Open Enrollment – Medical Plan - Human Resources at Ohio State

2020 Open Enrollment

November 1-14, 2019

Medical Plan

The Ohio State University Faculty and Staff Health Plan provides comprehensive coverage for employees and their eligible dependents.

All plan options provide coverage for the same types of medical services; however, the employee’s out-of-pocket costs for each service varies based on the plan you choose to enroll in. You have the flexibility to decide which plan option is best for you and your family.

Additional Related Information

2020 Medical Benefits

Effective January 1, 2020, The Ohio State University Faculty and Staff Health Plan will reorganize its health care providers into two networks: Premier Network and Standard Network. When you use a Premier Network provider, you will receive a higher level of benefit coverage than if you choose care from a Standard Network provider. Learn more

Premier Network Standard Network
  • OSUWMC, COPC, and other select providers
  • 100% Preventive and Primary Care
  • 80% Specialists and Other Services
  • No Deductible for Specialists and Urgent Care (in Prime Care Advantage)
  • Various Other Community Providers
  • 100% Preventive Care
  • 70% Primary Care (Deductible applies)
  • 70% Specialists and Other Services (Deductible applies)

The following changes to the medical and prescription drug plan will be implemented January 1, 2020:

  • Ohio State’s medical plan administrator, CoreSource, is changing its name to Trustmark Health Benefits. All plan members whose elections are confirmed during Open Enrollment will receive new Trustmark ID cards by early January. If you cover a spouse or dependent age 19 or older, a card with their name will be included. Cards will not be issued with the name of a child under 19 years of age.
    • If you need to use your medical ID card in 2020 before you receive it in the mail, you may access an electronic copy of your card through the Trustmark mobile app.
  • Download the app for free from your app store by searching for myCoreSource Mobile. You may also obtain a temporary card from the Trustmark Self Service site or by contacting HR Customer Service at (614) 292-1050.
  • Specialist office visits will not be subject to the deductible under the Prime Care Advantage Plan when using a Premier Network provider.
  • The outpatient procedure and outpatient surgery copays under Prime Care Connect will be $100.
  • Weight management programs will no longer be subject to an annual maximum.
  • Medical coverage for dental injuries will be available for up to 12 months from the date of the incident and will be limited to $3,000 per injury.

When selecting a plan option, think about how frequently you visit the doctor, decide whether you need out-of-network coverage and how you want to balance your employee payroll contributions with what you are required to pay out-of-pocket for medical services.

  • Prime Care Advantage provides coverage for most medical services only when you receive medical care from the plan’s statewide network of providers. Providers in both the Premier and Standard networks are available.
  • Prime Care Choice provides in-network and out-of-network coverage for medical services. Providers in both the Premier and Standard networks are available.
  • Prime Care Connect is available for individuals with limited household income to help reduce financial barriers with obtaining medical care. It provides coverage for most medical services only when you receive medical care from the plan’s statewide network of providers and is available only to faculty and staff who meet specific income qualifications and requirements. Providers in both the Premier and Standard networks are available.  Learn more about Prime Care Connect requirements
  • Out-of-Area Plan is available to employees and their dependents who:
    • Live in areas without adequate network access or
    • Are enrolled in a Prime Care plan option but will be outside Ohio for at least 30 consecutive days. You must meet certain criteria to enroll temporarily in this plan, as detailed on the 2020 Out-of-Area Benefit Election Form.
    • Use the zip code eligibility tool to see if this plan is available to you.

With the Trustmark mobile app, you can manage your medical coverage from your phone. Features include:

  • View all account balances such as deductibles and out-of-pocket costs.
  • See all medical claims.
  • Access an electronic version of your medical ID card
  • Search for a participating network provider

Download the app for free from Apple’s App Store or Google Play by searching for myCoreSource Mobile.

