2020 Provider Network

Introducing the 2020 Provider Network

The OSU Health Plan (OSUHP) is restructuring our provider network into the Premier and Standard networks to promote better health outcomes over time.

The new Premier Network and Standard Network are available in all Prime Care plan options. While members can choose providers from either network at any time, those utilizing Premier Network providers will receive higher benefit coverage.

Why did OSUHP restructure the provider network?

The Premier Network offers high-quality care with the greatest opportunities for integrated care. Why does that matter to you? Integrated care is expected to lower your costs and improve health outcomes over time. Instead of your primary care provider, specialists and other caregivers working in silos, they coordinate your care to provide you with better outcomes.

A two-tiered solution does that by offering a Premier Network with the greatest opportunities to integrate care thanks to providers mainly from The Ohio State University Wexner Medical Center and Central Ohio Primary Care.

You can continue to seek care from providers (physicians and other caregivers) in either network at any time. However, you will receive the highest level of benefit coverage if you use a Premier Network provider.

78% of members already use Premier Network providers.

All current in-network pediatricians and behavioral health professionals will be in the Premier Network.

Download the 2020 Provider Network brochure here.

How does the 2020 Provider Network benefit you?

  • Increased preventive care and screenings
  • Better management of chronic conditions
  • Lower costs from duplicated or unneeded tests
  • Better health outcomes

What are the Provider Networks?

The existing provider network will be structured into two tiers: Premier Network and Standard Network, which will be available in all Prime Care plan options.

  • Premier Network

    OSU Wexner Medical Center (OSUWMC), Central Ohio Primary Care, and all current in-network Behavioral Health, Post-Acute Care and Pediatric Providers

    Benefit Coverage:

    • Preventive: Plan pays 100%
    • Primary Care: Plan pays 100%
    • Specialists and Most Other Covered Services: Plan pays 80%
    • No Deductible for Specialists and Urgent Care (for Prime Care Advantage)
  • Standard Network

    Various other community providers

    Benefit Coverage:

    • Preventive: Plan pays 100%
    • Primary Care: Plan pays 70% (Deductible applies)
    • Specialists and Most Other Covered Services: Plan pays 70% (Deductible applies)

Questions?

Contact the OSUHP Concierge Service Team at 614-292-4700, Monday – Friday, 7:30 a.m. – 5:00 p.m. ET

What should you do now?

Though members can choose providers from the Premier or Standard Networks at any time, we encourage you to choose those in the Premier Network to provide the best opportunities to reduce your costs and integrate your care.

  • Find out which tier your provider is in. You can search here or click the button below.
  • Determine if you want to switch providers.
  • If yes, call your new provider to schedule an appointment.
  • Problems or questions? Call us at 614-292-4700 and we’ll help.
Get Started with Your Provider Search >

FAQ

General Question

What is the OSU Health Plan Concierge Team?

The OSU Health Plan Concierge Team are dedicated customer service specialists who are specifically trained to not only answer your health care benefit questions but help guide you through the complexities of claims and coverages. We have expanded the team to offer comprehensive support when you have a question. You can contact the team to:

  • Find and transition to providers in the Premier Network.
  • Assistance in scheduling with OSU and Central Ohio Primary Care providers.
  • Learn about your deductible, plan coverage information and cost of care.

HOURS

Monday – Friday
7:30 a.m. – 5 p.m. ET

PHONE

614-292-4700 or 800-678-6269

MAIL

OSUHealthPlanCS@osumc.edu

Overview of Network Change

What is changing this year in terms of the provider network?

Our single healthcare provider network used for The Ohio State University Faculty and Staff Health Plans will be reorganized, effective January 1, 2020, into two networks: the Premier Network and the Standard Network. This change does not affect any members enrolled in the Out-of-Area Plan.

What are the differences between the Premier and Standard networks?

The Premier Network consists primarily of Ohio State University Wexner Medical Center (OSUWMC) and Central Ohio Primary Care (COPC) providers, and other select community providers. All current in-network pediatricians and behavioral health professionals will be in the Premier Network. You can choose a provider in either network at any time when you need care, but when using a Premier Network provider, you can expect to receive the highest level of plan coverage with lower out-of-pocket costs to you.

Premier Network

  • OSUWMC, Central Ohio Primary Care, and other select community providers
  • 100% Preventive and Primary Care
  • 80% Specialists and Other Services
  • No Deductible for Specialists and Urgent Care (for Prime Care Advantage)

Standard Network

  • Supplemental OSUHP Network Providers
  • 100% Preventive
  • 70% Primary Care, (Deductible applies)
  • 70% Specialists and Other Services (Deductible applies)
Will this change in our network affect my deductible or the out-of-pocket maximum for my Ohio State University Faculty and Staff Health plan?

