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An Overview on Medical Insurance in Ohio

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Medical Insurance in Ohio

Medical Insurance in Ohio

Introduction: The overall health insurance situation in Ohio is average, in comparison to the overall health insurance situation of the United States. In accordance to a survey conducted by The Center for Disease Control, almost 12% of the total Ohio population was uninsured for medical insurance for each year, between 2001 and 2003.

To let the Ohio residents know the health insurance status of their state, we have provided a useful abstract, here. The abstract contains a comprehensive discussion on Ohio medical insurance regulations. Information on Ohio state-aided health insurance alternative programs are also provided in the abstract.

Some Important Regulations for Ohio Medical Insurance

To control the health insurance market and regulate the activities of different medical insurance companies, Ohio Department of Insurance has launched certain regulations that are discussed below:

  • As per state health insurance laws, Ohio medical insurance companies can not refuse or restrict an individual getting coverage under an employer Ohio medical insurance policy, if he or she is already covered under medical insurance through an employer.
  • Nevertheless, Ohio medical insurance companies can refuse or limit an individual getting coverage under an individual Ohio medical insurance policy, considering age, health and other criteria as deciding factors.
  • All Ohio medical insurance companies should compulsorily offer an open enrollment period in every year, so that any Ohio resident can buy medical insurance, on guaranteed basis; irrespective of age, health and other deciding factors.
  • During an open enrollment period, all Ohio medical insurance companies is required to offer either a standard plan or a basic plan, to every Ohio individual seeking health insurance. However, only limited numbers of individuals can avail guaranteed issue health insurance policies.
  • According to state laws, Ohio medical insurance companies can inflict both or a waiting period for pre-existing medical conditions and elimination riders.
  • Ohio health insurance law defines a pre-existing condition as an illness for which an individual has already been treated, received medical advice or diagnosed within 6 months before applying for new Ohio health insurance plan.
  • Ohio medical insurance companies can impose a waiting period for any pre-existing medical condition for the first one year of the respective health insurance policy.
  • Continual coverage for pre-existing waiting period can be transferred from previous Ohio medical insurance policy to new Ohio medical insurance policy.
  • An elimination rider can even permanently keep away specific health conditions, body systems or body parts from coverage.
  • HICs and HMOs can not impose a pre-existing waiting period for basic health care services.
  • As per Ohio state health insurance regulation, pregnancy may be considered as a pre-existing medical condition and thus subject to exclusion period.
  • Except guaranteed issue policies, all other Ohio health insurance policies can keep away pregnancy or maternity from coverage for the initial 270 days, even if she is not expecting yet, at the time of beginning of the policy.
  • Every newborn and adopted child should be covered, automatically, under their parent's individual Ohio medical insurance plan that offers dependant coverage; for the initial 31 days from the day of birth or adoption.
  • Disabled and handicapped children are able to be covered under their parent's health insurance plans, even if they are beyond the decided upper age limit.
  • All Ohio medical insurance policies should offer a guaranteed provision for renewal.
  • A guaranteed renewability provision lets an individual renew his or her existing Ohio medical insurance policy.
  • Renewal provision is guaranteed, if and only if the individual has disbursed all the premiums, in time and provided no fake information during the term of respective policy.
  • Ohio medical insurance costs are not regulated. They can differ, considering age, health status and other criteria as deciding factors.
  • Rates of guaranteed issue policy are regulated.
  • Ohio individuals, who are between jobs or medical insurance policies, are eligible to obtain temporary Ohio medical insurance plans offered by some of the insurers.

Ohio Medical Insurance Alternative Options

Ohio Department of Insurance offers some medical insurance alternative programs to let the Ohio residents, who are not able to afford the cost of medical insurance, get coverage. The programs are as follows:

  • Ohio Medicaid: This program is available to Ohio individuals, parents and children, who meet all the income as well as other eligibility criteria.
  • Ohio Healthy Families: This state-aided program is also available to everyone who meets all the qualifying criteria including income criteria.
  • Healthy Start: This is Ohio State Children's Health Insurance Program or OCHIP that is available to the children below and up to the age of 19. However, children from families that are unable to pay for Ohio health insurance or ineligible for Ohio Medicaid, can only access the program. Some expecting women can also avail this program, if meet the qualifying criteria.
  • Ohio's Best Rx Program: This program is especially designed to help the senior Ohio residents getting insurance coverage, if meet the required income criteria. It also helps them obtaining prescription drug coverage.

Ohio Department of Insurance

For more information on Ohio health insurance, you can contact at the following address:

The Ohio Department of Insurance
2100 Stella Court
Columbus, Ohio 43215-1067
(614) 644-2658
(614) 644-3743 (Fax)
1-800-686-1578 (OSHIIP Hotline)
1-800-686-1526 (Consumer Hotline)
1-800-686-1527 (Fraud Hotline)

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