Ohio insurance law and regulation
The state insurance department can be reached by telephone at (800) 686-1526 or by mail at P O Box 303351, Montgomery, AL 36130-3351. The state children’s health insurance plan (CHIP) Web site is Ohio Healthy Start.
News that affects your health insurance and planning
August 31, 2019 – Health care is expensive in Ohio, and it’s not because the care is better. The Health Policy Institute of Ohio recently ranked near the bottom (46th) compared to other states on health value, which is a composite measure of population health and health care spending. One health care executive in the state is quoted saying “We tend to have a less healthy population that therefore costs more, uses more health care resources”. The average Ohioan with private health insurance spending more than $5,900 on medical care in 2017.
June 16, 2019 – Status of alternative non-ACA health plans: Ohio does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.
March 29, 2019 – Small business health plans – Yesterday a federal court in the District of Columbia ruled in favor of states in striking down U.S. Treasury regulations that permitted the expansion of small business association health plans. Even before the court ruling, association health plans were not showing promise as cost-saving measures as was hoped. What this means to small businesses is that if they want a lower cost health plan then they must design it themselves independently from an insurance company. The problem is that most firms providing benefits services are primarily in the business of selling insurance rather than lowering costs. Freedom Benefits offers an affordable consultation to help small business owners design and document an alternate small business health plan without necessarily requiring the purchase of insurance.
December 2, 2018 – Retired police and firefighters in Ohio face difficult questions related to health care choices in 2019 following the state’s decision to terminate it’s group insurance coverage. The change provides a monthly stipend to retirees so that they can buy their own health insurance beginning in 2019. The Ohio Police Union’s President said, “Many of our members have been frustrated with the lack of responsiveness, which is why we’re appreciative that the pension fund leaders have been pushing hard to get those problems resolved.” Meanwhile, Freedom Benefits is stepping up access to personal service on questions related to supplemental coverage for any of the benefits listed on the Smart Insurance Exchange. While our support is not meant to advise on primary coverage options, we will help direct users to available resources.
The history of health care planning in Ohio (Information is outdated and links may be expired)
2/21/2015 Most health insurance companies in Ohio and across the nation missed their enrollment goals for 2015. But one Dayton-based company is an exception. CareSource enrolled about 65,000 of the 230,000 Ohio residents who purchased individual health insurance this year, more than double the number they enrolled in the previous year.
12/20/2014 Thousands of United Healthcare patients living around Cincinnati may need to change doctors for 2015 because United Healthcare has not renewed its contract with UC Health system.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Ohio residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
1/11/2013 Ohio health care costs increased at a faster pace than the national average in 2012, forcing health insurance costs significantly higher. Younger and healthier people who buy individual health insurance from private companies are most greatly affected because insurers are no loner able to separate the rates for these customers from those of less healthy people. Celtic Insurance, for example, paid medical claims that greatly exceeded the premiums it collected. The only way to remain in business was to increase rates to policyholders by an average of 39%. Golden Rule Insurance, another carrier with historically lower premiums, will raise rates by 19%. Industry experts say that these cost increases are only the beginning of the trend of increased medical insurance expenses triggered by the federal health insurance reform known as Obamacare. A Milliman study commissioned by state government predicts that health insurance premiums for individuals buying insurance in Ohio will rise an average 55 to 85 percent in 2014.
2/21/2012 Ohio High Risk Pool plan administered by Medical Mutual of Ohio is designed to give uninsured Ohioans with pre-existing conditions access to quality health insurance. With two affordable plan choices, responsive local customer service and access to the largest network of doctors and hospitals in the state, the Ohio High Risk Pool gives you the coverage you need—right now. This program is funded by the U.S. Department of Health and Human Services. Rates have changed for all enrollees and new applicants effective Nov. 1, 2011. Deductibles for all members will also reset on Jan. 1, 2012. Throughout the year, your contribution amount may be affected based on your age. Any adjustments will take effect at the beginning of the month following your birthday. Rates will also be adjusted based on changes in your region or status as a tobacco user. For more information, contact customer service at 877.730.1117.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Anthem BCBS and Medical Mutual of Ohio are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
7/21/2011 Despite strong opposition to federal health care reform, Ohio’s governor John Kasich supports alternate insurance exchange proposals. “We want to create an exchange, but we don’t want an Obama exchange,” Kasich said, later adding: “The idea of a place where people can shop and small businesses can shop, I fully support the idea.” The comments reported in The Columbus Dispatch follow release of federal guidelines that allow states liberal in the setup and endorsement of health insurance exchanges. It is still too soon to predict the form state support will be available for private independent exchanges like Freedom Benefits and support services like OnlineAdviser andOnlineNavigator.