The deductibles and out-of-pocket maximums will not change in 2020 for any of Ohio State’s faculty and staff medical plans. What is changing is the benefit coverage you may receive each time you use a provider. You will receive the highest level of benefit coverage when you use a Premier Network provider. For example, the deductible for an individual enrolled in the Prime Care Advantage plan is unchanged at $450. However, if you use a Premier Network specialist, you will not have to pay any deductible. If you use a Standard Network specialist, you will have to first meet the deductible and then you will pay 30% of the remaining eligible cost.

What Should I Do Now?

What should I be doing now because of this change?

Review the information sent to you about the change to better understand the benefit differences between the Premier and Standard Networks. If you exclusively use Premier Network providers, you don’t have to do anything. Approximately 78 percent of members are not impacted by the decision to split the networks and will automatically continue to receive the highest level of benefit coverage in 2020 if they continue seeing those providers. A letter was distributed the first week of August, and members would have been informed if they had had a claim during the past 12 months with a provider who will be moving to the Standard Network. You can also verify the network participation of any OSUHP provider by checking the 2020 OSU Health Plan Provider search tool at osuhealthplan.com.

Because the Out-of-Area plan does not utilize a network, this change does not affect members who are enrolled in that plan in 2020.

Does this change impact any existing network providers “outside of Franklin and adjacent counties,” members participating in the “Out-of-Area (OOA) Plan” or the “Temporary OOA Benefit”?

Outside of Franklin and contiguous counties, the OSUHP network consists of statewide providers offered through a partnership with Ohio PPO Connect, which covers the majority of zip codes in Ohio. Those providers will participate in the Premier Network, beginning in 2020.

Members who live in zip codes that do not have adequate network access are eligible to participate in the OOA Plan. The OOA plan does not require the use of network providers. Qualification for this plan is determined each year.

The temporary OOA benefit is available to a member who is enrolled in Prime Care Advantage, Prime Care Choice or Prime Care Connect and who will be residing outside of Ohio for at least 30 consecutive days. Members must meet certain criteria to temporarily enroll in this plan. A member must apply for this benefit within 30 days of moving outside of Ohio in order to qualify. Members with the temporary OOA benefit are not required to utilize network providers when obtaining services outside of Ohio, but if they travel back to Ohio for health care services, claims will be subject to the network requirements of the Prime Care plan in which they participate.

What do I do if I use a provider who will be moving to the Standard Network and want to continue using that provider?

You don’t have to do anything. You can choose to continue using that provider, however, you should note where there are differences in the level of benefit coverage provided for Standard Network providers starting on January 1, 2020.

What should I do if I use a Standard Network provider and want to change to a Premier Network provider?

If you would like to switch to a Premier Network provider, you can search for providers near you using the 2020 Provider Search tool at osuhealthplan.com. Contact the office of your selected Premier Network provider to begin transitioning your care to the provider or to schedule an appointment. You should also consult with your primary care physician if you are changing specialists. Members seeking to establish care with a new provider at Ohio State can get priority service with our Premier Network providers by mentioning they are members of the OSUHP. If you have any issues finding a provider or have other questions, you can contact the OSU Health Plan Concierge Team at 614-292-4700 for personalized assistance. Members wishing to see a Central Ohio Primary Care provider can contact them at 614-326-4646 and speak to a member of their Concierge Service for assistance in scheduling.

What should I do if I am currently under the care of a Standard Network provider for certain conditions such as postoperative care, cancer treatment or established pregnancy?

If you are actively receiving care for certain conditions, such as postoperative care, cancer treatment or an established pregnancy, from a provider who will be moving to the Standard Network in 2020, you may qualify to continue to receive the higher Premier Network level of benefit coverage without changing providers while completing your treatment. Care must be established and ongoing prior to December 31, 2019. Call the OSU Health Plan at 614-292-4700 to discuss your ongoing care needs or if you have questions.

I’m not sure what to do. What help is available to me?

Please review the information that was sent to your home. There is additional information available at osuhealthplan.com. You can also contact the OSU Health Plan Concierge Team at 614-292-4700. They can guide you through the change and what it means to you.

Reason for Change/Benefits of Integrated Care

Why are we making this change?

We continually look for ways to expand on the positive healthcare results we have experienced over the last few years. Reorganizing the provider network and encouraging members’ use of Premier network providers will provide the best opportunity for improved member health outcomes through integrated care. We expect that this change will help:

  • Improve health outcomes and help manage costs;
  • Increase long-term plan stability; and
  • Take full advantage of the world-class resources available to our members through our unique relationship with OSUWMC, while still preserving provider choice for members.
How will this specifically benefit members and the plan?

