Ohio (OH)
Individual Health Insurance Regulations

Learn more about Ohio Individual Health Insurance

Individual health insurance in Ohio is not guaranteed issue, so the insurance companies have the legal right to deny you coverage. This is most commonly done if you have pre-existing medical conditions that the insurance companies views as high-risk. Once a year during January, the insurance companies are required to accept all applications on a guaranteed issue basis until they have met their enrollment cap. Only a basic and a standard plan must be offered guaranteed issue during this open enrollment period. A state board regulates the minimum requirements of these standard plans. The standard plan has lifetime maximum of $1 million and an annual deductible of $750. You may only apply for a guaranteed issue plan if you are not eligible for group health insurance as an employee or the eligible dependent of an employee. All other health plans offered by insurance companies in Ohio are medically underwritten year round. The insurance company may also place an elimination rider on new policies that exempts them from paying benefits on a specified pre-existing medical condition. For pre-existing health conditions for which an elimination rider was not imposed, the insurance company may still exclude paying benefits toward that condition for a period of 12 months. The exclusion period may be reduced if the enrollee has prior creditable coverage that can be applied to that period. To determine if a claim applies to a pre-existing condition, insuance companies in Ohio may look back 6 months at medical care or treatment that was received prior to applying for coverage. Insurance companies may not place an exclusion period on HMO plans for basic health care services.

Ohio (OH)
Small Group Health Insurance Regulations

Any employer with 2-50 employees may qualify for small group health insurance in the state of Ohio. Small group health plans are guaranteed issue, which means that the group applying for new coverage may not be denied based on the health status of the group. In addition, group health plans are guaranteed renewable and may not be cancelled or refused renewal based on the claims received from the members of that group. Insurance companies may require that a minimum percentage of all eligible employees working for the company are enrolled in the group's health plan. No single employee may be denied coverage based on their individual health status, but the insurer may use medical underwriting to determine what premium to charge the employer. Regardless of the healthiness of the group as a whole, the premiums charged may not exceed 35% of the standard rate. For any employee that does not have prior creditable coverage, there will be a 12 month exclusion on receiving benefits toward the treatment of any pre-existing medical condition.

Ohio COBRA and Continuation Coverage

As is the same with any state, employers in Ohio who have 20 or more employees are subject to federal COBRA regulations that allow any employee leaving the company to remain on the group health plan for a period of 18 months. Some qualified dependents may remain on the plan for as long as 36 months. Ohio also has a state law that is similar to federal COBRA that applies to employers with fewer than 20 employees. Under this state COBRA regulation, an employee may continue on the group plan for a period of 6 months, but only if they have been insured under the employer sponsored health plan for at least 3 months prior to their last date of employment. Ohio state COBRA must be accepted by the employee within 31 days of receiving their notification of COBRA rights. Insurance companies that continue to insure an employee under state COBRA regulation may exclude some benefits from the policy, but must provide coverage for hospitalization and major medical. For those that are losing their group coverage under COBRA, there are basic or standard health plans for HIPAA eligible persons on the individual market. Conversion plans are also available through some insurance carriers.