Ohio Health Insurance Laws and Regulations

The Ohio health insurance laws are complicated and not easy to understand. Since it is important for individuals to understand their insurance rights, we have summarized those portions of Ohio’s health insurance laws that explain basic policyholder rights. Hopefully this summary will answer some of your health insurance questions.

The Rights of Individual Policyholder

Ohio has no laws which prevents insurance companies from denying insurance coverage to individuals based on their health status or health history. However, coverage cannot be denied for factors such as race, religion or sexual orientation.

Guaranteed Renewable Rights

In Ohio, your health insurance policy cannot be cancelled, unless you provided a fraudulent insurance application or failed to pay your premium. This means that your insurer must renew your insurance policy upon your request even if you become sick. The right to renew your health insurance policy is called the “Guaranteed Renewable” Provision.

Pre-Existing Condition

In Ohio, a pre-existing condition can be excluded from coverage for up to 12 months. After 12 months of continuous coverage, you cannot be denied benefits. Ohio law defines a pre-existing condition a condition for which you received medical advice, diagnosis, care, or treatment within six months prior to joining the individual plan.

Dependent Care

The Affordable Care Act requires plans and insurance companies that offer dependent coverage to make the coverage available until the adult child reaches the age of 26. There is no requirement that the child live with the parent or within the parent’s geographical service area.

 

The Rights of Individuals Covered by an Employer Sponsored Plan

In Ohio if an employer offers health insurance coverage to its employees, it must make it available to all employees on an equal basis. Employers can exclude employees that work less than 30 hours per week or who are seasonal. Some employees may be required to complete an affiliation/probation period of up to 3 months before they are allowed to enter the plan.

Non-Discrimination Rule

In Ohio under an employer sponsored group health care plan, no employee can be singled out to be excluded from coverage or receive limited coverage, or have to pay more for coverage because of their health status.

Pre-Existing Condition Rights

Ohio law prevents, group health insurance providers from denying coverage to a qualified employee because of their health condition.

Guaranteed Renewable Provision

Under the guaranteed renewable provision, an insurance company cannot deny you health insurance coverage if you have met the terms of your insurance contract even if you become sick.

Conversion Rule

In Ohio, if you have coverage through an employer’s fully insured group health plan and you leave that job, you can buy conversion coverage. This is an individual policy you get from the company that insured your employer’s group plan. To qualify, you must have been continuously covered under the group plan for at least one year.

Small Business Health Insurance Rights

There is no Ohio law that requires a business to offer health insurance to its employees. If an employer does offer health insurance coverage to its employees, it is not required to contribute towards the premiums.

According to Ohio health insurance laws, small group health insurance must be sold to any small business. In addition, a small business with 2 to 50 employees must be offered the same Ohio small business health insurance policy the insurance company sells to other small businesses.

If you are a small employer buying a group health plan, you can be charged more, within limits, due to the health status of those in your group. In addition, you can be charged higher premiums, within limits, because of age, gender, family size, tobacco use, or where your business is located.

Resources:

http://healthinsuranceinfo.net/getinsured/ohio/individual-health-plans/conversion/

http://www.insurancecompanyrules.org/pages/ohio_rules/

http://www.healthinsuranceindepth.com/group-insurance-Ohio.html