7/12/2011 UnitedHealthOne critical illness insurance is now available. This insurance pays $10,000 to $50,000 in addition to any other insurance at the time that a diagnosis of stroke, heart attack or life-threatening cancer. Personal rates quotes are available by email fromOnlineAdviser. A brochure and application can be downloaded from www.uhcenrollment.com
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
1/19/2011 Child-only health insurance for children with significant medical problems will be available through an open enrollment period mandated by federal state law during the month of March. All children, regardless of medical condition, continue to be eligible for insurance when applying as a dependent on a parent’s policy and healthy children are eligible for child-only insurance at any time. When applying for child-only insurance for more than one child, make a separate application for each child.
1/11/2011 Ohio became the 21st state to join in a multi-state lawsuit against the federal government challenging the authority to effect health care reforms. Four states are making separate legal challenges to the law, making the total 25 states fighting against Obamacare. Legal experts believe the case will eventually be heard by the U.S. Supreme Court in 2012. We believe that the individual mandate provision, called the backbone of the reform law, will not survive legal challenge but it is uncertain what will happen with other reform provisions in the absence of this key provision.
1/1/2011 Ohio Open Enrollment Program – Ohio law requires insurance companies to accept a certain number of individuals for open enrollment coverage without regard to health status. If you qualify as a Federally Eligible Individual (FEI), your coverage will be effective immediately without any pre-existing condition exclusion period. If you do not qualify as a FEI, you may apply for non-FEI open enrollment coverage.
You are a Federally Eligible Individual if you meet all of the following conditions:
1. You had health coverage for at least 18 months without a break in coverage greater than 63 days.
2. Your most recent health coverage was under a group health plan, governmental plan or church plan.
3. You are not eligible for coverage under any of the following plans:
a. A group health plan
4. You do not have any other health coverage.
5. Your most recent health coverage was not terminated because of nonpayment of premiums or fraud.
6. If you had been offered the option to continue coverage under COBRA or a state continuation plan, you both elected and exhausted the continuation coverage.
You are a Non-Federally Eligible Individual if you meet the following conditions:
1. You are not applying for coverage as an employee of an employer, member of an association or member of any
2. You do not have any other health coverage and are not eligible to be covered under any private or public health benefit plans including the following:
a. Medicare or Medicare supplement policy
c. Any COBRA or state continuation coverage plan
d. Other health benefits arrangement
If the insurance company has not yet met its enrollment quota, they will offer you the Ohio health care Basic and Standard benefit plans for purchase. You may need to submit proof of previous creditable coverage. The insurance company is not required to accept applicants who at the time of enrollment, are confined to a health care facility due to chronic illness or permanent injury. As a Non-Federally Eligible Individual coverage may be limited for pre-existing conditions for the first 12 months, however, you will be credited time you were covered under a recent previous health plan. The open enrollment program will remain open until the statutory limit has been reached for each insurance company.
12/16/2010 Ohio Department of Insurance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, Ohio said that it would: 1) Coordinate public and stakeholder through a specially constituted task force, 2) Inform Ohioans of Exchange planning activities through public notices and Ohio’s health reform website, and 3) Conduct market analysis, modeling Ohio’s public programs and private insurance markets to provide projections and analysis necessary for planning and implementing an Exchange.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
6/28/2010 High Risk Health Insurance Up to 5,000 Ohio residents with significant ongoing medical expenses ineligible for other coverage are now eligible to purchase health insurance under the federal health insurance reform program. Individual open enrollment health insurance is offered through Medical Mutual of Ohio regardless of previous medical conditions except that those currently confined to a health care facility due to chronic illness or permanent injury are not eligible. Premium rates are currently $457 for basic coverage and $613 for standard coverage. The premium costs are subsidized by funds from the federal government totaling about $30,000 over the next three years for each expected participant in the plan. Coverage may be limited for pre-existing conditions for the first 12 months if the applicant is currently uninsured or there is a gap in previous recent coverage greater than 63 days. Otherwise, a three month waiting period applies to pre-existing medical conditions. Quotes are available online but application must be made with a paper application that may be downloaded in PDF format for printing at home.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Ohio is now available at Freedom Benefits.
3/23/2010 A citizen-based constitutional amendment has been introduced to protect the rights of Ohioans to opt out of the federal health care reform.