We’ve received a few recurring questions about the restructuring of the provider network. We thought we would highlight these questions in case you’re wondering about them too.

Q. Did our Medical Plans change or did our Providers’ Network change? What is the connection?

The Ohio State University Faculty and Staff Medical Plans (Prime Care Advantage, Prime Care Choice, and Prime Care Connect) did not change for 2020.  Only the provider networks supporting those plans have been changed—or restructured—to the Premier and Standard networks.

Q: Is the tiering of a provider network common?

Yes, it is quite common to employ network tiering to offer integrated care and the highest level of benefit coverage when utilizing one network over the other. Seventeen percent of large institutions that offer health benefits include a high-performance or tiered provider network in their health plan, according to the Kaiser Family Foundation (Employer Health Benefits 2018 Annual Survey).  Both Mount Carmel and Ohio Health have tiered their networks.

Q. Does this network change impact the plan option I should select during Open Enrollment later this year?

You do not have to elect a provider during Open Enrollment (November 1-14, 2019). You elect only your choice of the Prime Care plan options (Prime Care Advantage, Prime Care Choice, Prime Care Connect and the Out-of-Area Plan). Your choice of network providers does impact the level of benefit coverage you receive, so you should carefully consider these things as you plan for 2020.

If you have any additional questions, please contact the OSU Health Plan Concierge Services Team at (614) 292-4700. They are here to help!