Required Notices
Under the Affordable Care Act, group health plans and insurance companies must provide participants with SBCs and a glossary of terms commonly used in health insurance coverage. All group health plans and insurance companies use the same standard format for their SBCs and glossary. Our SBCs and glossary are available below and paper copies are available free of charge by contacting HR Connection at hrconnection.osu.edu, (614) 247-myHR (6947) or firstname.lastname@example.org.
- 2021 Prime Care Advantage SBC
- 2021 Prime Care Choice SBC
- 2021 Prime Care Connect SBC
- 2021 Out of Area SBC
- Glossary of Health Coverage and Medical Terms
- 2021 Benefits Information
Rewards for participating in YP4H may be earned by benefits-eligible employees and enrolled spouses. If you think you might be unable to meet a standard for a reward under YP4H, you may qualify for an opportunity to earn the same reward by different means. Contact YP4H at email@example.com and YP4H will work with you (and, if you wish, your doctor) to find a wellness activity with the same reward that is right for you in light of your health status.
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in the Ohio State Faculty and Staff Health Plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.
COVERAGE OPTIONS AND YOUR HEALTH COVERAGE:
The Patient Protection and Affordable Care Act (PPACA) requires the university to issue a notice to all employees informing them that they can purchase medical coverage from the Health Insurance Marketplace. This coverage option is in addition to any university sponsored medical coverage for which you may qualify.
PART A: General Information
Key parts of the health care law took effect in 2014, creating a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options.
Can I save money on my health insurance premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.
Does employer health coverage affect eligibility for premium savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5 percent of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit 1.
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution, as well as your employee contribution to employer-offered coverage, is often excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
How can I get more information?
For more information about your coverage offered by your employer, please check The Ohio State University Faculty and Staff Health Plan Specific Plan Details Document, available at hr.osu.edu/benefits/medical, or contact HR Connection at hrconnection.osu.edu, (614) 247-myHR (6947) or firstname.lastname@example.org.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
PART B: Information about Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
|3. Employer name
The Ohio State University
|4. Employer Identification Number (EIN)
|5. Employer address
1590 North High Street, Suite 300
|6. Employer Phone Number
|9. ZIP code
|10. Whom can we contact about employee health coverage at this job
|11. Phone number (if different from above)||12. Email address
Basic information about health coverage offered by this employer:
As your employer, we offer a health plan to:
Some employees. Eligible employees are described in The Ohio State University Faculty and Staff Health Plan Specific Plan Details Document.
With respect to dependents:
We do offer coverage. Eligible dependents are described in The Ohio State University Faculty and Staff Health Plan Specific Plan Details Document.
We do not offer coverage.
If checked, this coverage meets the minimum value standard. If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process.
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under WHCRA. For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
- All stages of reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other benefits provided under your medical plan.
If you would like more information on WHCRA benefits, contact OSU Health Plan by email at OSUHealthPlanCS@osumc.edu or by phone at 614-292-4700 or 800-678-6269.