Ohio health insurance laws are designed to protect Buckeye residents. Whether it’s your individual medical coverage, a plan through your employer or perhaps a guaranteed-issue policy through COBRA, laws and regulations help keep rates affordable and coverage up to date.
And of course, they also help protect consumers understand the rules. The Affordable Care Act also aids consumers with serious existing conditions that otherwise would not qualify for coverage. If you lose your job, have a debilitating condition, or can't afford to purchase medical benefits, you will be able to obtain a policy. Compliance is mandatory.
ACA (Affordable Care Act/Obamacare)
One of the main topics of conversation everyone is talking about is the effect that the ACA health care overhaul guidelines (Obamacare) have on individual and family medical plans. The full impact has already begun, both positive and negative.
In the Spring of 2012, the Supreme Court listened to testimony (both for and against) regarding the effectiveness of recent health care reform changes. The ruling was 6-3 in favor of moving forward with the complete implementation of the legislation. And that's where we are today.
Some of the most recent changes are allowing children under age 26 to remain on their parent's policies, eliminating lifetime benefit caps and forbidding insurers from terminating a policy without due process. Additional changes took effect in 2014 when the Exchange was created.
The Ohio Exchange is a marketplace where legal residents of the state can purchase health insurance. The live rates you see on our website are the lowest available direct prices so you can apply for a policy with the confidence of knowing you're getting the best deal.
Although the number of options is not as robust as pre-2014, you will not be asked any medical questions.We help you choose the most cost-effective plan and help you apply during Open Enrollment. If you miss enrollment deadlines, you can still purchase coverage. Short-term and limited-benefit policies are popular choices.
Your smoking status is the only condition that is factored into the underwriting process and specific benefits (10 required "essential" coverages) must be met. Most members of Congress have to purchase these identical plans, although each state has different prices and requirements.
Other notable changes you may notice are bundling of bills from specialists, physicians and hospitals. In the past, you often received multiple statements from different providers which is extremely confusing. A procedure will receive one payment from Medicare, for example, and the providers will disperse the correct amount each entity should receive. Thus, your billing statement is now much simpler.
Current laws require consumers to purchase a medical plan.The tax (penalty) is $95 per person (only $47.50 per child) or 1% of household income, whichever is higher. The tax increases to 2% in 2015 and 2.5% in 2016. The "per person" penalties also increase to as much as $695 per person in 2016.
However, there are many exemption situations that allow you to avoid the penalties. Some of them include:
Your religion opposes specific benefits
You are currently incarcerated
You are a member of a recognized Indiana tribe
You are an immigrant without legal documentation
You make too little money to file a tax return
Your least expensive policy option is 8% (or more) of your income
In the past, individuals and families without medical benefits usually found it more difficult to find treatment since many providers requested to be paid for services in advance. Regardless of existing medical issues, obtaining quality coverage is very easy since rates in Ohio are among the lowest in the US.
Small Businesses offer plans through a separate Exchange called the Small Business Health Options Program (SHOP). One prerequisite is that the number of employees of each company is no more than 50.
If you are self-employed and have no employees,you are eligible for coverage through the regular Marketplace. If your company has more than 50 employees, you are classified as a "large" business entity and different rules and provisions apply. Under the law,whether you are self-employed or working for a business, you are required to purchase coverage.
However, exceptions are often made, especially for businesses with 50-99 employees. They can wait until 2016 (previously it was 2015) to offer benefits to employees. However, they can not terminate workers just to reach the under-100 employee level.
Companies with 100 or more workers are also getting a break. Instead of having to provide healthcare for 95% of the full-time workforce in 2015, the percentage has been slashed to 70%. This is expected to give companies additional time to study potential impacts of the ACA law.
Thus, rates to tend to be more expensive than private plans. You can find information about companies in this article. Of course, if an employer is paying 100% of the premium, your only out-of-pocket cost would be the combination of deductibles, coinsurance, copays and exclusions. Unless the deductible is quite large ($10,000 per family), this situation is ideal. However, most employers no longer pay all or most of healthcare benefits.
Before 2014, existing health laws protected persons that had severe medical issues. “Ohio Open Enrollment,” which was available through the Department Of Insurance, was one option. A second option was the “Risk Pool,” which offered affordable coverage to applicants that had been denied policies by two carriers and had not had in-force qualified benefits for six months. The "Risk Pool" was administered by Medical Mutual. Rates were not cheap, but if you were facing expensive treatment in the future, the "Risk Pool" was not a bad option.
A law that went into effect in 2010 prohibits insurers from rescinding contracts, unless fraud or intentional misrepresentation was committed. So if you answered all of the questions on the application truthfully, your insurance policy cannot be canceled. As an example, if a person unexpectedly developed cancer just a week after a policy was approved, they can keep that policy for as long as they wish. Naturally, when they reach age 65 and become eligible for Medicare, they will have to change plans.
Laws are constantly changing and we will keep you updated as Exchanges and reform legislation always seem to be evolving.
Update 10-22-2013 - The Affordable Care Act (ACA) has been implemented and the Ohio Health Insurance Exchange Open Enrollment began three weeks ago. It will continue through the end of March, and start again in the fall of 2014. One of the new laws creates a tax of $95 per year (or 1% of income) if qualified coverage is not effective by Jan 1, 2014.
Policies can be purchased through our website at the lowest available prices. The official government healthcare web address will also accept applications, although major delays and accuracy issues have not been solved.
UPDATE 2-20-2014 - The ACA laws have been slightly modified by the White House. Small businesses have been given extra time to comply with the mandate that requires healthcare coverage on their employees. Additional changes have extended Open Enrollment deadlines (from February 15th to February 18th) and relaxation of billing and payment deadlines.
UPDATE 2-24-14 - Part-time employees across the state are seeing work hours reduced. Because of the employer mandate that requires businesses to provide medical coverage, average weekly hours are often lowered below the 30-hour level. The White House has already twice postponed enforcement of the law that would penalize companies that don't comply.