The health insurance laws of Ohio contain several key provisions. State law provides for an open enrollment period for individual health insurance, limits the length of time when coverage of pre-existing conditions can be excluded, and requires coverage of routine well-child benefits. In addition, Ohio law requires coverage for treatment of biologically based mental illness. State law also regulates the marketing of discount medical plans in Ohio.
Group Health Insurance
Many individuals receive group health insurance coverage through their employers. Ohio law, however, does not require employers to offer group health insurance. Employers who do provide group health care coverage are permitted to require a waiting period before offering the coverage to an employee. A health insurance policy might exclude coverage of pre-existing conditions, but the exclusion period can last no longer than 12 months. A group help insurance provider can review the six-month period before an individual joined the group plan for pre-existing conditions. Group health plans are prohibited from requiring an exclusion period for pregnancy, newborns or newly adopted children.
A self-employed individual without employees is not eligible to purchase group health insurance in Ohio. Small group health insurance is available for small businesses with up to 50 employees.
Individual Health Insurance
Ohio law provides for standard and basic individual health insurance plans, and state insurance regulations specify what must be covered by those types of plans. Ohio law also provides an open enrollment period for individual health insurance. Although state law ordinarily does allow an insurance provider to deny coverage based on an individual's health status, standard or basic health plan coverage can not be denied during the open enrollment period. The federal Health Insurance Portability and Accountability Act permits individuals to maintain health care coverage if they change jobs. An individual who is eligible for HIPAA protections is also eligible to purchase a basic or standard plan.
Insurance providers in Ohio cannot cancel insurance coverage if the covered individual becomes ill. This guaranteed renewability of health insurance applies so long as the individual makes insurance premium payments.
Coverage of Children
Health maintenance organizations in Ohio provide wellness coverage for children. Other health insurance plans that offer coverage of families must also cover routine well-child benefits for children from birth through age 8. These benefits include items such as immunizations, developmental assessments, physical examinations and laboratory tests. Health insurance plans are not required to pay more than $500 for these types of benefits from birth to age 1, or more than $150 from ages 1 to age 8.
If a family is covered by two health insurance plans, Ohio's coordination of benefits law allows both plans to be used to pay for insurance claims involving children. The plan that is designated as a child's primary insurance coverage will pay the claim first while the secondary plan will pay the amount remaining to be paid.
Group insurance plans geneally cease coverage of dependent children when they reach the ages of 19 to 23. However, a plan must continue coverage for a medically impaired or handicapped child for so long as the child depends on parents for support.
Mental Health Coverage
Health insurance plans in Ohio are required to cover diagnosis and treatment of mental illness that is biologically based. Except in limited situations, mental illness coverage must be on the same terms as the coverage of other illnesses. If the plan provides coverage for prescription drugs for physical illnesses, the plan must also cover prescription drugs for mental illness. The deductibles and other requirements for prescription drug coverage must be the same for mental and physical illness.
Discount Medical Plans
Ohio law (Ohio Rev. Code Title 39, Chapter 3961) regulates discount medical plans. Section 3961.04 requires discount medical plan organizations and marketers to make a series of disclosures in all their advertisements, brochures and marketing materials. The disclosures must also be included with the plan enrollment forms. Among other things, the discount plan organizations and marketers must advise the public that the discount medical plans do not constitute health insurance, that the range of discounts provided for by the plan will vary, and that enrollees in the plan are required to pay for all discounted medical services.
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