Worried About Health Care Costs?
You may qualify for Prime Care Connect!
What is Prime Care Connect?
Prime Care Connect is medical coverage is designed for those with limited household income and intended to reduce some of the financial reasons that may prevent members from getting appropriate and timely health care. The Ohio State University Health Plan provides support to help determine those who are qualified to participate in this plan.
Eligibility Requirements
All of these criteria must be met to qualify for Prime Care Connect:
- Full-time Ohio State faculty or staff employee (75%–100%) who is eligible for the full-time medical contribution rate.
- Taxable household income that does not exceed 225% of the federal poverty level (listed below).
| Persons in Family | Maximum Household Income |
|---|---|
| 1 | $28,980 |
| 2 | $39,195 |
| 3 | $49,410 |
| 4 | $59,625 |
| 5 | $69,840 |
| 6 | $80,055 |
| 7 | $90,270 |
| 8 | $100,485 |
| 9 and Up | add $10,215 per additional person |
Note: Affiliated Group members participating in Ohio State’s medical plan are not eligible for this plan.
How Do I Apply?
- You must be a full-time Ohio State faculty or staff employee.
- Your taxable household income (based on 2020 tax return) must be less than 225% of the federal poverty level.
- Complete an application during the university's Open Enrollment or within 30 days of a change in the number of family members which results in you meeting ALL eligibility requirements.*
- Note: COTC, OSUP, graduate associates, temporary employees and affiliated groups are not eligible for this plan.
If your application was approved and made due to an event, Prime Care Connect coverage will be effective on the event date. If approved and the application was made during Open Enrollment, coverage will be effective at the beginning of the next plan year on January 1.
A letter will be sent from OSU Health Plan advising you of the final eligibility determination. You must enroll in one of the university’s other medical plans and if your application is approved, your coverage will be automatically changed to Prime Care Connect.
*A decrease in household income during the plan year is not an event that allows enrollment during the plan year; household income is based on the prior year’s tax return.
Ready to Apply?
Click here for more information on Prime Care Connect requirements. To get your application, contact the OSU Health Plan at 614-292-4700 or 800-678-6269 or download the Prime Care Connect Application.
2022 Prime Care Connect Details
The employee contribution amount for Prime Care Connect is the same as for Prime Care Advantage, but the member and their dependents will have lower out-of-pocket cost due to the plan’s lower copayments, coinsurance and out-of-pocket maximum amounts.
| Benefit Component | NETWORK | |
|---|---|---|
| Premier | Standard | |
| Annual Deductible¹ | Individual: $150; Family: $300 | |
| Coinsurance | You Pay 15% | You Pay 25% |
| Annual Out-of-Pocket Maximum | Individual: $1,500; Family: $3,000 | |
| Preventive Care | Plan pays 100% | |
| Office Visit: Primary Care Provider (PCP)² | You pay $0 copay | You pay $20 copay |
| Office Visit: Specialist | You pay $20 copay | You pay $30 copay |
| Urgent Care | You pay $35 copay | |
| Emergency Room (waived if admitted) | You pay $100 copay | |
| Inpatient Hospitalization | You pay $200 copay | You pay $300 copay |
| Outpatient Surgery | You pay $100 copay | You pay $150 copay |
¹A separate deductible applies for infertility treatment. ²A PCP is a generalist physician designated as a family medicine, general internal medicine, geriatric medicine or general pediatrics provider. Primary care services can also be provided by a primary care nurse practitioner who practices with a PCP. This benefit also applies to University Health Connect, Convenient Care, and The Little Clinic visits.
Health Care Doesn't Have to Be Expensive.
If you believe that you meet all eligibility criteria, call the OSU Health Plan at 614-292-4700 or 800-678-6269 and a customer service specialist will provide information to help you with the application process.
You will be asked to complete and sign a brief application, provide proof of household income along with any other necessary documentation, and return the completed paperwork to OSU Health Plan. All applications are treated as confidential. Eligibility approvals will be sent to the Office of Human Resources for processing plan enrollment; however, no information contained in the application is made available to your employer.
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