Ngs american health insurance
Medical Plans – Human Resources at Ohio State
All of the benefits available to you reflect Ohio State’s commitment to provide high-quality, affordable plans and represent a significant component of your total rewards for working at Ohio State. We know that when our faculty and staff are healthy, everyone wins.
The university-sponsored medical plans provide comprehensive coverage and wellness benefits for you and your eligible dependents. All Ohio State medical plan options include preventive care with 100% coverage. Not every illness is preventable, but living healthier leads to a better quality of life, improved personal and professional productivity and lower out-of-pocket costs. From the available plan options, you choose which medical coverage and benefit levels best match the needs of you and your family. Informed Enrollment Online, an interactive tool to help you model your medical costs, is available in Employee Self Service.
Summaries of Benefits and Coverage (SBC)
Medical Plan Options
Your medical benefits provide comprehensive coverage for planned and emergency care. Each plan’s provisions vary, so you have flexibility when deciding which option is right for you and your family. All of the medical plans provide coverage for the same types of medical services; however, the employee contribution rate for each plan varies based on how the plan pays for those services.
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 contribution rates with what you are required to pay for medical services.
Prime Care Advantage ❯ ×
Prime Care Advantage requires that you receive medical care from a statewide network of providers. The plan requires an annual deductible and coinsurance for many services. Out-of-network services are not covered under this plan, except for emergencies. (see Prime Care Advantage Summary of Benefits and Coverage (SBC))
Prime Care Choice ❯ ×
Prime Care Choice has lower employee contribution rates and has both network and out-of-network coverage for medical services that are typically subject to a deductible and coinsurance. When services are received in the network, your deductible and coinsurance amount are lower than when you obtain services outside of the network. (see Prime Care Choice Summary of Benefits and Coverage (SBC))
Prime Care Connect ❯ ×
Prime Care Connect is available for individuals with limited household income. This plan is intended to help reduce the financial barriers to obtaining health care. This plan is available only to faculty and staff who meet specific income qualifications and requirements. Review the Prime Care Connect Requirements for more details, including eligibility requirements. (see Prime Care Connect Summary of Benefits and Coverage (SBC))
Out-of-Area Plan ❯ ×
The Out-of-Area plan is available only to individuals who live in areas without adequate network access (see Plan Eligibility by Zip Code). Access to this coverage is also available, with a special application, to individuals enrolled in Prime Care Advantage, Prime Care Choice or Prime Care Connect who will be outside Ohio for at least 30 consecutive days. You must meet certain criteria to temporarily enroll in this plan, as detailed on the Out-of-Area Benefit Election Form. (see Out-of-Area Plan Summary of Benefits and Coverage (SBC))
Medical Plan Comparison Chart ❯ ×
Effective Jan. 1 – Dec. 31, 2019
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).
NOTE: This medical plan comparison chart should be used as a general guide only. Refer to the 2019 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.
Using the Benefit
Based upon the medical plan you choose, you may be required to seek care at a network provider while some plans cover services obtained from an out-of-network provider. In either case, CoreSource processes your medical claims.
Statewide Network ❯ ×
If you use a network provider:
- Present your medical/prescription drug card to the provider at the time of service.
- No claim forms are necessary for network medical services. Your provider should file claims directly to the address listed on the back of your medical/ prescription drug card.
If you use an out-of-network provider:
- Your provider may require you to pay for services in full and you will be reimbursed from CoreSource by filing a claim.
- To file a claim use the Health Insurance Claim Form.
Access Outside Ohio ❯ ×
Emergency care is covered worldwide under the university’s faculty and staff medical plans. Access to non-emergency care when outside Ohio for more than 30 consecutive days is available through special enrollment in the Out-of-Area Plan by completing the Out-of-Area Benefit Election Form.