Benefits to Members

  • Instead of your doctors and other caregivers working in silos, they can coordinate your care to provide you with better outcomes
  • Better coordinated care for managing chronic conditions
  • Lower costs by reducing duplicate or unneeded tests
How were providers assigned to the networks?

Our best opportunity for integrated (or coordinated) care is to leverage our relationship with OSUWMC providers, so we started building the Premier Network from there. In determining network tiers within Franklin and its adjacent counties, we evaluated geographical access, timeliness access, provider capacity by specialty, quality, and opportunities to support more integrated care delivery. As a result, we added the Central Ohio Primary Care providers and other select community providers. We also included in the Premier Network all providers outside of Franklin and adjacent counties. Generally, the following specialties were assigned to the Premier Network and will be unaffected by the change:

  • Current in-network Pediatric providers serving the under-18 population, including Nationwide Children's facility and professionals and other community pediatricians
  • Current in-network Behavioral Health providers
Why are you encouraging members to use OSUWMC providers?

Approximately 78 percent of our members are not impacted by splitting the networks and many of them already use OSUWMC providers. For those not using Premier Network providers, it would be beneficial for them to begin using OSUWMC providers for a number of reasons:

  • At the top of the list is integrated care. OSUWMC offers the technology, capacity, quality and clinical expertise to make the benefits of integrated care a reality for our members. When seeing OSUWMC providers, you benefit from a common medical record that each of your providers have access to and ensures you get the best care, in the most appropriate setting, without unnecessary or duplicative testing. You can see one of the benefits of the technology supporting integrated care every time you use the MyChart tool offered through OSUWMC.
  • OSUWMC is one of the top health systems in the nation with a progressive mission to improve the health of all Ohioans, including our members.
  • OSUHP, along with OSUWMC and Central Ohio Primary Care is committed to creating an innovative health care delivery model that provides access to providers offering high-value care with an unparalleled patient experience.
How does the cost and quality of Premier Network providers compare to Standard Network providers?

You will receive the highest level of benefit coverage when using Premier Network providers. In most cases, that should result in lower out-of-pocket costs to you than if you use Standard Network providers. We carefully evaluate all providers in our networks and believe both Premier and Standard Network providers deliver consistent, high-quality care to our members.

Accessing Premier Network Providers

What do I do if I can’t get an appointment with an OSUWMC or another Premier Network provider?

You should contact the OSUHP Concierge Team at 614-292-4700, 7:30 a.m. to 5 p.m. Monday-Friday. We have expanded our customer service team to offer more comprehensive, personalized support whenever you have a question or need help getting an appointment particularly at Ohio State. You can also contact the Concierge Team to learn about your deductibles, plan coverage, and cost of care.

How are you addressing access issues, especially for OSUWMC specialty providers who already have long wait times for just to get a visit?

Members seeking to establish care can get priority service with OSU Wexner Medical Center and Central Ohio Primary Care providers. The OSUWMC provider network is also growing. In just the past two years, they have added providers in both primary care and specialties, and they are continuing to grow.

We know that getting a quick appointment with a Premier Network provider will be challenging for a few specialties. In those areas, we have included community providers in the Network to insure community access. We are working closely with the most impacted specialties to further develop new patient capacity in provider schedules to meet the needs of members.

If you do have issues getting an appointment, please call the OSUHP Concierge Team at 614-292-4700, 7:30 a.m. to 5 p.m. Monday-Friday. We have expanded our customer service team to offer more comprehensive, personalized support when you have a question or need help getting an appointment.

Considerations for 2020 Open Enrollment

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

Keep in mind that the network change applies to all Prime Care plan options, so whether your ability to see Premier or Standard Network providers is the same, regardless of the plan in which you participate. However, your choice of network providers, as was as your plan selection, will determine your out-of-pocket costs, so you should carefully consider these things as you plan for 2020.

Will the network change affect my coverage when I or my covered dependents are traveling?

Coverage for emergency care is available when you travel outside of the network area, and this network change does not impact that in any way. However, if you are enrolled in Prime Care Advantage you do not have coverage for non-emergency care with any provider who does not participate in the OSUHP network. If you are enrolled in Prime Care Choice, out-of-network providers are covered, but at a lesser level of benefit coverage.

Regardless of the plan in which you are enrolled, you automatically have access to Ohio State Travel Assistance services at no cost to you. This can help provide you with assistance with receiving treatment for emergencies and urgent care when traveling outside Ohio or internationally.

Will myBenefitsMentor® take into account the network changes to help me estimate my 2020 expenses during open enrollment later this year?

Yes, myBenefitsMentor® will be updated to account for the differences in benefit coverage between the Premier and Standard networks to help enable you to estimate your costs according to a number of factors, including the providers you utilize. At Open Enrollment, members should review their health coverage needs and compare the deductibles, premiums and out of pocket costs of all plans prior to election.