Ohio Health Insurance Guide
Health Insurance Resources for OH State Residents
As a resident of
Ohio you have access to several types of
health insurance plans. These may be provided by your employer or your spouse’s employer. If your employer doesn’t offer health insurance or you are self-employed, you have the option of buying major medical insurance from any company licensed to sell health insurance in Ohio.
Ohio Open Enrollment
Compared to many other states, Ohio currently has relatively few health insurance regulations, but those that are in place assure you of some important rights. One of the most important is the open enrollment law. While insurers selling individual health insurance in Ohio are generally free to deny you coverage because of your health and other factors, there is an open enrollment provision. Under this law, companies that sell individual health insurance policies in Ohio are required to have an annual 30-day open enrollment period during which they must sell you either a standard or a basic health insurance plan, regardless of your health, age or other factors that might affect your use of health care providers and services.
Indemnity health plans must have open enrollment beginning each January; managed care plans can select their own 30-day annual period. Generally, individual health insurers must advertise their open enrollment periods in newspapers at least two weeks before throughout their open enrollment period. Note that there are state-approved enrollment caps. If a plan reaches its cap, it can refuse to sell you health care coverage during that 12-month period. You can also be refused coverage if you’re already confined to a health care facility because of chronic illness.
Under an open enrollment plan, your premiums will typically be more expensive than policies that are underwritten, but effective January 2010, Ohio state law enacted caps that limit how much insurers can charge people with diabetes, cancer and other pre-existing or chronic conditions who purchase individual health insurance policies during open enrollment. (Note that anyone who is HIPAA-eligible is always guaranteed the right to purchase basic or standard plans.)
Guaranteed Renewability
Other Ohio consumer protection provisions include guaranteed renewability. If you have an individual health insurance policy, your carrier cannot cancel it because of illness, as long as you pay your premiums, don’t defraud the carrier and, if you’re in a managed care plan, you continue to live in the service area. Guaranteed renewability does not prevent your carrier from increasing your premiums.
Mandated Coverage
Ohio law mandates coverage for certain benefits for all health care plans. Some of these mandates include women’s care coverage such as mammography, mastectomy, pap smears and maternity stays, as well as general coverage mandates for well-child care, dental services, chiropractic services, optometry, podiatry, emergency services and mental health services. Ohio does not require health plans to cover prescription drugs. Ohio law also does not require health insurance plans or private employers to provide coverage for domestic partners and their families.
Ohio Basic and Standard Health Insurance Plans
Basic health plans sold in Ohio cover hospital and physician services and some other health services. Routine maternity care is not covered, but basic plans do include limited prescription drug benefits. Generally, plans pay 50% of your cost for covered services after you’ve satisfied an annual $1,000 deductible. Coverage is capped at $50,000 per calendar year. There may also be specific limits on services such as preventive care and mental health.
Standard health plans sold in Ohio cover hospital and physician services and other health services, plus limited prescription drug benefits. There is a maximum lifetime limit for all services of $1 million, although some services including mental health, organ transplants, maternity care and preventive care have their own special limits. You will have an annual deductible of $750, but may also be required to share costs for other plan services depending on the type of plan you choose.
Alternative Health Programs in Ohio
- Healthy Start
Healthy Startis part of the State Children’s Health Insurance Program that provides health insurance coverage for children whose families don’t qualify for Medicare but who meet certain income guidelines.
- Regulatory Agencies
The Ohio Department of Insurance is responsible for regulating health insurance policies sold in the state.
Get access to
Ohio health insurance quotes from E-Insurance
based on your personal coverage needs and medical history.
Ohio Department of Insurance
The Ohio Department of Insurance
50 W. Town Street
Third Floor - Suite 300
Columbus, Ohio 43215
(614) 644-2658
Consumer Hotline: 1-800-686-1526
Fraud Hotline: 1-800-686-1527
OSHIIP Hotline: 1-800-686-1578
TDD Number: (614) 644-3745
www.insurance.ohio.gov
OSHIIP – Ohio Senior Health Insurance Information Program
www.insurance.ohio.gov
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
www.naic.org
Insurance Information Institute (I.I.I.)
The mission of the Insurance Information Institute (I.I.I.) is to improve public
understanding of insurance -- what it does and how it works.
Contact Info for (I.I.I.)
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org