Open Enrollment – Medical Plan - Human Resources at Ohio State

2021 Open Enrollment

November 1-15, 2020

Medical Plan

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

Medical plan ID cards will be sent by the end of 2020 if you make changes during the Open Enrollment period. If any changes are made after November 15, 2020, new ID cards may not be sent until after January 1, 2021.

Additional Related Information

2021 Medical Benefits

The following changes to the medical plan will be implemented January 1, 2021:

  • Eligibility for Prime Care Connect is being expanded. Individuals whose household family income does not exceed 225% of the federal poverty level (up from 175%) will now qualify for this plan to help reduce financial barriers with obtaining medical care.
  • Hearing aid coverage is increasing from a benefit level of $1,200 every four plan years to $1,400 per hearing-impaired ear ($2,800 for both ears) every three plan years

Exercise is MedicineTM, a physical activity program offered through Wexner Medical Center, will be available to faculty, staff and dependents enrolled in the medical plan. Any dependent under the age of 18 will require an adult sign-off to participate. The program provides physical activity resources, one-on-one sessions with a health coach and 16 group exercise sessions over eight weeks. To participate, you will need a physician referral into the program based on readiness to change and health indication(s), including:

  • Lack of adequate physical exercise
  • Need for exercise counseling
  • Obesity
  • Physical deconditioning
  • Sedentary lifestyle
  • Muscular deconditioning

Exercise is MedicineTM will cost you $200 when you enroll. However, the medical plan will reimburse you 50% of that cost after you attend the three one-on-one sessions and at least 12 group sessions. You can also receive incentive points for participation through Your Plan for Health (YP4H).

Locations around central Ohio that provide the Exercise is MedicineTM program are:

  • Health and Fitness Center, 150 W Main St Suite A, New Albany
  • Outpatient Care Upper Arlington, 1800 Zollinger Road, Columbus
  • Eldon and Elsie Ward Family YMCA, 130 Woodland Avenue, Columbus
  • Worthington Community Center, 345 E Wilson Bridge Road, Worthington
  • Milo Grogan Community Center, 862 E 2nd Ave, Columbus
  • Coming Soon: The Ohio State University Adventure Recreation Center (ARC), 855 Woody Hayes Dr, Columbus

When selecting a medical 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 when you receive medical care only 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 when you receive medical care only from the plan’s statewide network of providers and is available 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 2021 Out-of-Area Benefit Election Form (coming soon).
    • Use the zip code eligibility tool to see if this plan is available to you.

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

  • Viewing account balances, such as 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, 2021

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 2021 Faculty and Staff Health Plans Specific Plan Details (SPD) Document (coming soon) 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 contact HR Connection at 614-247-myHR (6947) or (800) 678-6010.

*Summary of Benefits and Coverage

Open Enrollment Information