Open Enrollment – Medical Benefits - Human Resources at Ohio State

2018 Open Enrollment

November 1-14, 2017

Medical Benefits

Ohio State’s medical benefits provide comprehensive coverage for planned and emergency care.

All Ohio State medical plans provide coverage for the same types of medical services; however, the employee contribution amount for each plan varies based on how the plan pays for those services. You have flexibility when deciding which option is right for you and your family.

When selecting a plan, think about how frequently you visit the doctor, 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 requires that you receive medical care from a statewide network of providers for non-emergency services.
  • Prime Care Choice provides both network and out-of-network coverage for medical services.
  • Prime Care Connect is available for individuals with limited household income to help reduce the financial barriers with obtaining health care. Prime Care Connect is available only to faculty and staff who meet specific income qualifications and requirements. See Prime Care Connect Requirements.

Use OSU Health Plan’s provider directory to determine which providers participate in the network for each of the Prime Care plans.

  • Out-of-Area Plan is only available to employees and their dependents who:
    • Live in areas without adequate network access or
    • Are enrolled in a Prime Care plan 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 Out-of-Area Benefit Election Form.

Use the zip code eligibility tool to see if this plan is available to you.

Medical plan contribution rates will decrease for many participants. See 2018 rates.

Annual out-of-pocket maximums are increasing for Prime Care Advantage, Out-of-Area Plan and Prime Care Connect. Deductibles, coinsurance and some copayments are also increasing for Prime Care Connect. See the Medical Plan Comparison Chart below for details.

Effective Jan. 1 – Dec. 31, 2018

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Benefit Component Prime Care Advantage1 Prime Care Choice1 Prime Care Connect4 Out-of-Area Plan5
Network Network Out-of-Network3 Network Non-Network
Annual Deductible2 Individual: $450
Family: $900 for most services
Individual: $950
Family: $1,900 for most services
Individual: $1,900
Family: $3,800 for most services
Individual: $150
Family: $300 for most services
Individual: $450
Family: $900 for most services
Coinsurance Plan pays 80% for most services after deductible Plan pays 80% for most services after deductible Plan pays 60% for most services after deductible Plan pays 85% for most services after deductible Plan pays 80% for most services after deductible
Annual Out-of-Pocket Maximum 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
Preventive Care Plan pays 100% Plan pays 100% Plan pays 60% after deductible Plan pays 100% Plan pays 100%
Office Visit – Primary Care Provider (PCP)6 Plan pays 100% Plan pays 100% Plan pays 60% after deductible Plan pays 100% Plan pays 100%
Office Visit – Behavioral Health Plan pays 80%, no deductible Plan pays 80% after deductible Plan pays 60% after deductible Plan pays 100% Plan pays 80% after deductible
Office Visit – All Other Plan pays 80% after deductible Plan pays 80% after deductible Plan pays 60% after deductible You pay $20 copay Plan pays 80% after deductible
Immediate Care – Convenient Care Plan pays 100% Plan pays 100% Plan pays 60% after deductible Plan pays 100% Plan pays 100%
Immediate Care – Urgent Care Plan pays 80%, no deductible Plan pays 80% after deductible Plan pays 60% after deductible You pay $35 copay Plan pays 80% after deductible
Immediate Care – After Hours Care Plan pays 80% after deductible7 Plan pays 80% after deductible Plan pays 60% after deductible You pay $20 copay7 Plan pays 80% after deductible
Immediate Care – Emergency Care Plan pays 80% after deductible Plan pays 80% after deductible Plan pays 80% after deductible You pay $100 copay Plan pays 80% after deductible
Inpatient Hospitalization Plan pays 80% after deductible Plan pays 80% after deductible Plan pays 60% after deductible You pay $200 copay Plan pays 80% after deductible
Outpatient Surgery Plan pays 80% after deductible Plan pays 80% after deductible Plan pays 60% after deductible You pay $150 copay Plan pays 80% after deductible
Lab and X-ray Plan pays 80% after deductible Plan pays 80% after deductible Plan pays 60% after deductible Plan pays 85%, no deductible Plan pays 80% after deductible

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 and weight-loss surgery.
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 online.
5 Must meet eligibility criteria. Review eligibility by zip code online.
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 Services and clinics in a retail setting (convenience care).
7 Utilization of services at Martha Morehouse and Gahanna AfterHours is a cost-effective alternative to the ER for more serious conditions than can be handled at convenient care or urgent care.

NOTE: This medical plan comparison chart should be used as a general guide only. Refer to the Medical Plans Specific Plan Details for further information. If the information provided in this summary chart differs from the online document, the online document will govern.

For employees enrolled in an Ohio State medical plan:

  • University Health Connection on the Columbus campus offers walk-in and scheduled primary care appointments at McCampbell Hall, 1581 Dodd Drive, Suite 201, at the corner of Cannon Drive and 10th Avenue. There are no out-of-pocket costs to you for office visits.
  • OSU Health Plan’s Prime Access helps connect members looking for a new health care provider in a timely fashion. In order to access an appointment held for Health Plan members, call 614-418-6260 for an Ohio State provider or (614) 564-9678 for a Central Ohio Primary Care provider. Let the scheduler know that you are a member of OSU Health Plan. Participating specialties include:
    • Ohio State: general internal medicine/family medicine; ear, nose, throat (ENT); allergy and immunology; comprehensive orthopedics and sports medicine; colorectal/general surgery; obstetrics and gynecology
    • Central Ohio Primary Care: general internal medicine/family medicine

For employees eligible for an Ohio State medical plan:

  • Ohio State’s Employee Assistance Program (EAP) helps to address complex issues that can affect your mental and emotional well-being. The EAP partners with IMPACT Solutions to offer 24/7 phone coverage and statewide access to confidential counseling. The benefit includes free resources, such as counseling sessions and other services, for you, your household, parents and parents-in-law.¬†Call 1-800-678-6265 or read more on eligibility and features.
  • The 24/7 Nurseline has registered nurses available 24 hours a day, seven days a week, to assist you, or your family members, with health-related questions. You can access this complimentary service by calling 1-800-678-6269 (option 1).

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 online or paper copies are available free of charge by contacting OHR Customer Service at hr@osu.edu, (614) 292-1050, or (800) 678-6010.

2018 Summaries of Benefits and Coverage


 

Open Enrollment Information