Open Enrollment – Medical Benefits - Human Resources at Ohio State

2022 Open Enrollment

November 1-15, 2021

Medical Benefits

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

All benefit 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 benefit you choose. You have the flexibility to decide which benefit option is best for you and your family.

Medical Benefit Information

The following changes to the medical benefit will be implemented January 1, 2022:

Medical ID Cards

As a result of a new federal requirement relating to information that must be included on health care ID cards, new medical ID cards will be reissued and mailed to your home address. The changes will include the following:

  • Network and out-of-network deductibles
  • Network and out-of-network out-of-pocket limits
  • Phone number and web address for a member to get assistance, including help finding a network provider.

As a result, Trustmark will reissue and mail medical ID cards, regardless of whether or not you make a change during Open Enrollment. The electronic version of your medical ID card will also be updated and available through Trustmark’s mobile app.

Labial Frenectomy Procedures

Medical coverage will no longer exclude labial frenectomy, which is a procedure to correct a condition commonly referred to as “tongue-tied” or “lip-tied.” Prior authorization will be required to ensure claims are not paid under both the medical and dental plans.

When selecting a medical benefit option, think about how frequently you may need to access medical services, 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 when you receive care from the statewide network of providers. Providers in both the Premier and Standard networks are available. Services received by out-of-network providers are not covered unless they are for emergency care.
  • 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 when obtaining medical care. It provides coverage for most medical services when you receive care only from the statewide network of providers and is available to faculty and staff who meet specific eligibility and income requirements. Providers in both the Premier and Standard networks are available. Services received by out-of-network providers are not covered unless they are for emergency care. Learn more about Prime Care Connect requirements
  • Out-of-Area is available to employees and their dependents who:
    • Live in areas without adequate network access or
    • Are enrolled in a Prime Care benefit option but will be outside Ohio for at least 30 consecutive days. You must meet certain criteria to enroll temporarily in this benefit, as detailed on the Out-of-Area Benefit Election Form.
    • Use the zip code eligibility tool to see if this benefit option is available to you.

Trustmark is Ohio State’s medical plan administrator. You can track your claims and information using Trustmark’s website and mobile app. Prior to using the mobile app, you need to register at mytrustmarkbenefits.com. With the Trustmark mobile app, myTrustmarkBenefits Mobile, it is easy manage your medical coverage from your phone. Features include:

  • Viewing balances, such as accrued deductibles and out-of-pocket costs
  • Reviewing medical claims
  • Accessing an electronic version of your medical ID card
  • Searching for a participating network provider

Download the app for free from Apple’s App Store or Google Play.

Effective Jan. 1 – Dec. 31, 2022

2022 Medical Comparison Chart PDF Version
Provisions Prime Care Advantage1 Prime Care Choice1 Prime Care Connect4 Out-of-Area5
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 Out-of-Area 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 2022 Health Plan 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 benefit 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 contact HR Connection at hrconnection.osu.edu, 614-247-myHR (6947) or (800) 678-6010.

Open Enrollment Information