Effective Jan. 1 – Dec. 31, 2020

PDF Version

Provisions Prime Care Advantage1 Prime Care Choice1 Prime Care Connect4 Out-of-Area Plan5
Premier Network Standard Network Premier Network Standard Network Out-of-Network3 Premier Network Standard Network Non-Network
Annual Deductible Individual: $450
Family: $900
Individual: $950
Family: $1,900
Individual: $1,900
Family: $3,800
Individual: $150
Family: $300
Individual: $450
Family: $900
Annual Out-of-Pocket Maximum (including deductible)2 Individual: $2,600
Family: $5,200
Individual: $3,750
Family: $7,500
Individual: $7,500
Family: $15,000
Individual: $1,500
Family: $3,000
Individual: $2,600
Family: $5,200
Coinsurance* Plan pays 80% Plan pays 70% Plan pays 80% Plan pays 70% Plan pays 60% Plan pays 85% Plan pays 75% Plan pays 80%
Preventive Care* Plan pays 100%
(no deductible)
Plan pays 100%
(no deductible)
Plan pays 60% Plan pays 100%
(no deductible)
Plan pays 100%
(no deductible)
Office Visit – Primary Care Provider (PCP)6* Plan pays 100%
(no deductible)
Plan pays 70% Plan pays 100%
(no deductible)
Plan pays 70% Plan pays 60% Plan pays 100%
(no deductible)
You pay $20 copay Plan pays 100%
(no deductible)
Office Visit – Behavioral Health Provider* Plan pays 80%
(no deductible)
Plan pays 80% Plan pays 60% Plan pays 100%
(no deductible)
Plan pays 80%
Office Visit – Specialist* Plan pays 80%
(no deductible)
Plan pays 70% Plan pays 80% Plan pays 70% Plan pays 60% You pay $20 copay You pay $30 copay Plan pays 80%
Office Visit – Other Practitioners7* Plan pays 80% Plan pays 70% Plan pays 80% Plan pays 70% Plan pays 60% You pay $20 copay You pay $30 copay Plan pays 80%
Immediate Care – Convenient Care Clinic* Plan pays 100%
(no deductible)
Plan pays 100%
(no deductible)
Plan pays 60% Plan pays 100%
(no deductible)
Plan pays 100%
(no deductible)
Immediate Care – Urgent Center* Plan pays 80%
(no deductible)
Plan pays 80% Plan pays 60% You pay $35 copay Plan pays 80%
Immediate Care – Emergency Care* Plan pays 80% Plan pays 80% You pay $100 copay Plan pays 80%
Inpatient Hospitalization* Plan pays 80% Plan pays 70% Plan pays 80% Plan pays 70% Plan pays 60% You pay $200 copay8 You pay $300 copay8 Plan pays 80%
Outpatient Surgery and Procedures* Plan pays 80% Plan pays 70% Plan pays 80% Plan pays 70% Plan pays 60% You pay $100 copay8 You pay $150 copay8 Plan pays 80%
Outpatient Lab and X-ray* Plan pays 80% Plan pays 70% Plan pays 80% Plan pays 70% Plan pays 60% Plan pays 85%
(no deductible)
Plan pays 75%
(no deductible)
Plan pays 80%

*after deductible, unless noted otherwise

1 With application, an individual enrolled in this plan may qualify for the Out-of-Area Plan’s non-network benefits.
2 A separate deductible applies for infertility treatment.
3 Out-of-pocket costs that you incur when receiving services from out-of-network providers will apply to the network out-of-pocket maximum.
4 Special application is required. For faculty and staff who have applied and been approved for enrollment in this plan, the network restriction will be removed if your permanent home address is outside Ohio or in select areas of Ohio without adequate network access. Review eligibility by zip code.
5 Must meet eligibility criteria. Review eligibility by zip code.
6 A PCP is a generalist physician designated as a family medicine, general internal medicine, geriatric medicine or general pediatrics provider. PCP services also can be provided by a Primary Care Nurse Practitioner who practices with a PCP. This benefit also applies to University Health Connection and clinics in a retail setting (convenience care).
7 Includes acupuncture, chiropractic, occupational therapy, speech therapy and physical therapy.
8 Your copay is applied to the facility claim.

NOTE: This medical plan comparison chart should be used as a general guide only. Refer to the 2020 Faculty and Staff Health Plans Specific Plan Details (SPD) Document for further information. If the information provided in this summary chart differs from the Specific Plan Details Document, the Specific Plan Details Document will govern.

Under the Affordable Care Act, group health plans and insurance companies must provide participants with a Summary of Benefits and Coverage (SBC) for each plan option 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 OHR Customer Service at HR@osu.edu, (614) 292-1050, or (800) 678-6010.

*Summary of Benefits and Coverage

Open Enrollment Information